The objective of the study was to demonstrate the effect of pioglitazone and pioglitazone in combination with statin on East Indian patients with hyperinsulinemia and hyperlipidemia. It was a randomized, placebo-controlled, double-blind study with a parallel-group design comprising 83 patients. Patients of either sex with cardiac complications, including hyperlipidemia and (or) diabetes mellitus with or without hyperinsulinemia, were enrolled. Patients over 70 years of age, with renal or hepatic failure, or with severe diabetes mellitus (total glucose >400 mg/dL) were excluded from the study. Enrolled patients were randomly assigned to 4 groups that received placebo, pioglitazone, atorvastatin, or both. Blood samples were collected before and after treatment for analysis of serum glucose, insulin, lipid profile, apolipoprotein (apo) A1, apo B, and fibrinogen. Data were compared with that of patients with normal insulin or hyperinsulinemia. The patients with hyperinsulinemia receiving only pioglitazone showed a significant decrease in insulin levels compared with those with normal insulin levels. These patients also showed a significant increase in HDL levels. However, no significant change was observed in patients treated with both atorvastatin and pioglitazone. Pioglitazone was also found to increase significantly the apo A1 levels in patients with hyperinsulinemia, but there was no significant increase in patients given both atorvastatin and pioglitazone. Our data suggests that pioglitazone should be given preferably to the patients with hyperinsulinemia and statin should not be coadministered.

In the light of increased incidences of cardiovascular diseases world wide, there is also an increase in number of percutaneous interventions (PCI) and many new devices are introduced that may be expensive. Distal Protection Device (DPD) is one of them with costs that are twice those of conventional devices. In the present study we evaluated the usefulness of DPD after acute coronary syndrome (ACS) in patients undergoing PTCA and to analyze the effect on major adverse cardiac events (MACE) at the end of three months and consider its requirement as compared to the conventional stents. 109 patients with ACS were divided into two groups: PTCA done using DPD and PTCA done without DPD. Patients having active significant bleeding, major surgery within the previous six weeks or those who were participating in other trials using investigational drugs or devices were excluded. All patients without DPD required the administration of intracoronary (IC) adenosine and sodium nitroprusside to avoid no-reflow but in patients with DPD only 7.7% patients required IC vasodilators. In patients with DPD only 29% patients required the additional use of glycoprotein IIb/IIIa (Gp IIb/IIIa) receptor antagonists as compared to 100% usage in patients without DPD. On studying the MACE data it was found that amongst the patients with DPD no patient had either dysnea or needed repeat revascularization or urgent Coronary Artery Bypass Grafting (CABG). Amongst the patients without DPD four patients had angina and one had dysnea. In conclusion, although one can suggest that the use of DPD is safe and, it cannot be used indiscriminately because it is an expensive modality.

Association of scabies with a bullus pemphigoid - like eruption is being reported because of its rarity. Histopathology revealed subepidermal bullae with intact basal layer. Treatment with topical gammabenzene hexachloride and systemic antibiotics was effective.