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Biomedical subjects

Shashank R Joshi

Publications and source records attributed to Shashank R Joshi.

At least 19 recordsLinked to original sources
PubMed2006

Gestational diabetes mellitus--guidelines.

The Diabetes In Pregnancy Study group India (DIPSI) is reporting practice guidelines for GDM in the Indian environment. Due to high prevalence, screening is essential for all Indian pregnant women. DIPSI recommends that as a pregnant woman walks into the antenatal clinic in the fasting state, she has to be given a 75g oral glucose load and at 2 hrs a venous blood sample is collected for estimating plasma glucose. This one step procedure of challenging women with 75 gm glucose and diagnosing GDM is simple, economical and feasible. Screening is recommended between 24 and 28 weeks of gestation and the diagnostic criteria of ADA are applicable. A team approach is ideal for managing women with GDM. The team would usually comprise an obstetrician, diabetes physician, a diabetes educator, dietitian, midwife and pediatrician. Intensive monitoring, diet and insulin is the corner stone of GDM management. Oral agents or analogues though used are still controversial. Until there is evidence to absolutely prove that ignoring maternal hyperglycemia when the fetal growth patterns appear normal on the ultrasonogram, it is prudent to achieve and maintain normoglycemia in every pregnancy complicated by gestational diabetes. The maternal health and fetal outcome depends upon the care by the committed team of diabetologists, obstetricians and neonatologists. A short term intensive care gives a long term pay off in the primary prevention of obesity, IGT and diabetes in the offspring, as the preventive medicine starts before birth.

Continuity of Patient Care↗
PubMed2005

Kaposi's sarcoma with thrombocytopenia in a heterosexual Asian Indian male.

A 45-year-old heterosexual male patient with retroviral disease since 12 years presented with hyperpigmented lesions, misdiagnosed initially as purpura due to an associated thrombocytopenia, but was biopsy proven to be Kaposi's sarcoma (KS). Bone marrow examination revealed excess megakaryocytes. Low CD4 count and absence of platelet specific IgG reduced the likelihood of immune thrombocytopenia (ITP). However after 6 weeks of antiretroviral therapy the patient's lesions have reduced and platelet counts are improving, possibly suggesting a sequestration thrombocytopenia in the abnormal tumor vessels of KS.

Diagnosis, Differential↗
PubMed2005

Study of efficacy and safety of losartan (losar) in Asian Indian hypertensives.

Although there has been widespread dissemination of knowledge about hypertension, it remains poorly treated in most populations. Systemic hypertension is associated with increased risk for coronary artery disease, stroke, nephrosclerosis, peripheral vascular disease, etc. The treatment of hypertension includes non-pharmacological measures and the specific drug therapy. Losartan potassium is an orally active, non-peptide angiotensin II receptor antagonist. It is the first of this new class of drugs introduced for clinical use in hypertension. Data was obtained of 347 patients from 140 general physicians. The study revealed that losartan potassium is used in the treatment of mild to moderate hypertension with excellent to good response in 98.8% of the cases. Mild adverse reactions were reported in 5.8% of the cases. None of the adverse reactions were severe enough which required discontinuation of therapy or needed hospitalisation. Thus, the present postmarketing surveillance study confirms the safety and efficacy of losartan potassium in Indian population.

Antihypertensive Agents↗
PubMed2005

Metformin: old wine in new bottle--evolving technology and therapy in diabetes.

Metformin is the most common prescribed oral antidiabetic drug in the world. It shall continue to maintain its position despite of several other classes of oral agents have been recently introduced both as initial therapy and in combination with these newer drugs for prevention and treatment of type 2 diabetes mellitus (DM). The current review focuses on novel mechanism of action, efficacy, toxicity, administration of newer metformin formulation and technology of metformin. Metformin is a hepato-selective insulin sensitizer. It has beneficial properties of metformin including weight loss, lipid reduction and modulator of endothelial function. It is an atherostatic agent and also improves ovarian function in some insulin-resistant women. It does not cause hyperinsulinaemia or hypoglycaemia. Metformin is effective as monotherapy and, in combination with both insulin secretagogues and thiazolidinediones (TZDs) and may obviate the need for insulin treatment. Several fixed-dose combination pills containing metformin and other agents are available. Metformin remains a safe and effective agent for the therapy of patients with type 2 DM. It is still in most circumstances the agent of choice for first line initial therapy of the typical obese patient with type 2 DM and mild to moderate hyperglycaemia. With the current sustained release (XL) formulation of metformin, metformin therapy has now upgraded itself from the Gold Standard to Platinum. These unique XL bioequivalent metformin preparations will become the platinum standards in modern diabetes management.

Delayed-Action Preparations↗
PubMed2004

Calcitonin-secreting tumor of the pancreas.

Pancreatic endocrine tumors (PETs) are unusual tumors arising from cells belonging generically to the amine precursor uptake and decarboxylation systems. We present a case of a calcitonin-secreting PET in a 56-year-old female who presented with watery diarrhea, dehydration and hypokalemia. Investigation revealed hypercalcemia, hyperphosphatemia, hypercalcitonemia and a well-defined mass in the head of the pancreas on CT scan. Following a pancreaticoduodenectomy her serum calcitonin levels returned to normal and diarrhea disappeared. The identification of this particularly rare presentation of a calcitonin-secreting PET provides the opportunity to examine this pathological entity within the context of the very few previously reported instances of this disease.

Calcitonin↗
PubMed2004

Greek stroke score, Siriraj score and Allen score in clinical diagnosis of intracerebral hemorrhage and infarct: validation and comparison study.

AIM: To compare Greek stroke score with available previous two stroke scores for the diagnosis of cerebral ischemia and hemorrhage in acute stroke patients, and validate the Greek stroke score. SETTING: A tertiary hospital in India. MATERIALS AND METHODS: In a prospective study acute stroke patients were evaluated with Greek stroke score, Allen score and Siriraj stroke score. Comparability (Kappa Statistics) and validity (sensitivity, specificity, negative predictive value and positive predictive value) of the Greek stroke score and previous scores were tested. RESULT: Out of the 91 patients enrolled in the study, 47 patients had cerebral infarction and 44 patients had hemorrhage by CT scan. Allen score was uncertain/equivocal in 39 patients, Siriraj Stroke score in 22 and Greek stroke score in 47 patients. Sensitivity, Specificity, positive predictive value, negative predictive value for Allen score were 0.5(95% CI:0.34,0.58), 0.94(95% CI:0.86,0.98), 0.81(95% CI:0.56,0.95), 0.78(95% CI: 0.71,0.81) for Siriraj score were 0.75(95% CI: 0.63,0.84), 0.81(95% CI: 0.71,0.89), 0.77(95% CI: 0.65,0.86), 0.78(95% CI 0.69,0.86) and for Greek Score were 0.42(95% CI: 0.23,0.53), 0.93(95% CI: 0.87,0.98), 0.71(95% CI:0.39,0.91), 0.81(95% CI:0.75,0.85) respectively. Greek stroke score was compared with previous scores using kappa statistics which revealed substantial strength of agreement between the Allen Score for certain results. CONCLUSION: The overall comparability of Greek stroke score and Allen score was better as compared to Greek stroke score and Siriraj stroke score. Greek Stroke score was more specific in diagnosing hemorrhage as compared to Siriraj score. However, all these stroke scores lack accuracy hence could not be applied safely to guide the physician in management of stroke.

Cerebral Hemorrhage↗
PubMed2004

Evaluation of efficacy and tolerability of Losartan and Ramipril combination in the management of hypertensive patients with associated diabetes mellitus in India (LORD Trial).

AIM: The study was conducted to evaluate efficacy and tolerability of fixed dose combination (FDC) of Losartan and Ramipril in the management of mild to moderate hypertensive Native Asian Indian patients with associated diabetes mellitus. The secondary objective was to evaluate the efficacy of the combination in reducing microalbuminuria. MATERIAL AND METHODS: The study was an open, non-comparative, multicentric clinical trial conducted in seven Indian centres in 315 eligible patients. All the patients were treated with Losartan 50 mg + Ramipril 2.5 mg or Losartan 50 mg + Ramipril 5 mg once a day in 12 weeks and consisted of a total of eight visits. RESULTS: The mean age of patients was 52.93 years (range 45 - 60 years). Of the total patients, 62.86% were males and 37.14% were females. The mean prestudy systolic blood pressure was 160.56 +/- 14.44 which was significantly reduced to 126.85 +/- 9.78 at the end of 12 weeks (P < 0.001). Similarly the mean diastolic blood pressure was 98.91 +/- 8.33 at baseline (stage I) which was significantly reduced to 79.82 +/- 5.42 at the end of 12 weeks (P < 0.001). A mean fall of 33.72 mmHg in systolic blood pressure and the mean fall of 19.10 mmHg was observed in systolic and diastolic blood pressure respectively at the end of the treatment which was statistically highly significant (P < 0.001). The JNC-VII goal of blood pressure < 130/80 was achieved in 79.05% patients after the treatment which losartan and ramipril combination only. Microalbuminuria (urinary albumin excretion > 30 but < 300 mg/day) was seen in 83/250 (33.2%) patients and 135 (54%) patients had clinical proteinuria (albuminuria) at baseline. At the end of the therapy 20.8% patients achieved normoalbuminuria. Good to excellent efficacy response was reported in 98.09% patients and 98.41% patients reported good to excellent tolerability to the treatment. CONCLUSION: The fixed dose combination of Losartan and Ramipril showed good to excellent efficacy response in 98.10% patients and achieved a target blood pressure of 130/80 mmHg in 79.05% patients in 12 weeks. The combination reduced the urinary albumin excretion in majority of the patients with microalbuminuria and proteinuria (the major marker of nephropathy).

Albuminuria↗