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Type 2 diabetes mellitus (T2DM) is a metabolic disorder characterized by insulin deficiency or resistance. Management starts with single oral antidiabetic drug (OAD) but eventually switch over to combination therapy because of progressive b-cell dysfunction. Hypoglycemia, weight gain, and adverse cardiovascular events are major limitations of the available OADs (Sulfonylureas [SUs], thiazolidinediones [TZDs]). Saxagliptin, a reversible, competitive dipeptidyl peptidase-4 inhibitor, is recently approved agent in the treatment of T2DM. It acts by preventing the degradation of glucagon-like peptide - 1 and hence increases secretion of insulin and decreases secretion of glucagon. It is a well-tolerated agent with commonly reported adverse events which include upper respiratory tract infection, urinary tract infection, and headache. Hypoglycemia, weight gain, and adverse cardiovascular events are negligible as compared with other OADs. In clinical studies, saxagliptin was found to be effective and well tolerated when used as a monotherapy as well as in combination with metformin, SUs and TZDs. It is administered in the dose range of 2.5 to 5 mg once a day regardless of meal. Dosage reduction is required in patients having moderate to severe renal impairment as well as with concurrent administration of strong CYP3A4/5 inhibitors. To conclude, saxagliptin because of its novel mechanism of action (preserving beta cell function) and better tolerability profile seems to be a promising agent in the treatment of T2DM, especially in the early stage of the disease, but long-term clinical studies are required to prove its status in the management of T2DM.

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Sugar is an inseparable part of the food we consume. But too much sugar is not ideal for our teeth and waistline. There have been some controversial suggestions that excessive sugar may play an important role in certain degenerative diseases. So artificial sweeteners or artificially sweetened products continue to attract consumers. A sugar substitute (artificial sweetener) is a food additive that duplicates the effect of sugar in taste, but usually has less food energy. Besides its benefits, animal studies have convincingly proven that artificial sweeteners cause weight gain, brain tumors, bladder cancer and many other health hazards. Some kind of health related side effects including carcinogenicity are also noted in humans. A large number of studies have been carried out on these substances with conclusions ranging from "safe under all conditions" to "unsafe at any dose". Scientists are divided in their views on the issue of artificial sweetener safety. In scientific as well as in lay publications, supporting studies are often widely referenced while the opposing results are de-emphasized or dismissed. So this review aims to explore the health controversy over perceived benefits of sugar substitutes.

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Objective: To assess the impacts of chronic disease assistance program (CDAP) on economic parameters, human resource and pharmacy structure and pharmaceutical care on the retail industry in Trinidad and Tobago. Materials and Methods: A partially perceptual retrospective investigation was carried out in 60 pharmacies from all regions (North East, North West, Central and South) in Trinidad. Questionnaires were distributed to all pharmacists of the each pharmacies indicated above. The validated questionnaires were distributed, over a period of approximately 2 weeks. Pharmacists employed at each pharmacy were asked to complete the questionnaire which consisted of 11 questions based on the three aspects of investigation. A five-point Likert scale (1 = strongly disagree, 5 = strongly agree) was used. Information from the completed questionnaires was tabulated in Microsoft Excel and the respective percentages and proportions were generated. Results: From the 60 pharmacies, 61% (n=37) believed that there was a decrease in sale of original brands while more than half of the respondents [53% (n=32)] believed there was an increase in sale of generics. The 60% (n=36) respondents viewed that there was compromised dispensary sale of original brands while 65% (n=39) felt there was increased orders for generic drugs. Of the CDAP prescriptions, it was disclosed that there was an overall increase in CDAP prescriptions from the year 2005-2008. A medium-scale pharmacy disclosed 1801 prescriptions in 2005, 2265 prescriptions in 2006, 3002 prescriptions 2007 and 3344 prescriptions in 2008 with overall increase in each year. Conclusions: The implementation of CDAP can explain the phenomenal increase in sale of generics drugs and the decrease in the sale of brands. There is a need for such a program in the developing countries.

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Objectives: To evaluate appropriateness of prescribing medicines in geriatric patients using both Beers criteria and Phadke's criteria and compare them for validation of Phadke's criteria as a tool to evaluate rationality of prescribing in elderly. Materials and Methods: A cross-sectional prospective observational study was conducted and the baseline data were collected from different inpatient and outpatient departments in Shree Krishna Hospital (SKH), Karamsad. A total of 400 patients of geriatric age group (≥65 years) from various inpatient and outpatient departments of SKH were included in the study. Relevant information from patients included in the study was recorded in a structured proforma from their case files. Data were evaluated for appropriateness of prescribing by using both Beers criteria and Phadke's criteria and comparison between the two criteria was also carried out. Results: Out of total 400 patients, 291 (72.75%) patients were prescribed appropriately according to Beers criteria. Based on Phadke's criteria, 158 (39.5%) prescriptions were rational, 129 (32.3%) were semirational and 113 (28.3%) were irrational. Mean rationality score on a 30-point semiscientific scale was found to be 18.47 ± 9.66 (mean ± SD). The comparison of outcome by both the criteria showed no significant difference in appropriateness of prescribing (P>0.05). Conclusions: Inappropriate prescribing is common in elderly patients. Beers criteria is a well-established method for evaluating appropriateness of prescribing. This study has shown that Phadke's method of evaluating rationality of prescriptions compares equally well and hence can be a valuable objective tool for assessing appropriateness of prescribing in geriatric patients.

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Objective: To evaluate the antitubercular efficacy and safety of New Chemical Entity (NCE): 8-[(4-Chloro phenyl) sulfonyl]-7-Hydroxy-4-Methyl-2H-chromen-2-One (CSHMC) in guinea pigs. Materials and Methods: This pilot study was carried out in guinea pigs. They were infected with M. tuberculosis H ₃₇ Rv (1.5 × 10 ⁴ cfu/guinea pig) via intramuscular route. After 30 days, infections were confirmed in 6 guinea pigs by histopathology of spleen, lung, and liver. After that CSHMC (5 and 20 mg/kg) was administered for 1 month and its effect was compared with vehicle, rifampicin (60 mg/kg) and isoniazid (30 mg/kg). Efficacy of CSHMC was evaluated on the basis of histopathologic scoring of lesion in lung, spleen, liver, and safety on the basis of measuring hemogram, liver and renal function parameters. Results: Isoniazid, rifampicin, and CSHMC (20 mg/kg) significantly reduce the median lesion score in lung, spleen, and liver as compared to disease control group. Reduction in median lesion score for lung and spleen were not statistically significant for CSHMC 5 mg/kg. CSHMC (20 and 5 mg/kg) did not produce any changes in hemogram, liver and renal function parameters with respect to normal values. Conclusions: CSHMC had shown significant antitubercular efficacy comparable to isoniazid and rifampicin and did not show hematological, hepato- and nephrotoxicity.

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Objective: To evaluate and compare the effects on high-sensitivity C-reactive protein (hs-CRP) levels and lipid profile of atorvastatin and rosuvastatin in obese type 2 diabetes mellitus (T2DM) patients. Materials and Methods: A total of 40 subjects with 20 in each group were randomly allocated to two groups. Group 1 patients received atorvastatin and that of Group 2 rosuvastatin treatment for 6 months. The patients were administered atorvastatin (40-80 mg) and rosuvastatin(10-40 mg) in accordance to their LDL-C status as per NCEP-ATP III guidelines. The parameters studied were, hs-CRP and lipid profile comprising LDL-C, HDL-C, TG and TC. Results: Results obtained from the study, clearly indicate that atorvastatin (A) as well as rosuvastatin(R) have significant effect on lowering of hs-CRP levels (for A P=0.001; for R P=0.002), reducing LDL-C levels (for A P=0.008; for R P=0.001), elevating HDL-C levels (for A P=0.02; for R P=0.001) along with reducing TC (for A P=0.003; for R P=0.002) and TG (for A P=0.000; for R P=0.000) levels in obese T2DM patients. It is also seen that there is no significant (P>0.05) difference in effect of atorvastatin and rosuvastatin in lowering of hs-CRP levels, elevating HDL-C levels and reducing TG levels in obese T2DM patients. However, percentage lowering of LDL-C (P=0.000) and TC (P=0.001) by rosuvastatin is to a greater extent than that caused by atorvastatin in these patients. Conclusions: Thus this study throws light on the fact that rosuvastatin should be preferred over atorvastatin in obese T2DM patients in whom LDL-C and TC levels are deviated from normal reference values. In rest of obese T2DM either of atorvastatin or rosuvastatin can be employed to lower hs-CRP levels, to elevate HDL-C levels or to reduce TG levels.

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Introduction: To study the effects of heparin and low-molecular weight heparin (LMWH) on potassium and sodium levels in patients with cardiovascular diseases (CVDs) and stroke. Materials and Methods : Sixty patients were recruited with 30 patients each receiving heparin and enoxaparin. Patients with CVD and stroke receiving heparin and LMWH were compared for their demographic profile and laboratory data, and this was analyzed by descriptive statistics. Risk factors associated with the development of hyperkalemia were analyzed using multiple logistic regression model. Results : There was an increase in potassium levels and decrease in sodium levels compared with baseline in both the groups. The difference between the groups with respect to sodium and potassium levels was not statistically significant. On analysis, the risk factors for development of hyperkalemia were baseline potassium levels, serum creatinine, and creatinine clearance. The change in sodium and potassium levels on the fifth day of therapy was increased with LMWH compared with heparin, although not statistically significant. Conclusions : The clinician should anticipate hyperkalemia especially in patients with renal impairment receiving these drugs.

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Objective: To compare the efficacy and safety of olopatadine and rupatadine in seasonal allergic rhinitis (SAR). Materials and Methods: A 2-week, single-centered, randomized, open, parallel group comparative clinical study was conducted on patients with SAR. Following inclusion and exclusion criteria, 70 patients were recruited and were randomized to two treatment groups and received the respective drugs for 2 weeks. At follow-up, clinical improvement was assessed in terms of change in total and differential count of leucocytes, serum Immunoglobulin E (IgE) level, Total Nasal Symptom Score (TNSS) and Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) scoring. Results: Both the drugs significantly reduced the differential count (P<&0.001) and absolute eosinophil count (P<</i>0.001), but olopatadine was found to be superior. In olopatadine group, there was significantly higher reduction in serum IgE (P=0.01), TNSS (P< 0.001) and RQLQ score (P=0.015) than that of rupatadine. Incidence of adverse effects was found to be less in olopatadine group when compared with rupatadine group. Conclusions: Olopatadine is a better choice in SAR in comparison to rupatadine due to its better efficacy and safety profile.

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Aim: To study the adverse drug reaction (ADR) pattern in a pediatric population in a tertiary care hospital. Materials and Methods: An observational study was done in the department of pediatrics in a tertiary care hospital. The ADRs occurring in the inpatient wards and outpatient department of pediatrics were actively monitored. The collected reports were analyzed for ADR pattern, drug groups, demographic profile, causality, severity, and preventability of the ADR. Results: A total of 30 ADRs were documented during the mid period of 2009 among pediatric patients. Most of the ADRs (60%) occurred below the age of 1 year. Antibiotics comprised the major group of drugs causing ADRs (67%). Rashes and urticaria were the most common type of ADR (37%) followed by fever, anaphylactic shock, vomiting, chills, and rigors. A single case of death had been reported in the study period. There were more occurrences of ADRs with multiple drugs compared to single drug therapy. About 80% of the ADRs were of probable causality and 87% were of probable preventability. There were no mild reactions, with 77% of reactions being moderate and 23% of reactions being severe in the severity scale. Conclusions: ADRs occur more among infants and antibiotics were more commonly implicated. Most of the reactions were of moderate severity. This indicates the need for a rigid ADR monitoring among pediatric patients to ensure safety of drug therapy.

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With burgeoning reports of adverse drug reactions due to pharmacotherapy, pharmacovigilance (PV) is the buzz word in health care circles. While there are experts in this rapidly expanding field, there are many health care professionals who do not fully appreciate the import of PV in the context of modern therapeutics. In view of the national directive to institutionalize a PV center in every medical college of India, there is an urgent need to inform, educate, and enlighten the readers about the constitution and dynamics of a PV center, which this article attempts to fulfill.

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A 70-year-old black woman presented with intermittent palpitations and dyspnea was found to be bradycardic with a normal sinus rhythm. She had instilled her topical timolol maleate approximately 30 minutes prior to each of these episodes. Topical timolol was discontinued and the conduction abnormality resolved. She was diagnosed as having intermittent sinus bradycardia with intermittent atrioventricular block, likely induced by topical beta-blocker therapy. Topical timolol maleate is an effective treatment for ocular hypertension, acting by reducing aqueous fluid production. However, it can induce systemic side effects and should be used with caution in patients with, or predisposed to, cardiac or respiratory depression.

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