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Biomedical subjects

I V Mehra

Publications and source records attributed to I V Mehra.

7 recordsLinked to original sources
PubMed1997

Strategies of the treatment of type II diabetes mellitus.

In Type Diabetes mellitus (DM), the two primary defects that occur are insulin resistance and impaired insulin secretion. Currently, no data exist showing improved outcomes or reduced macrovascular complications with tight glycemic control in Type II DM, and only minimal data shows a reduction of microvascular complications. Still, the current standard of practice is to attempt to attain glycemic goals in patients with Type II DM. As an attempt to resolve this issue, the United Kingdom Prospective Diabetes Study (UKPDS) was initiated. This 11-year study is comparing conventional therapy to intensive therapy in patients with Type II DM. The American Diabetes Association's (ADA) guidelines state that either sulfonylureas, metformin, acarbose, or insulin can be used as first-line treatment for Type II DM; however, oral agents can be attempted first in most patients. Until results from the ongoing UKPDS trials are available, the guidelines for glycemic control from the ADA should be followed.

Blood Glucose↗
PubMed1994

Oral ondansetron for preventing nausea and vomiting.

Available clinical data on the use of oral ondansetron for the prevention of nausea and vomiting in patients undergoing cancer chemotherapy or surgery are reviewed. Injectable ondansetron hydrochloride is very effective in preventing nausea and vomiting associated with even the most emetogenic antineoplastic drugs. In December 1992, 4- and 8-mg oral tablets (ondansetron hydrochloride dihydrate) became available. Many of the clinical trials of oral ondansetron have not compared it with other antiemetics or have compared it only with placebo. Oral ondansetron has shown efficacy in such trials, but the standard of care for preventing chemotherapy-induced emesis is not placebo. Studies involving a prechemotherapy i.v. dose of ondansetron followed by oral therapy have shown high response rates for the whole study period; however, when day 1 is excluded, the results are not impressive for the remainder of the study period. It seems that the period beyond 24 hours is when oral ondansetron is effective, and that efficacy against acute emesis is due to i.v. ondansetron. Clinical trials in which oral ondansetron and oral metoclopramide were compared showed ondansetron to be, at best, equal to metoclopramide. One study showed the combination of dexamethasone and metoclopramide to be superior to oral ondansetron. Oral ondansetron is more effective than placebo in preventing post-operative nausea and vomiting in gynecologic surgery patients; however, there have been no comparative studies, and routine use of antiemetics in most surgical patients may be unnecessary because newer anesthetics are less emetogenic. Although the adverse effects of oral ondansetron are milder than those of standard antiemetics, this may not compensate for the drug's high cost. Oral ondansetron is not superior to traditional antiemetics for the prevention of nausea and vomiting caused by chemotherapy or surgery.

Animals↗
PubMedDate not supplied

Current issues in treating the hypertensive patient with diabetes: focus on diabetic nephropathy.

OBJECTIVE: To review the pathophysiology of hypertension and complications in patients with diabetes mellitus, specifically focusing on diabetic nephropathy; to evaluate the current clinical literature regarding the appropriate management of hypertension in this patient group; and to offer treatment recommendations. DATA SOURCES: A MEDLINE search of applicable English-language clinical studies, abstracts, and review articles pertaining to hypertension, diabetes, and diabetic nephropathy. STUDY SELECTION: Relevant studies on humans, examining hypertension, diabetes, and diabetic nephropathy, and the effects of drug therapy on these interrelated disease states. DATA SYNTHESIS: Pathophysiology of hypertension in the patient with diabetes mellitus and the pathophysiology of diabetic nephropathy are discussed. Studies evaluating the therapeutic effect of certain antihypertensive agents, their effect on glucose control and insulin sensitivity, and the progression of diabetic nephropathy are reviewed. Recommendations on the treatment of the patient with diabetes and hypertension are given. CONCLUSIONS: The treatment of the patient with diabetes mellitus and hypertension remains complex. Interventions in this patient population should not only decrease blood pressure, but also reduce the risk of both vascular and nonvascular complications. Data support the theory that by controlling a patient's hypertension, the incidence of albuminuria and the progression of diabetic nephropathy are slowed. Additionally, data are available to support the use of pharmacologic interventions in nonhypertensive patients with diabetes and proteinuria. Drug therapies that have produced reductions in proteinuria in this patient population include angiotension-converting enzyme inhibitors and nondihydropyridine calcium-channel antagonists. Additional information is needed to better differentiate the individual agents within each of the antihypertensive drug classes regarding their individual effects on the patient with diabetes and hypertension, specifically effects on diabetic nephropathy and its progression to endstage renal disease.

Adrenergic alpha-Antagonists↗
PubMedDate not supplied

The use of angiotensin-converting enzyme inhibitors after acute myocardial infarction.

During and immediately after myocardial infarction (MI), many interrelated and complex processes manifest the body's attempt to minimize damage and compensate for lost cardiac function. Although these compensatory responses may provide some short-term restoration of function, their long-term consequences actually may increase morbidity and mortality. Several agents have established roles in the treatment of these patients, whereas others, including the angiotensin-converting enzyme (ACE) inhibitors, have yet to be investigated thoroughly. Results of two trials investigating the role of ACE inhibition after MI seem to provide sufficient data to warrant the use of these drugs in certain patient populations. These results are promising, but further investigation is necessary to answer key questions arising from these trials.

Angiotensin-Converting Enzyme Inhibitors↗
PubMedDate not supplied

Monoclonal antibody therapy for gram-negative sepsis: principles, applications, and controversies.

Gram-negative sepsis is a common event in hospitalized patients and is a leading cause of death in the United States. Endotoxin (lipopolysaccharide, LPS), a component of the cell wall of gram-negative microorganisms, is responsible for the cascade of events leading to the sepsis syndrome consisting of fever, tachycardia, tachypnea, and evidence of organ hypoperfusion. The lipid A region of endotoxin produces most of these biologic and toxic effects. Monoclonal IgM antibodies directed against the lipid A portion of endotoxin (anti-LPS MoAb) have been developed for the treatment of gram-negative sepsis. Results of two large-scale clinical trials suggest that these antibodies offer clinically and statistically significant reductions in mortality by a factor of about one-third. However, in both trials, this apparent beneficial effect was limited to particular subsets of patients, and no overall benefit was seen. These considerations, in addition to the likely high cost of the agents, pose questions about their ultimate use in the treatment of patients with gram-negative sepsis. Nevertheless, the logic of the approach, the demonstration of efficacy in disease models, and the advances in modern techniques of molecular biology all suggest that these or other closely related products will play a significant role in the treatment of this disorder.

Antibodies, Monoclonal↗