Efficacy and Safety of Empagliflozin as Add-On Therapy in Patients of Type-2 Diabetes Mellitus

OBJECTIVES: To assess efficacy of two doses i.e., 10 mg and 25 mg in lowering the glycated haemoglobin (HbA1C) and fasting blood glucose (FBG) in patients of type 2 diabetes mellitus (T2DM) having suboptimal glycaemic control on maximal doses of Metformin and Sitagliptin, and to see the frequency of its side-effects. METHODOLOGY: The study design was a randomized control trial. Fifty nine adult patients of T2DM who were already on 2000 mg of Metformin and 100 mg of Sitagliptin and were having suboptimal glycaemic control (HBA1C >7% and <12%) were randomized to two groups, one group receiving 10 mg (Group A) and the other group receiving 25 mg of empagliflozin (Group B) as an additional treatment. HbA1C and FBG were taken before and 12 weeks after addition of empagliflozin in both the groups. Side effects of empagliflozin such as urinary tract infections (UTI) and genital mycotic infections were also recorded in both the groups. RESULTS: Total patients in-group A were 31 and their mean age was 51.48±4.29 years. In-group B there were 28 patients and their mean age was 52.39±5.20 years. There was a statistically significant reduction of both HbA1C and FBG in both the groups after empagliflozin treatment; (p=0.000) for both HbA1C and FBG in both the groups. Although numerically UTI and genital mycotic infections were more than pre-treatment numbers, they were not statistically significant (p>0.05). CONCLUSION: Empagliflozin can be safely added to the oral anti-diabetic regimen of patients with type 2 diabetes mellitus who have suboptimal glycaemic control and results in significant improvement in HbA1C.

Pulmonary Candidiasis Associated with Severe COVID-19: Case Report

Co-infections have been widely described in COVID-19 patients. Bacterial infections being the main cause but also have been reported fungal infections in up to 20 % of the cases. Candida species are the second most common fungi identified in pulmonary mycotic infections affecting hospitalized COVID-19 patients after Aspergillus. We present a case of severe COVID-19 associated with pulmonary candidiasis.

Mycotic infections in animals in India: An update

This review traces the early records of mycotic infections in India, and presents an update of animal mycoses reported from several parts of India. The types of mycoses covered are the dermatophytosis (ringworm) in domestic animals due to well-known species of zoophilic dermatophytes, viz. Trichophyton simii, T. mentagrophytes, T. verrucosum, Microsporum canis and M. nanum, and the geophilic dermatophyte, M. gypseum, Aspergillus spp, Cryptococcus species and other yeast like fungi, histoplasma and blastomyces. The brief clinical and demographic features of infections in different animals are described. A particularly noteworthy finding in literature search is the report of clinical infections in one dog and two cows by an anthropophilic dermatophyte, T. rubrum from Belgachia, Kolkata, West Bengal in 1954. Veterinary scientists are urged to investigate the possible occurrence of infections in animals due to other pathogenic fungi including the dimorphic ones like Histoplasma and Blastomyces.

Epidemiology of Mycotic Infections: Experience From A Tertiary Care Center Of Uttarakhand, India

Introduction: The overall changing epidemiology of fungal infections in the current scenario isbecause of an increase in immunocompromised population including cancer patients, Humanimmunodeficiency virus (HIV)-infected patients, transplant receipts, and prolonged hospitalizationwith overuse of antimicrobial agents. These infections are challenging to diagnose and subsequentlymanage as their clinical symptomatology often mimics other common diseases like tuberculosis.Rapid diagnosis is limited and culture is often delayed due to slow growth rates of the causativeagents. Objective: This is a retrospective study to know the spectrum and burden of mycoticinfections in a tertiary care hospital. Methods: All samples collected from clinically suspected casesof fungal infections were sent to the Microbiology department over one year. The common specimensreceived were respiratory samples, scrapings from cornea, skin, and nail. All samples were firstobserved under direct microscopy using Potassium hydroxide (KOH) examination for the presence offungal elements and Gram stain for yeasts. India Ink examination was performed for sterile fluids.Fungal culture was done on Sabouraud's dextrose agar. Result: A total of 900 samples from variousdepartments were included, KOH examination was positive for 380 samples (42%) and fungalgrowth was obtained in 144 samples (16%). Rare fungi like Trichosporon dohaense (blood culture),Cladophialophora bantiana (brain abscess), Scedosporium apiospermum and Candida auris (bloodculture) were also isolated. Conclusion: Similar studies are needed to estimate the actual burden ofthe fungal infections in tertiary care health facilities, to help decrease the morbidity and mortalityassociated with underdiagnosed mycotic infections.

Dermatophytoses in patients attended from a private clinical analysis laboratory in João Pessoa-PB, between 2015 to 2019

<p><strong>Introduction</strong>: dermatophytoses or “tineas” are characterized by being mycoses caused by fungi of the genera Epidermophyton, Trichophyton and Microsporum. These mycotic infections can present themselves as a form of lesions that affect the skin, hair and ails of individuals of both genders and all ages. <strong>Objective</strong>: to elucidate the epidemiological profile of dermatophytoses in patients examined by a private clinical analysis laboratory in João Pessoa-PB, between 2015 and 2019. <strong>Methodology</strong>: this is an epidemiological, analytical, retrospective and documentary study, in which data collection took place at the Clinical Pathology Laboratory – “HEMATO”, located in João Pessoa – PB. <strong>Results</strong>: the profile of those affected was predominantly female (58.5%), 18 to 59 years old (38.4%), white (53.6%) and with lesions, mainly in skin glabrous (38.5%), feet (33.3%) and nails (12.8%). When relating the age group to the injury site, it was noticed that injuries on glabrous skin, feet and nails, were more frequent in individuals aged 18 to 59 years, while injuries to the scalp were mostly found in individuals younger than 18 years old. The most prevalent species were M. canis (31.9%) and T.rubrum (31.9%). When correlating the fungal species with the lesion site, it was noted that M. canis was the main agent responsible for lesions in glabrous skin, scalp and hands, while T. rubrum was predominantly observed in nails and T. mentagrophytes in feet. <strong>Conclusion</strong>: it is concluded that the data present in this research can promote the development of indicators and public policies for the population most susceptible to dermatophytosis.</p>

Efficacy and Safety of a Sodium-Glucose Co-Transporter-2 Inhibitor Versus Placebo as an Add-on Therapy for People With Type 2 Diabetes Inadequately Treated With Metformin: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Metformin monotherapy is often insufficient to achieve or sustain glycemic targets in people with type 2 diabetes. Therefore, we performed a systematic review and meta-analysis to assess the efficacy, safety and tolerability of sodium-glucose co-transporter-2 inhibitors versus placebo as add-on therapy after metformin in type 2 diabetes. The systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A search was performed in the PubMed, www.clinicaltrials.gov and Cochrane Central Register of Controlled Trials databases for relevant randomized controlled trials up until 30th October 2020 that compared sodium-glucose co-transporter-2 inhibitors versus placebo as add-on therapy to metformin. A random-effects model was used. Thirteen randomized controlled trials (4270 participants) met the inclusion criteria. Compared with placebo, sodium-glucose co-transporter-2 inhibitor treatment, as add-on therapy to metformin, was associated with a significant reduction in HbA1c level (mean difference [MD]: -0.6%, 95% CI: -0.7, -0.5; p&lt;0.01), fasting plasma glucose level (MD: -1.4mmol/l; 95% CI; -1.5, -1.3; p&lt;0.01), weight (MD: -2.0kg; 95% CI: -2.2, -1.8; p&lt;0.01), systolic blood pressure (MD: -4.7mmHg; 95% Cl: -5.4, -3.9; p&lt;0.01) and diastolic blood pressure (MD: -2.0mmHg; 95% Cl: -2.5, -1.5; p&lt;0.01). Significantly more participants achieved HbA1c &lt;7% (odds ratio [OR]: 3.1; 95% CI: 2.6, 3.6; p&lt;0.01) in the sodium-glucose co-transporter-2 inhibitor group. Genital mycotic infections (OR: 2.6; 95% CI: 1.4, 4.6; p&lt;0.01) were more common with sodium-glucose co-transporter-2 inhibitors, but there was no significant statistical difference in urinary tract infections (OR: 1.4; 95% CI: 1.0, 2.0; p=0.06), in hypoglycemia (OR: 1.5; 95% CI: 1.0, 2.4; p=0.07), or in discontinuation rates due to adverse events (OR: 0.9; 95% CI: 0.6, 1.5; p=0.68) between the two groups. In summary, in comparison with placebo, add-on therapy with a sodium-glucose co-transporter-2 inhibitor is significantly more efficacious in lowering HbA1c, fasting plasma glucose, weight and blood pressure in people with type 2 diabetes following inadequate glycemic control with metformin. The rate of discontinuation due to adverse events was similar despite higher risk of genital mycotic infections.

Correlation of diabetes with mycotic infections: a pilot study

Background: The immuno-compromised individuals have a high Incidence of fungal infections of the nose and the paranasal sinuses. There is a variation in the fungal species that manifest in different subset of individuals. The species and the susceptible individuals were studied in the Punjab population, to suggest measures to attain a better outcome.Methods: 50 subjects treated for paranasal fungal infection by rhinology division of the oto-rhino-laryngology services, Dayanand Medical College and hospital, Ludhiana, were analysed. The prospective study was carried out in a period of one and a half year (June 2009 to December 2010).Results: Mycotic infections was predominantly noted in the age group 51-60 years i.e. in 14 patients (28%) followed by 41-50 years, 13 cases (26%). There were 29 (58%) of males and 21 (42%) females with a male:female ratio of 1.4:1. Amongst 50 patients with mycotic infection, 19 (38%) were diabetic. All 15 (100%) patients with zygomycosis had underlying diabetes while only 4 (21%) with aspergillosis were diabetic.Conclusions: Zygomycosis occurs usually in diabetics, while in aspergillosis the underlying morbidity may or may not be diabetes. Timely medical treatment is essential to check diabetes and species identification to select the appropriate antifungal medication.

Vaccines for human fungal diseases: close but still a long way to go

Despite the substantial global burden of human fungal infections, there are no approved fungal vaccines to protect at risk individuals. Here, we review the progress that has been made and the challenges that lie ahead in the quest towards efficacious fungal vaccines. In mouse studies, protection has been achieved with vaccines directed against fungal pathogens, including species of Candida, Cryptococcus, and Aspergillus, that most commonly cause life-threatening human disease. Encouraging results have been obtained with vaccines composed of live-attenuated and killed fungi, crude extracts, recombinant subunit formulations, and nucleic acid vaccines. Novel adjuvants that instruct the immune system to mount the types of protective responses needed to fight mycotic infections are under development. Candidate vaccines include those that target common antigens expressed on multiple genera of fungi thereby protecting against a broad range of mycoses. Encouragingly, three vaccines have reached human clinical trials. Still, formidable obstacles must be overcome before we will have fungal vaccines licensed for human use.