SUs have been linked to CV events, growth hormone (GH) disorder, malignancy, weight gain, erectile dysfunction and central nervous system (CNS) adverse effects. These adverse effects generally get masked as they are thought to be related to diabetes per se. The current article will allow the fraternity to ponder and undertake further research on the ill effects of largely prescribed antidiabetic medication.
Enteric fever is an endemic disease in the tropics and subtropical region. It is caused by the bacterium Salmonella typhi. It is a systemic disease and occurs by ingestion of infected food or water usually from a feco-oral source. It is primarily found in developing countries where sanitary conditions are poor [1,2]. Despite the emergence of newer antibacterial drugs, enteric fever has continued to be a major health problem. S. typhi bacterium has gained resistance to antibiotics like ampicillin, ceftriaxone and cotrimoxazole, besides developing resistance to previously efficacious drugs like ciprofloxacin [3]. The emergence of multidrug resistance to the commonly used antibiotics has further complicated the treatment and management of enteric fever and this is recognized as one of the greatest challenges in the management of the disease [4,5]. Resistance to various antibiotics has been previously reported in Salmonella typhi. However, to the best of our knowledge, a strain that is resistant to 3 rd generation cephalosporins, as well as commonly used fluoroquinolones but sensitive to chloramphenicol has not been identified yet. In this case report, we provide evidence of such a strain and its successful resolution through the use of chloramphenicol.
Hypertriglyceridemia can cause severe diseases such as acute pancreatitis (AP) and coronary artery disease. The routine management of hypertriglyceridemia is dietary restriction of fat and lipid-lowering medications to manage the secondary or precipitating causes of hypertriglyceridemia. However, in cases of AP with severe hypertriglyceridemia (SHTG) (triglycerides [TG] >1000 mg/dl) rapid reduction of TG levels to well below 1000 mg/dl can improve outcome and prevent further episodes of pancreatitis. Plasmapheresis is a therapeutic option in such medical emergencies. We discussed 2 cases of severe AP with SHTG where we used early plsmapheresis along with other supportive management.
Statins are considered the main stay of treatment in the prevention of cardio-vascular morbidity and mortality. They have multiple pleiotropic effects, like stabilization of atherosclerotic plaques, inhibition of platelet aggregation, and vascular smooth muscle proliferation; in addition to their lipid lowering action. Statins manifest these pleiotropic effects because they activate KATP channels in the cardiac and vascular tissue. Simultaneous activation of the KATP channels by statins in β cells of pancreas may inhibit insulin release which may lead to diabetes. Areas covered: Literature published between 1980 and 2016 on cholesterol biosynthesis, new onset diabetes and on the pleiotropic effects of statins, was reviewed. A comprehensive search on PubMed, Embase and Cochrane databases was carried out. Expert opinion: Statins exert their beneficial pleiotropic effects on the cardiovascular system by activating KATP channels in the cardiac and vascular tissue. However, simultaneous activation of KATP channels in the beta cells of pancreas leads to inhibition of insulin release. This disturbs the carbohydrate metabolism and probably leads to diabetes. In our opinion, use of stains should be more judicious and restricted to secondary prevention only.
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