The prevalence of type 2 diabetes mellitus and its resultant morbidity and mortality is rapidly increasing. An important factor in reducing the microvascular complications of diabetes is strict glycemic control. Most patients require additional insulin therapy in spite of regularly taking oral anti-diabetic drugs. Though classically used later in the natural course of the disease, newer treatment guidelines suggest early initiation of insulin analogues. The discovery of insulin has been hailed as one of the most dramatic events in the history of diabetes, improving the life-span of most diabetics. Replacement insulin therapy should mimic physiological insulin release patterns. Modern insulin and its analogues have been developed to serve as an ideal replacement therapy. There are various insulin preparations available in the market and each of them has their own advantages and disadvantages. The modern insulin’s have been developed to overcome certain side effects of the older preparations. A range of insulin products are under development that aim to increase absorption prolong action and provide alternative delivery methods. Greater patient adherence is important since most patients are reticent about insulin therapy.  This review describes the role of insulin in the management of type 2 diabetes mellitus.

Pharmacovigilance is the science and activities relating to detection, assessment, understanding and prevention of adverse effects or any other drug-related problems. 3Pharmacovigilance Programme of India (PvPI) came into action from July 2010. 4 The spontaneous reporting of ADRs is considered as foundation of post-marketing ABSTRACT Background: Early detection of adverse drug reaction is one step towards the prevention of ADRs. Foundation of Pharmacovigilance is spontaneous reporting which is minimal in India. Among the all health care professionals, nurses are caregivers at bedside. Improvement in knowledge and practice of adverse drug reaction reporting among nurses will definitely increases spontaneous reporting. In this study, knowledge, attitude and practice of nursing staff about pharmacovigilance was evaluated. Methods: It was prospective, cross-sectional, observational, questionnaire-based study among the nurses of the tertiary care hospital Solapur. A questionnaire evaluating knowledge, attitude and practice was distributed among nursing staff and filled questionnaire were collected back and analyzed by microsoft excel 2013. Results: Response rate of our study was 44.88%. 38.61% doctors were knowing meaning of pharmacovigilance while 61.38% participants knew that all drugs available in market are not safe. Taking proper medication history before prescribing drugs was considered important by 92.57% participants. 79.70% participants were aware about Pharmacovigilance program of India. 64.35% doctors answered correctly to elements which are mandatory to record. Only 24.75% participants were knowing the basis that pharmcovigilance provides for. Conclusions: Nursing staff of tertiary care hospital, Solapur had very appreciable and positive attitude towards pharmacovigilance but there is a need for improvement in knowledge and practice of ADR reporting.

A new drug Bedaquiline, a diarylquinoline agent has been approved by the Food and Drug Administration for the treatment of pulmonary multidrug-resistant tuberculosis. It has been given approval for use along with the basic regimen with only conditional access through the National Program for tuberculosis in India. The major problem with existing antitubercular drugs used for the treatment of multi-drug resistant tuberculosis is antimicrobial resistance, less efficacy, and poor side effect profile. Bedaquiline might be a solution to these issues. Bedaquiline is a first of its class drug with a unique and specific mechanism of action. It inhibits mycobacterial adenosine triphosphate (ATP) synthase's proton pump. There are many randomized clinical trials and cohort studies that reported a higher culture conversion rate with bedaquiline treatment as compared to the control group. Many meta-analyses and systematic reviews have reported higher culture conversion rate, higher cure rate, and lower mortality rate in patients with drug-resistant tuberculosis treated with a bedaquiline-containing regimen. Here is a detailed drug profile of bedaquiline to help health care workers treat tuberculosis patients.

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Type 2 diabetes mellitus (T2DM) is caused by insulin resistance and characterized by progressive pancreatic β-cell dysfunction. Recent innovative treatment approaches target the multiple pathophysiological defects present in type 2 diabetes. The targets for glycemic control as set by the American Diabetes Association (HbA1C<7%) and the American Association of Clinical Endocrinologists (HbA1C<6.5%) sometimes appear daunting and unattainable. It is therefore of the utmost importance to have an excellent understanding of the mechanism of action of these drugs in order to optimize patient therapy. Here, we present a corresponding discussion of all the available oral antidiabetic drugs according to the different classes, their mechanisms of action and pharmacological profiles.

Proton pump inhibitors (PPIs) block the parietal cell H+/K+ ATPase, are superior at suppressing acid secretion & promoting peptic ulcer healing, wildly used clinically for the therapy of gastro-esophageal reflex disease, gastritis due to excess stomach acid, and gastric ulcers. After blocking the production of gastric acid, the proton-pump inhibitors indirectly elevate serum gastrin levels via a negative feedback effect. Evidences are reported that gastrin promotes β cell neogenesis in pancreatic ductal complex, modest pancreatic β cell replication and improvement of glucose tolerance in animal models. Some recent clinical studies have shown improved glucose tolerance in type-2 diabetes mellitus (T2DM). Although PPIs may be possible candidates for a new approach in the therapy of diabetes, a prospective, long-term, randomized, double-blind, placebo-controlled study is needed to establish the effect of PPIs on glycemic control in a large number of patients with T2DM.

Background: One of the conservative management of ureteric caculi is by medical expulsive therapy by targeting common causes of obstruction such as edema, ureteral spasm and infection which will favour expulsion of calculi. The objective of this study was to assess comparative efficacy and safety of medical expulsive therapy of ureteric calculi.Methods: This was a randomized, prospective, open label, comparative study. Subjects satisfying inclusion and exclusion criteria were randomized into 4 groups tamsulosin, nifedipine, progesterone and control. Medical expulsion of calculi of 6mm to 15 mm size was carried out in 120 patients. Patients were followed up on OPD basis every third day. Calculi expulsion until day 28 as confirmed by abdominal ultrasonography was taken as the end point.Results: Expulsion rate in tamsulosin group was 90%, whereas nifedipine, progesterone group were 83.33% and 70% respectively which was significant compared to control group which was 36.6% (p < 0.005). Expulsion time was also reported to be significantly less in these groups as compared to control group. Therapy related adverse effects were minor and were seen in only 6 patients.Conclusions: Medical expulsive therapy of ureteric calculi of size 6 to 15mm with Tamsulosin, nifedipine and progesterone were safe and efficacious and could be implemented for initial management in selected patients.

With continuous rapid expansion of the human population there is escalating demand for resources, including human and veterinary pharmaceuticals. This has lead to rapid development of global pharmaceutical industry and with that increase in issues caused by pharmaceutical products. In recent years a great concern has been expressed over the occurrence and persistence of pharmaceutical products in the environment and their potential impact on environment. Owing to this the new branch of science called environmental pharmacology has sprouted. Environmental pharmacology deals with dispersion and impact of pharmaceutical products on environment. Solutions need to be suggested to save this only liveable planet from ill effects of these pharmaceutical products. This has given birth to the science of Ecopharmacovigilance (EPV).