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The relationship between plasma endogenous secretory receptor for advanced glycation end product (esRAGE) level and diurnal variation of blood pressure in type 1 diabetic patients based on their glycemic status has not yet been studied. So, the aim of the present study was to see if a correlation exists between plasma esRAGE levels and dipper status in type 1 diabetic patients based on their glycaemic status. Type 1 diabetic patients were divided as good and poor glycaemic controlled groups based on their HbA1c values. Blood glucose levels, insulin, insulin antibodies, homocysteine and esRAGE levels were determined. The hourly daytime and night-time blood pressure was monitored by using a non-invasive blood pressure (NIBP) apparatus. Of the 16 patients in the well-controlled group, most (14/16) were dippers (95 % confidence interval 1.5 to 20.7 vs. P = 0.006, Fisher’s exact test) when compared to those in the poorly controlled group (5/18). There was a significant correlation between plasma esRAGE levels and % decline in nocturnal blood pressure in both the good (r = 0.69, P = 0.003) and poorly (r = 0.79, P = 0.0002) controlled groups. Most of the poorly controlled patients showed abnormal circadian blood pressure pattern and low esRAGE level and hence were more prone to end organ damage.

Integrity is a necessary attribute expected in practitioners of medicine. Unfortunately there is evidence on hand that academic dishonesty is widely prevalent in many Indian medical colleges and that a proportion of students seem to think that there is nothing wrong in participating in such acts. This practice needs to be discouraged as those indulging in unethical acts during student days are likely to indulge in similar practices while dealing with their patients. It is, therefore, necessary that teachers in medical colleges show 'zero tolerance' to such acts. There is a need for faculty and administrators to be above board in their actions and be role models for ethical behaviour. Hence, acts of academic misconduct committed by faculty and administrators should also be dealt with quickly, fairly and firmly. A milieu of transparency, fairness and student awareness will go a long way in minimizing this pervasive malady.

In spite of the existence of a dual system of postgraduation, one under the Medical Council of India (MCI) and the other on a parallel track under the National Board of Examinations, postgraduate medical education in India is beset with several problems. For example, the curriculum has not been revised comprehensively for several decades. The diploma course under the MCI has become unpopular and is largely a temporary refuge for those who do not get admission to degree courses. The level of skills of the outgoing graduate is falling and the increase in the number of seats is taking place in a haphazard manner, without reference to the needs. In spite of increase in seats, there is a shortage of specialists at the secondary and tertiary care levels, especially in medical colleges, to share teaching responsibilities. Further, the distribution of specialists is skewed, with some states having far more than others. To remedy these ills and fulfil the requirements of the country over the next two decades, a working group appointed by the erstwhile governors of the MCI was asked to suggest suitable modifications to the existing postgraduate system. After an extensive review of the lacunae in the present system, the needs at various levels and the pattern of postgraduate education in other countries, it was felt that a competency-based model of a 2-year postgraduate course across all specialties, the use of offsite facilities for training and a criterion-based evaluation system entailing continuous monitoring would go a long way to correct some of the deficiencies of the existing system. The details of the proposal and its merits are outlined for wider discussion and to serve as a feedback to the regulatory agencies engaged in the task of improving the medical education system in India. We feel that the adoption of the proposed system would go a long way in improving career options, increasing the availability of teachers and dissemination of specialists to the secondary and primary levels, and improving the quality of outgoing postgraduates.

Essential medicines lists have been shown to improve the quality and cost-effectiveness of health care delivery when combined with proper procurement policies and good prescribing practices. The Ministry of Health, Government of India revised the National List of Essential Medicines of India (NLEMI 2011) in June 2011, eight years after the last revision. The NLEMI 2011 contains 348 medicines and was prepared over one and a half years by 87 experts. Though there are some positive aspects to the list such as the documentation of a detailed description of the revision process, inclusion of many experts from various fields in the review committee, well written description of the essential medicines concept and others, a critical review of the list reveals areas of major and minor concerns. Improper medicine selection like the inclusion of a nearly obsolete medicine such as ether, an anesthetic agent; non-inclusion of pediatric formulations; spelling errors; and errors in the strengths of formulations diminishes the significance of the NLEMI 2011. In its present form, the NLEMI 2011 did not align with the Indian Pharmacopoeia, and the National Health Programs as well as the National Formulary of India 2010. Formatting errors, non-inclusion of an index page, syntax and spelling errors may also undermine the usefulness of the NLEMI 2011 as a reference material. An urgent revision of the NLEMI 2011 is suggested so as to avert misinforming the wider international and local readers.

The National Formulary of India (NFI), 4th edition, 2010 (pre-print version) was published amidst a lot of advance publicity by the Indian Pharmacopoeia Commission (IPC). The book was released by Shri K. Chandramouli, Secretary, Ministry of Health and Family Welfare, Govt. of India and Chairman, IPC on 16th December 2010, at Nirman Bhawan, New Delhi, in the presence of offi cials.[1] Coming after a gap of three decades, the NFI will be a much sought after document for health care providers all over India. The need for unbiased, quality information on medicines is felt all over the country and the NFI 2010 may have been the answer which health professionals were waiting for. However, a quick look at the preprint version of the NFI shows that much work has to be done before the fi nal version is printed.

Since proper storage of insulin is necessary for its action, the present study was undertaken to determine the extent to which improper temperature storage conditions could have contributed to the potency of the three insulin formulations tested.Two human insulin formulations (regular and biphasic) from three different manufacturers were stored at 5 different temperatures. In vitro potency of insulin was determined by high performance liquid chromatography on every seventh day for a period of 28 days. For the in vivo study, insulin tolerance test was done by injecting human regular insulin intraperitoneally to rabbits on the 25(th) day of storage. Blood glucose was determined at 0, 15, 30 and 60 min after insulin injection using glucometer.Storage at 32 and 37 degrees C showed 14-18 per cent decrease in potency of insulin in both the formulations on 28(th) day for all the three brands. Also the rabbits receiving insulin stored in 32 and 37 degrees C did not show a significant decrease in blood sugar level when compared to those receiving insulin stored at 5 degrees C.Improper storage of insulin decreases the potency and hence the pharmacological action of insulin. Patients should be educated on the proper methods of storage, and free supplies of insulin for more than two weeks use should not be dispensed.

Noise is considered to be a non-specific stressor which generally causes physiological and psychological effects in an individual. Many occupations involve workers being subjected to loud noise levels without adequate protective measures. The study was done to document the changes, if any, in the nocturnal sleep architecture of healthy persons exposed to loud occupational noise during daytime.The study was a retrospective cohort design wherein three groups of eight subjects each, exposed to continuous occupational background noise levels of75dB for 1-2 years, 5-10 years and15 years were selected. Corresponding age and gender matched healthy controls (eight for each group) who worked in a quiet atmosphere were also recruited. All night sleep polysomnography was done on all subjects. In the morning, subjects rated their quality of sleep on a Visual Analogue Scale.There is a strong association between occupational exposure to loud noise and poor sleep efficiency (Relative Risk 2.49; Confidence Interval 1.12 to 5.57; P = 0.01, Fisher's exact test). The group exposed to noise for 1-2 years had a decrease in Total Rapid Eye Movement Time, Non Rapid Eye Movement Time, Slow Wave Sleep Time, Sleep Onset Latency and Total Sleep Time. The other two groups showed lesser number of changes in sleep architecture. Subjectively there was a decrease for sleep continuity in Group I and an increase for sleep onset in Group II. There is no correlation between loudness of noise in the workplace and sleep efficiency.It can be concluded that workers exposed to loud background occupational noise are at an increased risk of having poor quality sleep but adaptation to this effect probably takes place after a few years.

This is a single blind crossover study designed to test the effects of hyoscine butylbromide (HBB), an anticholinergic which does not cross the blood brain barrier (BBB), on the temporal changes in heart rate during nocturnal sleep. The effects were compared with atropine sulphate which is known to cross the BBB. Ten healthy male volunteers slept in the JIPMER sleep disorders laboratory for three nights and received either saline, atropine sulphate (0.4 mg, i.v.) or HBB (10 mg, i.v.) just prior to sleep onset. All night polysomnography recording was done to monitor heart rate during the specific stages of sleep. The normal physiological fall in heart rate is blunted by both drugs during slow wave sleep whereas only HBB prevented the fall in rapid eye movement sleep. Therefore, HBB may be a better choice as pre-anaesthetic medication for patients with cardiac abnormalities since it does not alter heart rate during both slow wave sleep and rapid eye movement sleep.

The changes in sleep architecture, heart rate and respiratory rate to hyoscine butylbromide (HBB), a peripherally acting anticholinergic was studied. These effects were compared with that of atropine sulphate, a drug known to cross the blood brain barrier. The study followed a single blind cross over design with a one week washout period. Atropine sulphate (0.4 mg) and HBB (10 mg) were given intravenously to ten adult healthy male volunteers before sleep onset. Normal saline was used as control. All night sleep polysomnography was done with the standard montage for sleep staging. Respiration and airflow were also monitored. Rapid eye movement (REM) latency was significantly increased with both the drugs whereas the duration of REM sleep was decreased only with atropine. Slow wave sleep (SWS) was also increased significantly by atropine. There was no change in heart rate, or respiratory rate during any of the sleep stages. HBB affects the initiation of REM sleep whereas atropine affects both its initiation and maintenance.

The raga Nelambari in the classical Indian Karnatic system of music is said to be able to induce sleep and also have some sleep promoting qualities. This hypothesis was scientifically tested using sleep polysomnography with eight healthy subjects who listened to either Neelambari (test) raga or Kalyani (control) raga. There was no difference in sleep architecture or in subjective feeling of quality of sleep. The anecdotal references to the quality of sleep promoting effects of Neelambari probably reflect a conditioned response since most lullabies in South India are sung in Neelambari raga.

Ascorbic acid (1 g/kg) accentuated anorectic and locomotor effects of amphetamine (5 mg/kg) and delayed development of tolerance to anorectic effect. On the contrary, it did not alter the pattern of reverse tolerance to increased locomotor activity. The results suggest that modulation of dopamine receptor sensitivity by ascorbic acid may be the reason for the delay in development of tolerance to amphetamine induced anorexia.

Digoxin pharmacokinetics was studied in eight patients with uncomplicated type II diabetes mellitus and seven healthy volunteers. After a single oral dose of digoxin (1 mg), the drug concentration was measured in the serum collected at different time intervals, using a radioimmunoassay method. The diabetics had a higher serum concentration of drug when compared to control. The clearance rate of digoxin was significantly reduced in diabetics when compared to healthy volunteers. The elimination half-life of about 22 hours in both groups is much less than that reported in Western data. Possible reasons for this discrepancy are discussed.

Primary health centres provide health care to the majority of the population in developing countries. A drug utilization study was conducted for 1 y at two primary health centres in Pondicherry, India. Information on complaints, diagnosis and drugs prescribed was collected. From the 2953 prescriptions studied, it was found that on an average each patient received 2.71 drugs. Vitamins, antibiotics, analgesics and antihistamines were the most commonly used, accounting for more than 80% of the drugs prescribed. The antimicrobials which constituted one fourth of the drug consumption, comprised sulphonamides, tetracycline and cotrimoxazole. About half of the patients received injections, particularly of the vitamin B Complex and antibiotics. The results will be used to plan intervention strategies for the promotion of rational drug use.Records from 2 of the 8 primary health care clinics (PHCs) in Pondicherry, India, were surveyed one day per month in 1988 by medical graduates to determine drug utilization. 2953 patients treated during the morning hours received 8021 prescriptions, an average of 2.71 each. The most commonly prescribed drugs were vitamins (24.7% of total drugs), antimicrobials (24.3% of drugs, 66.2% of patients), analgesics (19.9% of drugs) and antihistamines (10.3%). The most prevalent diagnoses were would infection (20.5%), myalgia (11.3%), urinary tract infections (10.2%), pain, skin diseases, cold and diarrhea. Asthma, worms and fever of unknown origin were found in 5% or fewer patients. Among antimicrobials, the most commonly prescribed were sulfonamides, tetracycline, and cotrimoxazole. Children received more antibiotics than adults. Chloramphenicol was given to 42 patients, 28 of them children. Penicillin made up only 6.4% of the antibiotics given. 32.8% of the antibiotics were administered intramuscularly, including 355 tetracycline injections. B-vitamin complex was also injected intramuscularly in 474 patients. Both consumers and practitioners in developing locales must be informed that injections, particularly of agents such as tetracycline and vitamins which are safer and cheaper to give orally, are not the administration route of choice for all medications. A safer antibiotic than chloramphenicol should be chosen for serious infections, especially in pediatrics.

BACKGROUND Though patients attending a diabetic clinic in a tertiary care hospital were given free monthly supplies of insulin, it was found that their glycemic control was poor. SETTINGS AND DESIGN A prospective interventional study was carried out at the outpatient clinic in a tertiary care hospital. AIMS To evaluate the effectiveness of a six month educational interventional program on the knowledge, attitude and practices (KAP) of type-1 diabetic patients receiving free monthly supplies of human insulin and to assess their adherence. METHODOLOGY Sixty-seven type-1 diabetics, receiving free insulin vials each month, were recruited. The patients' baseline glycemic index, plasma insulin and KAP scores were determined using a validated questionnaire. The patients were educated about the disease and use of insulin for the next six months. In the seventh month, the KAP questionnaire was readministered and blood parameters measured. STATISTICAL ANALYSIS Blood glucose, glycosylated hemoglobin and plasma insulin were compared by paired t tests. Mean KAP scores by Wilcoxon matched-pairs signed-ranks test. Difference in the proportion of patients answering the items was compared using test of proportions for dependant groups. RESULTS The overall mean scores (+/- SE) increased from 30.8 +/- 0.5 to 42.2 +/- 0.4 (P < 0.001). The improvement in practice scores, though significant, was marginal, that is, from 17.7 +/- 0.3 to 18.8 +/- 0.3. In three out of the ten items under practice domain, only the manner in which vials were being stored at home showed significant improvement (P < 0.0001). The adherence to the insulin regimen increased from 82 to 86%, but was not significant. Patients cited financial reasons for nonadherence. CONCLUSION The study showed that a planned educational intervention in type-1 diabetics, receiving monthly supplies of insulin free of charge, did not improve the key aspects of the practice component, even though the knowledge and attitude improved.

The BMJ publishes local editions in 16 countries, including India. These make reliable information available in countries where doctors either do not speak English or cannot afford the weekly journal. The local editions contain articles from the weekly edition of the BMJ , some local material, and advertisements. The Indian edition of the BMJ has been published monthly since 1986. All the articles in it are from the BMJ 's international edition except for one or two pages dealing with local news. The edition is reasonably priced and is therefore available to many readers. Unfortunately, the advertisements in the Indian edition do not have the same international standard as those in the weekly BMJ , are misleading, and make unsubstantiated claims. We studied advertisements from pharmaceutical companies appearing in five issues of the Indian edition (August to December 1992; 116 advertisements) and in four issues of the British edition (March 1993; 87 advertisements). Advertisements for parenteral fluids, milk foods, and laboratory equipment were excluded. We noted whether the …