Introduction: 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 activateKATP channels in the cardiac and vascular tissue.Simultaneous activation of the KATP channels by statins in 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.

Metformin and Sitagliptin are often used in combination in the management of non-insulin dependent diabetes mellitus. Though toxicity is rare, but occurs more frequently in cases of intentional or unintentional overdose of these drugs. Here, we present a case of an intentional overdose of a metformin- sitagliptin combination (70g metformin and 3500mg sitagliptin) in a suicide attempt by a young non-diabetic female who presented with severe lactic acidosis and was successfully treated with prompt hemodialysis and bicarbonate therapy.

BACKGROUND:Within a few years of diagnosis, patients with Type 2 Diabetes Mellitus (T2DM) develop hypertension. It has been hypothesized that both are part of metabolic syndrome. However, studies on diabetic patients have been undertaken while they are on treatment for diabetes. Thus, the results of these studies and inference drawn thereon may not be due to the diabetic process per se but may also be due to the medications.METHODS:A comprehensive literature search was carried out on PubMed, EMBASE and Cochrane databases and articles published between January 1970 to June 2015 were reviewed.RESULTS:Sulfonylureas due to their action on SUR1 in pituitary gland may release growth hormone and anti-diuretic hormone; action on SUR2B acting upon smooth muscle may interfere with vasodilatation, thereby causing hypertension.CONCLUSIONS:Sulfonylureas may cause hypertension by their extra-pancreatic effects, further studies are needed to validate this hypothesis.

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.

Introduction: Sulfonylureas (SUs) are the most commonly prescribed medications for type 2 diabetes mellitus worldwide. Differences among SUs for kinetic and adenosine triphosphate sensitive potassium (KATP) channels selectivity and consequential extrapancreatic effects, although recognized in literature, are not considered by treatment guidelines. Areas covered: The roles of SUs in various system-related adverse effects have not been well understood. Inconsistencies in the literature and lack of clinical trials assessing the long-term effects of monotherapy or combination therapy with SUs add to the concern. This review provides insights in issues concerning safety of SUs based on literature published between 1980 and 2011. A comprehensive search was carried out on PubMed, Embase and Cochrane databases using the search terms: sulfonylureas, sulfonylureas and KATP channels, sulfonylureas and cardiovascular (CV) effects and sulfonylureas side effects. Expert opinion: 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.