Context:Pain is the most common symptom in admitted cancer patients. The association between the severity of cancer pain and distress symptoms such as depression and anxiety is a subject of research.Aims:The aim is to study the prevalence of pain, anxiety, and depression in admitted cancer patients and determine the association between pain and anxiety and depression at a tertiary cancer care institute.Settings and Design:This was prospective observational study.Subjects and Methods:We enrolled 393 cancer inpatients prospectively after written informed consent. Their disease details, presence, severity, and character of pain were recorded. Numerical Pain Scale was used for pain scores, self-reporting Hospital Anxiety and Depression Scale for anxiety and depression.Statistical Analysis Used:Normal data were analyzed with parametric, nonnormal with nonparametric methods, and categorical with the Chi-square test.Results:The prevalence of moderate-to-severe pain was 41.5%, anxiety 20.3%, and depression 24.8%. Proportion of patients with anxiety and depression was 9.2% and 17.7% in patients with no pain; about 32.8% and 36.7% with severe pain, respectively (P < 0.000). In patients with no depression 6% had anxiety; with depression 44.9% had anxiety (P < 0.000). Odd's ratio to have anxiety and depression was 4.44 (95% confidence interval [CI] 2.0318–9.7024) and 2.92 (95% CI 1.5739–5.4186), respectively, in patients with pain as compared to no pain (P < 0.00). There was a positive correlation between pain, anxiety, and depression scores.Conclusions:There is strong association between the presence and severity of pain and distress symptoms such as anxiety and depression in admitted cancer patients.

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There are two important incretin hormones, glucose-dependent insulin tropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1). The biological activities of GLP-1 include stimulation of glucose-dependent insulin secretion and insulin biosynthesis, inhibition of glucagon secretion and gastric emptying, and inhibition of food intake. GLP-1 appears to have a number of additional effects in the gastrointestinal tract and central nervous system. Incretin based therapy includes GLP-1 receptor agonists like human GLP-1 analogs (liraglutide) and exendin-4 based molecules (exenatide), as well as DPP-4 inhibitors like sitagliptin, vildagliptin and saxagliptin. Most of the published studies showed a significant reduction in HbA 1c using these drugs. A critical analysis of reported data shows that the response rate in terms of target achievers of these drugs is average. One of the first actions identified for GLP-1 was the glucose-dependent stimulation of insulin secretion from islet cell lines. Following the detection of GLP-1 receptors on islet beta cells, a large body of evidence has accumulated illustrating that GLP-1 exerts multiple actions on various signaling pathways and gene products in the β cell. GLP-1 controls glucose homeostasis through well-defined actions on the islet β cell via stimulation of insulin secretion and preservation and expansion of β cell mass. In summary, there are several factors determining the response rate to incretin therapy. Currently minimal clinical data is available to make a conclusion. Key factors appear to be duration of diabetes, obesity, presence of autonomic neuropathy, resting energy expenditure, plasma glucagon levels and plasma free fatty acid levels. More clinical evidence is required to identify the factors affecting response rate to incretin therapy.

Diabetes mellitus is part of the insulin resistance syndrome, which includes hypertension, dyslipidemia, and obesity as its other components. Conversely, insulin resistance is a major pathophysiologic factor in the development of type 2 diabetes. It makes sense, therefore, to choose an anti-diabetic medication that acts on insulin resistance and its clinical components, while having anti-hyperglycemic effects as well. This review discusses the non-glycemic, or extra-pancreatic effects, including insulin sensitization, of liraglutide, a novel GLP-1 analog.

The effects of type of questioning (leading or nonleading) and type of relationship between child and defendant (defendant is known, i.e., relative, or unknown, i.e., stranger) on mock jurors' perceptions of a child witness were investigated. 92 students read a transcript (a prosecutor questioning a child witness), then answered questions (each on an 11-point scale) regarding their perceptions of the child witness. When the questioning was nonleading (vs leading), the mock jurors judged the certainty of their verdict to be greater ( M = 8.1, SD = 1.9 M = 7.1, SD = 25, respectively) and the child witness to be more credible ( M = 9.0, SD = 1.7; M = 7.9, SD = 2.6, respectively) and honest ( M = 9.8, SD = 1.2; M = 8.7, SD = 2.4, respectively). The type of relationship between the defendant and the child witness did not affect perceptions of the child witness. Possible reasons and implications for the findings are discussed.