Material and methods T2DM patients (Group I: ⩽5 years duration of diabetes, n = 11; Group II: >5 years duration of diabetes, n = 17) without clinical evidence of central nervous system damage and non-diabetic controls ( n = 18) were studied clinically and P300 event-related potentials (ERPs) recorded using three stimuli oddball paradigm. Subjects were examined with Folstein mini-mental state examination (MMSE) for cognitive function and those showing scores more than 26 (maximum score = 30) were enrolled for the study. Patients with known diabetic complications were excluded. Results P300 latencies in diabetic group did not relate linearly to the duration of diabetes. Diabetic subgroups with ⩽5 years and >5 years duration of diabetes showed striking differences, patients with over 5 years of disease duration had much prolonged P300 latencies in contrast to patients with 5 years or less disease duration who showed trends similar to that of control group. Differences in P300 amplitudes between groups were non-significant. Hypertensive diabetics showed much prolongation in P300 latencies compared to normotensive diabetics. Conclusions P300 ERPs revealed cognitive dysfunction which was not detected by neuro-psychometric test (MMSE). Patients with T2DM have decreased cognitive function which is more prominent when the disease duration exceeds 5 years. Co-existence of hypertension with T2DM further increases the risk of cognitive impairment. Keywords P300 Type 2 diabetes mellitus Hypertension Duration of diabetes Three stimuli odd-ball paradigm Cognitive impairment 1 Introduction The incidence of type 2 diabetes mellitus (T2DM) is increasing worldwide, and has become a significant public health problem [1] . It is associated with mortality and significant morbidity, including neurological disability. Although the effects of diabetes on the peripheral nervous system (PNS) are well established, its effects on higher mental functions (HMF) are often overlooked, due to lack of clear signs and unavailability of standard assessment techniques [2,3] . Even mild form of cognitive dysfunction might hamper everyday activities depending on the work and situation, which requires various cognitive domains such as general intelligence, processing speed, psychomotor efficiency, attention, perception, learning, memory, and executive functions [4] . Several studies have reported a cognitive decline in T2DM [5,6] . However, there is no consensus as to the specific domains of cognition that may be affected by T2DM, and thus, which domains can be recommended for testing. P300 event-related potential (ERP) measures the speed of neural events related to attention and short-term memory. Hence, P300 latency increases systematically as cognitive capability decreases [7] . P300, having a high temporal resolution, demonstrates reasonable success as a potential tool to assess the decline in cognitive functions when compared to functional imaging (Positron Emission Tomography – PET, functional Magnetic Resonance Imaging – fMRI) which possess good spatial resolution [8,9] . The objective of the present study is to decipher the pattern of cognitive impairment in relation to the duration of diabetes, using P300 ERP, three stimuli odd-ball paradigm. 2 Material and methods 2.1 Subjects A cross-sectional study was conducted after approval by the Institutional Ethics Committee and obtaining written consent from all subjects. The study group comprised of twenty eight T2DM subjects belonging to both genders in the age group 40–65 years. The study group was divided into two sub-groups (Group I: ⩽5 years duration of diabetes, n = 11; Group II: >5 years duration of diabetes, n = 17). Eighteen non-diabetic individuals, matched by age, were taken as the control group. The demographic and clinical data of the participants are listed in Table 1 . Patients with known diabetic complications such as retinopathy, nephropathy, and peripheral neuropathy were excluded from the study. Persons with a history of auditory disorders and psychological disturbances, which might interfere with auditory P300 assessment, were also excluded. 2.2 Plasma glucose Plasma glucose levels were assessed through use of the glucose oxidase method. Fasting plasma glucose level of ⩽110 mg/dL without history of diabetes mellitus was the inclusion criteria for controls. 2.3 Blood pressure (BP) A sphygmomanometer was used to measure arterial blood pressure. BP was recorded on the left arm of the subjects in sitting posture. Systolic BP of ⩽140 mm Hg and diastolic BP of ⩽90 mm Hg without the history of hypertension were labeled as normotensives. 2.4 Mini-mental state examination (MMSE) Subjects were examined through a Folstein mini-mental state examination (MMSE), a brief 30-point neuro-psychometric test, for cognitive functions which reflects orientation, memory, attention, ability to follow verbal and written commands, writing, and copying [10] . Subjects showing a score of higher than 26 (maximum score = 30), indicating no cognitive impairment, were selected for the study. 2.5 P300 potential Nicolet Viking Select [Viasys Healthcare, USA] was used to elicit P300 cognitive potential. The investigation was performed in a silent room, with subjects in a reclining position with eyes closed, in order to eliminate disturbance caused by movement. Two channel recording was undertaken, active electrodes were connected to bilateral mastoids (A1/A2) and the reference electrodes were connected to the scalp at Cz and Pz position. The ground was connected to the Fpz location and impedance was kept below 5 kilo-ohms. Stimuli were delivered using TDH-39P headphones at a frequency of 1.0 Hz. A novel three stimuli odd-ball paradigm, characterized by random presentation of two rare (target) stimuli interspersed in presentation of frequent stimulus, was designed. The characteristics of the stimuli are depicted in Table 2 ....

Background: The alterations in extracellular calcium level may influence intracellular calcium level and possibly play a role in the pathogenesis of essential hypertension. Aim: The purpose was to find out the association between serum calcium levels and hypertension; and to compare the serum calcium levels between normotensive controls, hypertensive subjects on calcium channel blockers, and hypertensive subjects on antihypertensive medication other than calcium channel blockers. Materials and Methods: Thirty one individuals including normotensives (n = 12) and hypertensives (n = 19) were enrolled for the study and their blood pressure recorded. Hypertensive group was sub divided into two: hypertensives on calcium channel blockers and hypertensives on antihypertensive medication other than calcium channel blockers. Serum calcium levels were measured by Accucare Calcium Arsenazo III kit. Differences between the groups were analyzed using ANOVA. Results: No significant difference in serum calcium level was found between normotensive and hypertensive groups; and no correlation was found between calcium levels and the blood pressure. Also the difference in serum calcium levels in hypertensive group on calcium channel blockers and those on antihypertensive other than calcium channel blockers was insignificant. Conclusions: Serum calcium levels are tightly regulated. Subtle changes in serum levels do not affect blood pressure.

Background: This study aims at simplifying the practical patient management and offers some general indications for pharmacotherapeutic choice by the implementation of (Global Initiative for Chronic Lung Disease) guidelines. This study was designed to evaluate the clinical and economic consequences of salmeterol/fluticasone (SF), formoterol/budesonide (FB), and formoterol/fluticasone (FF) in severe and very severe chronic obstructive pulmonary disease (COPD) patients. Objectives: The aim was to find out the most cost-effective drug combination between the three combinations (SF/FB/FF) in COPD patients. Materials and Methods: A prospective observational comparative study (cost-effectiveness analysis), in which 90 severe (30 ≤ forced expiratory volume in 1 s [FEV ₁ ] <50% predicted) and very severe (FEV ₁ < 30% predicted) COPD patients (outpatients/inpatients) who are prescribed with any one of the following combinations (SF/FB/FF) were selected. In our study, we have divided 90 COPD patients into three groups (Group I, Group II, and Group III) each group consisting of 30 patients. Group I was prescribed with medication SF, Group II with medication FB, and Group III with medication FF. We used five different parameters such as spirometry test (mean FEV ₁ initial and final visit), number of symptom-free days (SFDs), number of moderate and severe exacerbations, Number of days of hospitalization and direct, indirect, and total cost to assess the cost-effectiveness of SF/FB/FF. Comparison of cost and effects was done during the period of 6 months of using SF/FB/FF. Results: The average FEV ₁ for Group I, Group II, and Group III subjects at initial visit was 33.47%, 33.73%, and 33.20% and was increased to 36.60%, 35.8%, and 33.4%, respectively. A 3% increment in FEV ₁ was reported for Group I subjects (SF) and was highly significant statistically (t = −8.833, P = 0.000) at 95% CI. For Group II subjects (FB), a 2% increment in FEV ₁ was reported and was highly significant statistically (t = −9.001, P = 0.000) at 95% CI. For Group III (FF) subjects 0.2% increment in FEV ₁ . The overall mean total cost for Group I, Group II, and Group III subjects during the 6 months period was found to be Rs. 29,725/-, Rs. 32,602/- and Rs. 37,155/-. Incremental cost-effectiveness of FB versus SF was Rs. 37,781/- per avoided exacerbation and Rs. 661/- per SFD. Conclusion: This study highlights the favorable therapeutic performance of combined inhaled bronchodilators and corticosteroids (SF/FB/FF), thus suggesting that healthcare costs would be also affected positively. Results from our study showed that SF and FB were the most effective strategies in the treatment of COPD, with a slight clinical superiority of SF. The FF strategy was not much effective (i.e. associated with fewer outcomes and higher costs).

Cement dust poses an occupational hazard causing respiratory (owing to its inhalation), dermatological, ocular and hematological problems. The purpose of the current study was to evaluate the effect of occupational exposure of cement dust on hematological parameters in construction workers. Apparently healthy sixty five (65) adult male construction workers aged 25-50 years participated in this study. Three (3.0) ml venous blood samples were collected from each participant for hematological analysis at two different time points, one at 8 AM and second at 4 PM at the end of work shift. Differences in means and test of significance were calculated using paired Student’s t-test. The results revealed that post shift samples showed statistically significant increase (p