Expert eValuation of Efficacy and Rationality of Vildagliptin "EVER-Vilda": An Indian Perspective.

Vildagliptin, a dipeptidyl peptidase-4 (DPP-4) inhibitor is effective in reducing HbA1c levels in patients with type 2 diabetes (T2DM) when administered as monotherapy, dual or triple combination therapy. In India, Vildagliptin is commonly prescribed in T2DM patients because it reduces mean amplitude of glycemic excursion (MAGE), has lower risk of hypoglycemia and is weight neutral. Early combination therapy with vildagliptin and metformin is effective and well-tolerated in patients with T2DM, regardless of age or ethnicity. In view of already existing data on vildagliptin and the latest emerging clinical evidence, a group of endocrinologists, diabetologists and cardiologists convened for an expert group meeting to discuss the role and various combinations of vildagliptin in T2DM management. This practical document aims to guide Physicians and Specialists regarding the different available strengths and formulations of vildagliptin for the initiation and intensification of T2DM therapy.

Nasoruminal endoscopy of the rumen and reticulum in buffaloes (Bubalus bubalis) - a preliminary study.

Twenty apparently healthy buffaloes were withdrawn of feed and water for 48 hours. Buffaloes were administered with fluids and were subjected to endoscopy every 12 hours. Olympus™ [GIF V70] flexible video endoscope was passed through the ventral nasal meatus, the pharynx, oesophagus and then into the reticulo-rumen in physically restrained buffaloes. The entire reticulum and part of the rumen could be visualized, when the animals were off feed and water for at least 48 hours and evacuations of rumen contents were done even after 48 hours of starvation to visualize the rumen in six buffaloes. The reticulum appeared light brown to pink coloured with honeycomb shape and the rumen appeared smooth, shiny pink, with numerous papillae throughout its surface. The procedure was well tolerated by all the buffaloes and satisfactory reticular and ruminal images could be obtained including biopsy.

Crystal structure and photoluminescent properties of bis-(4'-chloro-2,2':6',2''-terpyrid-yl)cobalt(II) dichloride tetra-hydrate.

In the title hydrated complex, [Co(C15H10ClN3)2]Cl2·4H2O, the complete dication is generated by symmetry. The CoN6 moiety shows distortion from regular octa-hedral geometry with the trans bond angles of two N-Co-N units being 160.62 (9)°. In the crystal, O-H⋯Cl and C-H⋯O inter-actions link the components into (001) sheets. The title compound exhibits blue-light emission, as indicated by photoluminescence data, and a HOMO-LUMO energy separation of 2.23 eV was obtained from its diffuse reflectance spectrum.

Association of Anatomical Site and Clinical Outcome in Intracerebral Hemorrhage Patients with or without Intraventricular Extension.

OBJECTIVE: The present study intend to determine the association of anatomical site and clinical outcome in intracerebral hemorrhage patients with or without intraventricular extension. METHODS: The present 1-year cross-sectional study included 56 patients presenting with spontaneous intracerebral hemorrhage with or without intraventricular extension. Relevant data were collected through a detailed interview with either the patient or the attender. Clinical examination was performed with the help of a predesigned and pretested proforma. Anatomical site of intracerebral hemorrhage and volume of ventricular bleed was estimated by computed tomography/magnetic resonance imagining scans. Clinical outcome was assessed based on modified Rankin scale score and Glasgow outcome scale. Mann-Whitney U test and chi-square test were employed in the analysis. RESULTS: The most common clinical presentations were neuronal deficits, speech disorder, and cranial nerve dysfunction. Hypertension was the most important risk factor observed among the patients. Age, gender, habits, severity of hypertension, duration of hypertension, and site of bleed (P > 0.05) were not significantly associated with outcome. However, clinical features including neuronal deficits (P = 0.01), cranial nerve palsy (P = 0.0002), altered sensorium (P = 0.004), vomiting (P = 0.0006), volume or quantum of bleed (P < 0.04), and IVE of ICH (P = 0.026; significantly affected the outcome. CONCLUSION: The present study revealed that immediate outcome of patients with intracerebral hemorrhage associated with the clinical presentation of patients, quantum of bleed, and intraventricular extension of bleed.

Glucocrinology of Modern Sulfonylureas: Clinical Evidence and Practice-Based Opinion from an International Expert Group.

AIM: The primary objective of this document is to develop practice-based expert group opinion on certain important but less discussed endocrine and metabolic effects of modern sulfonylureas (SUs) and their usage in the management of diabetes mellitus (DM). BACKGROUND: Modern SUs may be considered a panacea in DM care with their beneficial extra-pancreatic, pleiotropic, and cardiovascular effects. Safe glycemic control with SUs could be achieved with appropriate patient selection, drug and dosage selection, and patient empowerment. Additionally, sulfonylureas also exhibit certain endocrine and metabolic effects, which could be considered beneficial in the management of DM. In this regard, a group of international clinical experts discussed the less known beneficial aspects of SUs and safe and smart prescription of modern SUs in DM care. RESULTS: The concept of glucocrinology or the relationship of glycemia with the endocrine system was emphasized during the meetings. Clinical experts arrived at a consensus for the usage of modern SUs in the presence of other endocrine dysfunction and the impact of these drugs on endocrine health. The beneficial pleiotropic and cardiovascular effects of modern SUs were also discussed. The key discussion points were considered to develop clinical expert opinions for the use of modern SUs in persons with DM. Clinical expert opinions were developed for indications, pleiotropic benefits, cardiovascular outcomes, adherence, and safe use of modern SUs. CONCLUSIONS: Appropriate clinical judgement coupled with a patient-centered approach is crucial to achieve the best outcome in persons with DM. Owing to their safety, efficacy, extra-pancreatic benefits including effects on endocrine and metabolic aspects, and low cost of therapy, modern SUs could be considered as drugs/agents of choice for the treatment of diabetes. FUNDING: Sanofi India.

BE-SMART (Basal Early Strategies to Maximize HbA1c Reduction with Oral Therapy): Expert Opinion.

The past three decades have seen a quadruple rise in the number of people affected by diabetes mellitus worldwide, with the disease being the ninth major cause of mortality. Type 2 diabetes mellitus (T2DM) often remains undiagnosed for several years due to its asymptomatic nature during the initial stages. In India, 70% of diagnosed diabetes cases remain uncontrolled. Current guidelines endorse the initiation of insulin early in the course of the disease, specifically in patients with HbA1c > 10%, as the use of oral agents alone is unlikely to achieve glycemic targets. Early insulin initiation and optimization of glycemic control using insulin titration algorithms and patient empowerment can facilitate the effective management of uncontrolled diabetes. Early glucose control has sustained benefits in people with diabetes. However, insulin initiation, dose adjustment, and the need to repeatedly assess blood glucose levels are often perplexing for both physicians and patients, and there are misconceptions and concerns regarding its use. Hence, an early transition to insulin and ideal intensification of treatment may aid in delaying the onset of diabetes complications. This opinion statement was formulated by an expert panel on the basis of existing guidelines, clinical experience, and economic and cultural contexts. The statement stresses the timely and appropriate use of basal insulin in T2DM. It focuses on the seven vital Ts-treatment initiation, timing of administration, transportation and storage, technique of administration, targets for titration, tablets, and tools for monitoring.Funding: Sanofi.

New design of highly sensitive AIE based fluorescent imidazole derivatives: Probing of sweat pores and anti-counterfeiting applications.

A novel aggregation induced emission based 2-(1-(3, 5-bis(trifluoromethyl)phenyl)-4,5-diphenyl-1H-imidazol-2-yl) phenol (4) (IMD) fluorescent tags (FTs) was designed by simple acid catalyzed five-member N-heterocyclic ring forming reaction process. Powder X-ray diffraction results showed mechanofluorochromic properties of IMD FTs are easily reversible under external force due to the decrease in crystallinity. These IMD FTs also exhibits strong cyan-blue luminescence in solid state with high quantum efficiency. Detailed investigation of latent fingerprints (LFPs) showed permanent, immutable and unique pores that are distributed on the ridges. The visualization of such sweat pores opens new avenue in the field of forensic science. Hence, the prepared IMD FTs exhibit excellent Lipophicity (LP) properties, which endorse its possible applications for the visualization of sweat pores present in the LFPs. The LFPs visualized by IMD FTs exhibit excellent efficiency, sensitivity, selectivity, low background hindrance and less toxicity. The obtained result evident that the prepared FT and followed technique opens possible applications for the visualization of LFPs on various porous/semi-porous/non-porous surfaces under UV 365 nm light.

Euthymia in Diabetes: Clinical Evidence and Practice-Based Opinion from an International Expert Group.

AIM: To develop an evidence-based expert group opinion on various types of euthymia associated with diabetes mellitus (DM) and its management. BACKGROUND: Diabetes mellitus is a metabolic syndrome characterized by diverse biomedical and psychosocial features. Emotional health disturbances may lead to psychological and psychiatric dysfunction and may negatively influence glycemic control. Patients with DM may experience diabetes distress (DD) associated with burden of self-care, interpersonal issues, and emotional worries regarding the ability to cope with the illness. Euthymia or a state of positive mental health and psychological well-being should be considered a key outcome of diabetes care. Therefore, to achieve optimal outcomes, the consideration and measurement of psychological and psychiatric aspects along with glycemic levels are very important. A group of multidisciplinary clinical experts came together in an international meeting held in India to develop a workable concept for euthymia in diabetes care. A multidisciplinary approach was suggested to enhance the clinical outcomes and facilitate patient-centered care. During the meeting emphasis was given to the concept of a euthymia model in diabetes care. This model focuses on enhancement of self-care skills in diabetic patients and preventative health awareness among diabetes care providers. Euthymia also encompasses patient-provider communication to aid enhancement of coping skills. RESULTS: After due discussions and extensive deliberations, the expert group provided several recommendations on implementing the concept of euthymia in DM care. CONCLUSIONS: Introduction of the concept of euthymia in routine clinical practice is important to improve the quality of life and coping skills in patients with DM. A timely clinical assessment of psychological and psychiatric aspects along with patient-reported outcomes of diabetes contributes to overall health and well-being of affected individuals. FUNDING: Sanofi India.

Consensus recommendations on exploring effective solutions for the rising cost of diabetes.

Diabetes remains asymptomatic for a long period of time and its real burden gets noticed only once the complications set in. The number of individuals affected with the disease is also on the rise and more so in the low income countries. This scenario calls for urgent precautionary measures that need to be undertaken to equip ourselves to fight against this chronic disease. Individuals with financial constraints cannot afford to access even the basic treatment facilities and thus stands the most burdened. The International Diabetes Federation calls for 'Eyes on Diabetes' for the society to focus on early screening and early intervention. The rising cost of diabetes results from delayed and denied treatment. The panel discussion organized as a part of 4th Annual global diabetes convention of Jothydev's Professional Education Forum (JPEF, 2016) facilitated a platform to address diabetes as a serious health concern that needs to be given immediate priority by the policymakers as well as public and also to discuss about the feasible measures that will help achieve cost effective and affordable diabetes treatment. This was followed by in-depth literature search and finally a set of recommendations have been arrived at by the key opinion leaders to realize the dream of affordable diabetes care to all deserving individuals.

Zinc silicates with tunable morphology by surfactant assisted sonochemical route suitable for NUV excitable white light emitting diodes.

The cationic surfactants assisted ultrasound route was used to prepare Dy3+ doped Zn2SiO4 nanophosphors. The final products were characterized by powder X-ray diffraction (PXRD), ultraviolet visible spectroscopy, scanning electron microscopy, transmission electron microscopy and photoluminescence. Orthorhombic phase of Zn2SiO4:Dy3+ (JCPDS card No. 35-1485) was confirmed from PXRD. It was evident that the morphology of spherical and broom like structures were obtained with epigallocatechin gallate (EGCG) and cetyltrimethylammonium bromide (CTAB) surfactants respectively. Further the size and agglomeration of the products were varied with surfactants concentration, sonication time, pH and sonication power. The probable formation mechanisms to obtain various micro/nano superstructures were discussed. The characteristic PL peaks were observed at 484, 574 and 666nm due to the electronic transitions 4F9/2→6Hj (j=15/2, 13/2, 11/2) of Dy3+ ions upon excited at NUV pumping wavelength of 350nm [6H15/2→6P7/2 (4M15/2)]. The Judd-Ofelt intensity parameters and radiative properties were estimated by using PL emission data. The photometric studies indicated that the obtained phosphors could be promising materials in white light emitting diodes (wLED's). The present synthesis route was rapid, environmentally benign, cost-effective and useful for industrial applications such as solid state lighting and display devices.

Dual color emitting Eu doped strontium orthosilicate phosphors synthesized by bio-template assisted ultrasound for solid state lightning and display applications.

A novel Sr2SiO4:Eu (1-5mol %) superstructures (SS) were synthesized using bio-sacrificial A.V. gel assisted ultrasound method. Powder X-ray diffraction patterns confirmed the presence of both α and ß phase formation. It was evident that the morphological growth was highly reliant on A.V. gel concentration, sonication time, pH and sonication power. The formation mechanisms for different hierarchical SS were proposed. From diffuse reflectance spectra, the energy band gap was estimated and found to be ∼4.70-5.11eV. The photoluminescence emission spectra for the excitation at 392nm, shows characteristic emission peaks at 593, 613, 654 and 702nm which were attributed to 5D0→7F0, 7F1,7F2 and 7F3 transitions of Eu3+ ions respectively. Conversely, when the samples were subjected to the heat treatment at 850°C for 3h under argon atmosphere, display an intense broad emission peak with two de-convoluted peaks at 490 and 550nm due to 4f65d1→4f1 (8S7/2) transitions of Eu2+ ions. The concentration quenching phenomenon was discussed which attributes to energy transfer, electron-phonon coupling and ion-ion interaction. The Judd-Ofelt intensity parameters and other radiative properties were estimated by using emission spectra. The CIE chromaticity coordinate values of Sr2SiO4:Eu2+ and Eu3+ nanophosphors were located in green and red regions respectively. The calculated CCT and CRI values specify that the present phosphor can be fairly useful for both green and red components of white LED's. Luminescence decay and quantum yield suggest the suitability of this phosphor as an efficient luminescent medium for light emitting diodes. Overall, the results elucidated a rapid, environmentally benign, cost-effective and convenient method for Sr2SiO4:Eu3+ synthesis and for the possible applications such as solid state lighting and display devices.

Novel EGCG assisted ultrasound synthesis of self-assembled Ca2SiO4:Eu(3+) hierarchical superstructures: Photometric characteristics and LED applications.

This paper reports for the first time ultrasound, EGCG assisted synthesis of pure and Eu(3+) (1-5mol%) activated Ca2SiO4 nanophosphors having self-assembled superstructures with high purity. The shape, size and morphology of the product were tuned by controlling influential parameters. It was found that morphology was highly dependent on EGCG concentration, sonication time, pH and sonication power. The probable formation mechanism for various hierarchical superstructures was proposed. The PL studies of Ca2SiO4:Eu(3+) phosphors can be effectively excited by the near ultraviolet (UV) (396nm) light and exhibited strong red emission around 613nm, which was attributed to the Eu(3+) ((5)D0→(7)F2) transition. The concentration quenching phenomenon was explained based on energy transfer between defect and Eu(3+) ions, electron-phonon coupling and Eu(3+)-Eu(3+) interaction. The Judd-Ofelt intensity parameters and radiative properties were estimated by using PL emission spectra. The photometric studies indicate that the obtained phosphors could be a promising red component for possible applications in the field of white light emitting diodes.

Multicomponent synthesis of spiropyrrolidine analogues derived from vinylindole/indazole by a 1,3-dipolar cycloaddition reaction.

A new series of spiropyrrolidine compounds containing indole/indazole moieties as side chains have been accomplished via a one-pot multicomponent synthesis. The method uses the 1,3-dipolar cycloaddition reaction between N-alkylvinylindole/indazole and azomethine ylides, prepared in situ from cyclic/acyclic amino acids. The 1,3-dipolar cycloaddition proceeds efficiently under thermal conditions to afford the regio- and stereospecific cyclic adducts.

Therapeutic management of botulism in dairy cattle.

AIM: To report the successful recovery of few dairy cattle from botulism in response to a modified therapeutic strategy. MATERIALS AND METHODS: Seventy four naturally-occurring clinical cases of bovine botulism encountered during the period of 2012-2014 which were confirmed by mouse lethality test became material for this study. Affected animals were made into three groups based on the treatment modifications made during the course of study. RESULTS AND DISCUSSION: With the modified therapeutic regimen, 17 animals recovered after 7-10 days of treatment. Clinical recovery took 2-30 days. Animals which were not given intravenous fluid and calcium recovered uneventfully. Cattle which were already treated with intravenous fluids, calcium borogluconate, and antibiotics did not recover. They were either died or slaughtered for salvage. CONCLUSION: In cattle with botulism, administration of Vitamin AD3E and activated charcoal aid the clinical recovery. Besides, strictly avoiding anti-clostridial antibiotics, fluid therapy, and calcium therapy may facilitate the clinical recovery. Upon fluid administration, the pulmonary congestion existed in the ailing cattle might have worsened the anoxia. Administration of antibiotics like penicillin, aminoglycosides, and tetracyclines further worsen the neuronal paralysis by increasing the availability of botulinum neurotoxin. Cattle in early botulism have fair chances of recovery with the modified therapy.

Electrical and optical characterization of copper oxide/calcium oxide nanocomposite fibers.

The Poly(vinyl alcohol)/copper acetate/calcium acetate sol was prepared by sol-gel route. Poly(vinyl alcohol)/copper acetate/calcium acetate composite nanofibers were synthesized by electrospinning process. These nanofibers had an average diameter of 200 nm. Calcining these fibers at 1000 degrees C produced copper oxide/calcium oxide nanofibers with average diameter of 75 nm. These fibers were characterized by Atomic Force Microscopy, Scanning Electron Microscopy, Fourier Transform Infrared spectroscopy, powder X-ray Diffraction, Ultraviolet spectroscopy, dielectric study and Second Harmonic Generation (SHG) efficiency test. Band gap energy was calculated as 4.1 eV. SHG efficiency was found to be 1.7 times than that of KDP.

Artificial neural network model for predicting production of Spirulina platensis in outdoor culture.

Process variables contributing to describe the growth of Spirulina platensis in outdoor cultures were evaluated. Mathematical models of the process using inputs which were simple and easy to collect in any operating plant were developed. Multiple linear regression (MLR) and artificial neural network (ANN) modelling procedures were evaluated. The dataset contributing to the growth prediction model were biomass concentration, nitrate concentration, pH and dissolved oxygen concentration of culture fluid, light intensity and days in culture, measured once a day. Datasets of 12days were sufficient to develop a model to predict the succeeding day's biomass concentration with a coefficient of determination of greater than 0.98 under outdoor growth conditions. Insufficient number of datasets resulted in overestimation of the predicted output value.

Smoking cessation among diabetes patients: results of a pilot randomized controlled trial in Kerala, India.

BACKGROUND: India has the second largest diabetic population (61 million) and tobacco users (275 million) in the world. Data on smoking cessation among diabetic patients are limited in low and middle income countries. The objective of the study was to document the effectiveness of diabetic specific smoking cessation counseling by a non-doctor health professional in addition to a cessation advice to quit, delivered by doctors. METHODS: In our parallel-group randomized controlled trial, we selected 224 adult diabetes patients aged 18 years or older who smoked in the last month, from two diabetes clinics in South India. Using a computer generated random sequence with block size four; the patients were randomized equally into intervention-1 and intervention-2 groups. Patients in both groups were asked and advised to quit smoking by a doctor and distributed diabetes specific education materials. The intervention-2 group received an additional diabetes specific 30 minutes counseling session using the 5As (Ask, Advise, Assess, Assist and Arrange), and 5 Rs (Relevance, Risks, Rewards, Roadblocks and Repetition) from a non-doctor health professional. Follow up data were available for 87.5% of patients at six months. The Quit Tobacco International Project is supported by a grant from the Fogarty International Centre of the US National Institutes of Health (RO1TW005969-01).The primary outcomes were quit rate (seven day smoking abstinence) and harm reduction (reduction of the number of cigarettes / bidis smoked per day > 50% of baseline use) at six months. RESULTS: In the intention to treat analysis, the odds for quitting was 8.4 [95% confidence interval (CI): 4.1-17.1] for intervention-2 group compared to intervention-1 group. Even among high level smokers the odds of quitting was similar. The odds of harm reduction was 1.9 (CI: 0.8-4.1) for intervention-2 group compared to intervention-1 group. CONCLUSIONS: The value addition of culturally sensitive diabetic specific cessation counseling sessions delivered by non-doctor health professional was an impressive and efficacious way of preventing smoking related diabetic complications. TRIAL REGISTRATION: Clinical Trial Registry of India (CTRI/2012/01/002327).

Serum levels of interleukin-13 and interferon-gamma from adult patients with asthma in Mysore.

Serum protein analysis for noninvasive quantification of airway inflammation in asthma is a promising research tool in the field of lung diseases. Cytokines are believed to have major role in inflammatory process of the airways of the lung. There is an imbalance between T-helper (Th)-2 cells, which secrete interleukin (IL)-4 and interleukin (IL)-13, and Th1 cells, which secrete interferon (IFN)-gamma in asthma. To test the hypothesis that serum IL-13 and IL-4 levels may be elevated whereas IFN-gamma would be decreased in this cohort of patients, a property that could make them possible candidate biomarkers in determining asthma occurrence and severity, we measured concentrations of IL-4, IL-13 and IFN-gamma in serum samples of 88 subjects (44 normal, 12 with mild asthma, 16 with moderate asthma, and 16 with severe asthma). Serum Levels of IL-4, IL-13, and IFN-gamma were determined by an enzyme-linked immune-sorbent assay (ELISA). Median serum level of IFN-gamma in asthmatic patients was 8.0 pg/ml, while it was 11.4 pg/ml in healthy controls. However, the difference was not significant. Among the different age groups in whom IFN-gamma was assessed, the highest median value in both cases and controls was observed in the age group of 31-40 years. The median serum level of IL-13 was 40.0 pg/ml in asthmatic patients and 58.25 pg/ml in healthy controls. The difference was not significant. On subgroup analysis, no significant difference of IFN-gamma and IL-13 between asthma of different severities was observed. The study also revealed nonsignificant difference of serum cytokines with the duration of asthma, number of allergens, and severity of sensitization. Normal serum levels of IFN-gamma and IL-13 in asthmatic patients suggest their neutral role in the inflammatory process; however, more studies are required to establish the effect of these cytokines in adulthood asthma in different ethnic populations.

Soluble intercellular adhesion molecule-1 and E-selectin in patients with asthma exacerbation.

Soluble intercellular adhesion molecule-1 (sICAM-1) and soluble E-selectin (sE-selectin) are important factors in immunological processes of inflammatory cell buildup in target tissues. Studies have suggested that these molecules could be important markers of inflammatory diseases. This study was undertaken to assess the levels of sICAM-1 and sE-selectin during an acute attack of asthma in adults and children and to establish normal values (95th percentile) in healthy control subjects. We analyzed serum levels of ICAM-1 and E-selectin in 120 children and adults obtained during an acute attack of asthma: 40 with severe and 80 with moderately severe attack, and 50 healthy subjects as controls by ELISA (enzyme linked immunosorbent assay). sICAM-1 from patients with asthma was significantly higher than healthy controls (P < 0.001) but not for sE-selectin (P = 0.778). Significant differences were observed in moderately severe attack versus controls and severe attack of asthma for sICAM-1. With 95th percentile levels as cutoff for normal values (sICAM-1 = 585.08 ng/ml, sE-selectin = 160.87 ng/ml), it was observed that 88.3% of subjects (sICAM-1) and 98.5% of subjects (sE-selectin) with an acute attack of asthma had levels within the normal range. Although mean serum levels of sICAM-1 are higher in asthmatics than normal controls, it may be necessary to establish individual baseline values for serial estimation to evaluate their clinical relevance.