#biguanides

[wellhealthhub]

Comprehensive Guide to Diabetes Medications

Welcome to this comprehensive guide on diabetes medications, where we shall explore the intricacies of various pharmacological agents that aid in effectively managing blood sugar levels and fostering a healthier life with diabetes. 1. Insulin Injections Insulin, a paramount hormone synthesized by the pancreas, orchestrates the regulation of blood sugar levels, a critical facet for individuals…

[macgyvermedical]

Hey babe, wanna hear something hot? *whispers* history of metformin

Ok okay I'll talk

So metformin is commonly thought of as the most boring of diabetes drugs. Like, everyone who has ever thought about maybe having type 2 diabetes is taking it unless it gives them diarrhea, and even then their doctor still probably wants them to take it. But it's a first line because it's old, it's cheap, it doesn't often cause hypoglycemia, and it has relatively few side effects compared to other diabetes drugs. Also, like a lot of older drugs, it does way more than it says on the packaging. And a lot of stuff we're still learning about.

In order to talk about metformin, we have to talk about a plant called goat's rue. Goat's rue is a plant native to Europe, Africa, and Asia, and currently grows just about everywhere. In ancient times it was used as an anti-parasitic, a plague remedy, and to relieve the excessive urination caused by what might have been diabetes. In 1918 it was found to contain a chemical called galegine, which did lower blood sugar. Galegine as an anti-diabetes medication is probably too toxic to use long term. However, with a few chemical tweaks, it could become a drug that lowered blood sugar without the toxic effects. Metformin was born.

Metformin came out in 1923 and is a type of drug called a biguanide. it's actually the only type in it's class still available as an anti-diabetic agent, because the other drugs in it's class that came out in the 1920s and 30s caused lactic acidosis and liver problems (similar to the types of reactions seen with galegine), and were taken off the market.

Metformin (and pretty much all oral antidiabetic agents in development at this time) didn't do well initially, probably because they came out the same decade as insulin, and insulin was a lot more effective at treating any kind of diabetes.

It fell out of use extremely quickly, and didn't get picked up again until the 1940s, when US access to antimalarial drugs was cut off, just as a war in the pacific was ramping up. Metformin was evaluated as an antimalarial during WWII, and while noted to have some anti-malarial properties (particularly as a malaria preventative) it also was noted to significantly lower blood sugar in diabetic patients- while not lowering blood sugar very much at all in non-diabetic patients.

This effect, rather than it's antimalarial properties, was what got scientists really interested. Unfortunately, it would not be until 1957 in France that metformin had its first major studies to determine that it did, indeed, work against diabetes. Metformin lost the race to the "first" (successful) oral antidiabetic agent by a year, to a different drug that was found while looking for a new antibiotic- Diabenese.

Metformin became a commercial success in France, while Diabenese became successful in the United States. Metformin would actually not be approved for use in the US until 1995.

But now we get to talk about what metformin does and why it's so freaking cool.

Type 2 Diabetes- lowers A1C (a measure of blood sugar control) by 1-2 full points

Prevents/reverses weight gain due to antipsychotics

Prevents and treats malaria

Makes the flu shot work better

Decreases severity of respiratory illness and complications related to the flu

Changes gut microbiome for the better

Regulates periods and reduces other symptoms in people with PCOS

Lowers risk of breast, colon, and prostate cancer

Lowers risk of dementia

Lowers risk of stroke

May increase lifespan

[neotrances]

obvious disclaimer by labor intensive i mean scientist and chemist actively spending long shifts making sure the medication being produced is up to standard obviously no one would be overworked or underpaid in a perfect world but it’s genuinely annoying seeing some anarchist say stuff like oh well just cook all the Biguanides for diabetes patients in a vat and pass it out like guys this take trial and close inspection obviously all meds should be given out for free and ppl shouldn’t have to fight to receive the best care but the reality is ur not gonna be making pills for treating high blood pressure out of a car trunk

[happy-smile-flowers]

Does Metformin, a glucose-lowering drug, hurt the kidneys?

Metformin is a biguanide compound that reduces blood sugar mainly by reducing hepatic glucose output, improving insulin resistance, and reducing glucose absorption in the small intestine. It is currently one of the world's most widely used oral hypoglycemic drugs. Drug safety evaluation studies have found that Metformin has a good safety profile, no carcinogenic or mutagenic effects, and no evidence that Metformin can increase the risk of lactic acidosis. Medicilon has a professional team and experience in preclinical drug safety evaluation services, providing high-quality data and a fast turnaround time to support all drug safety evaluation studies.

Many patients are concerned about the effects of long-term metformin use on the kidneys. The drug does not directly damage the kidneys but can lead to drug accumulation when taken by patients with existing kidney damage. Both the Chinese Guidelines for the Prevention and Treatment of Type 2 Diabetes (2017 edition) and the Expert Consensus on the Clinical Application of Metformin (2016 edition) suggest that Metformin is the drug of choice for the treatment of type 2 diabetes in the absence of contraindications and intolerance, and should always be retained in the glucose-lowering regimen.

1, Benefits of Metformin.

Metformin can reduce hyperglycemia with no hypoglycemic effect on those with regular blood sugar; the drug has the following benefits in addition to hypoglycemia.

(1), Metformin has the effect of reducing body weight.

(2) Metformin has apparent cardioprotective effects and reduces the risk of cardiovascular disease in newly diagnosed and established type 2, diabetes patients.

(3) Metformin can improve lipid synthesis, metabolism, and lipid profile.

(4) Metformin significantly improved liver serological enzyme profile and metabolic abnormalities in patients with non-alcoholic fatty liver.

2, Adverse reactions and countermeasures

The main adverse reactions of Metformin are diarrhea, nausea, vomiting, gastric distension, and other gastrointestinal responses, which mainly occur in the early stage of treatment (the majority happen in the first ten weeks). Most patients can gradually tolerate them, or their symptoms disappear as the duration of treatment increases. Start taking small doses, gradually increase the amount, adjust the quantity at the right time, take with meals, and choose enteric preparations and other methods, which can reduce gastrointestinal reactions.

Three 、Does Metformin hurt the liver and kidney?

Metformin has no hepatic and renal toxicity; Metformin is absorbed through the gastrointestinal tract for blood circulation, almost does not combine with plasma albumin, does not go through liver metabolism, does not compete with liver P450 enzymes, and does not degrade in the body, but acts directly on the liver and muscle, reducing hepatic glucose isomerism and increasing muscle glucose enzymes. Therefore, Metformin is not hepatotoxic.

Metformin is mainly excreted from the urine in its original form by the kidneys and is cleared rapidly, with approximately 90% clearance in 12-24h. The renal clearance of Metformin is about 3.5 times higher than that of creatinine, and renal tubular excretion is the main route of metformin clearance. Therefore, Metformin itself is not harmful to the kidney.

However, caution should be exercised when using Metformin in people with impaired liver and kidney function. Metformin should be avoided when serum transaminases exceed three times the upper limit of normal, and patients with renal insufficiency need to adjust the dose by estimating the level of glomerular filtration rate. Clinicians or pharmacists can assess the above.

4, long-term use of Metformin, the need for appropriate supplementation of vitamin B12

Studies have shown that: the incidence of vitamin B12 deficiency in glucose patients using Metformin is 5.8%, while the incidence of vitamin B12 deficiency in glucose patients not using Metformin and people without diabetes is 2.4% and 3.3%, respectively. Therefore, long-term metformin users should monitor vitamin B12 concentration regularly and increase the intake of vitamin B12-rich foods appropriately (vitamin B12 is mainly contained in animal proteins, such as meat, animal liver, fish, shellfish, eggs, etc.) to prevent and correct vitamin B12 deficiency. If this condition occurs, vitamin B12 should be supplemented in an appropriate amount under the guidance of professional doctors.

Five 、Stop taking Metformin 48 hours before and after doing a CT examination

Diabetic patients should stop taking Metformin 48 hours before and after doing enhanced CT because it is necessary to play contrast agent before doing CT. The contrast agent belongs to macromolecular substances excreted through the kidneys. If you retake Metformin, it will increase the burden on the kidney and cause contrast nephropathy.

6, the icing on the cake: combined with other glucose-lowering drugs

There are several different drugs when taking glucose-lowering drugs, often more than Metformin. This is because the combination of glucose-lowering medications mutually increases the hypoglycemic effect, improves insulin resistance, or reduces adverse reactions.

All diabetic patients should choose the appropriate hypoglycemic drugs according to their different conditions and pay attention to the indications and contraindications of each type of drug. At the same time, it is essential to emphasize that diet therapy and diet control are the cure for diabetic patients and must be adhered to for life. Diet therapy should not be relaxed or abandoned because of oral hypoglycemic drugs or increased dosages of hypoglycemic medications.

[edwinscotte9947]

Pioglitazone & Metformin HCl (Actoplus Met)

Met). Here’s why you should choose DiRx:

Cost Savings: DiRx offers lower prices compared to traditional pharmacies, helping you save money on essential diabetes medications.

Convenient Home Delivery: Medications are delivered right to your door, ensuring you never miss a dose.

No Insurance Required: DiRx doesn’t require insurance, making it easy for you to access affordable medications.

Visit DiRx today to see how you can save on your prescriptions and manage your diabetes more Pioglitazone & Metformin HCl, sold under the brand name Actoplus Met, is a combination medication used to treat Type 2 Diabetes. This drug combines two effective diabetes medications: pioglitazone (a thiazolidinedione) and metformin (a biguanide). Together, they work to control high blood sugar in individuals who cannot achieve adequate control with one medication alone. This combination helps improve insulin sensitivity and reduces the amount of glucose produced by the liver.

For those looking for an affordable solution to manage diabetes, DiRx offers Pioglitazone & Metformin (Generic Actoplus Met) at competitive prices, with the convenience of home delivery and no need for insurance. You can explore your savings at DiRx.

How Pioglitazone & Metformin (Actoplus Met) Works

The combination of pioglitazone and metformin targets blood sugar regulation through two distinct mechanisms:

Pioglitazone: Increases the body's sensitivity to insulin, helping cells use glucose more effectively. It belongs to the thiazolidinedione class, which helps improve insulin action in peripheral tissues, reducing blood glucose levels.

Metformin: Lowers glucose production in the liver and improves the body’s response to insulin. It also reduces the absorption of sugar from the intestines.

This dual-action approach makes Actoplus Met highly effective for individuals with Type 2 Diabetes who require additional blood sugar control.

For those managing diabetes, DiRx offers this essential combination medication at affordable prices. Check out DiRx for pricing details and convenient home delivery options.

Why Choose DiRx for Pioglitazone & Metformin (Actoplus Met)?

DiRx provides an accessible and affordable way to manage your Type 2 Diabetes medications, including Pioglitazone & Metformin (Generic Actopluseffectively.)

[joyamedicalsuppliesau]

Viraclean hospital-grade disinfectant is proven protection against pathogens, a premium quality TGA-registered hospital-grade disinfectant. It does not contain the biocide ingredient called Poly Hexa Methylene Biguanide (PHMB). Order Viraclean Disinfectant 15 Litres from Joya Medical Supplies.

[onlinegenericshop]

Bigomet 500 Tablet 10's belongs to a group of anti-diabetic medicines called biguanides used in the treatment of diabetes. Now Place Order Online, Worldwide & Get Delivery Immediately. Buy Now From onlinegenericshop.com.

[lalsingh228-blog]

Anti-diabetic Medication Market is Set To Fly High in Years to Come

Global Anti-diabetic Medication Market Report from AMA Research highlights deep analysis on market characteristics, sizing, estimates and growth by segmentation, regional breakdowns & country along with competitive landscape, player’s market shares, and strategies that are key in the market. The exploration provides a 360° view and insights, highlighting major outcomes of the industry. These insights help the business decision-makers to formulate better business plans and make informed decisions to improved profitability. In addition, the study helps venture or private players in understanding the companies in more detail to make better informed decisions. Major Players in This Report Include, AstraZeneca plc (United Kingdom), Bayer AG (Germany), C.H. Boehringer Sohn AG & Ko. KG (Germany), Bristol-Myers Squibb (United States), Eli Lilly (United States), Halozyme Therapeutics (United States), Johnson & Johnson (United States), Merck & Co. Inc. (United States), Novartis AG (Switzerland), Pfizer Inc. (United States). Free Sample Report + All Related Graphs & Charts @: https://www.advancemarketanalytics.com/sample-report/162818-global-anti-diabetic-medication-market Anti-diabetic medications are medicines developed to stabilize and control blood glucose levels amongst people with diabetes. Anti-diabetic medications are commonly used to manage diabetes. Anti-diabetic medications are all pharmacological agents that have been approved for hyperglycemic treatment in diabetes mellitus. The increasing prevalence of diabetes across the globe will stimulate the market potential for anti-diabetic medication during the forecast period. Market Drivers

Rising Prevalence of Chronic Diseases like Diabetes across the Globe

Growing Prevalence of Lifestyle-Induced Disorders such as Obesity

Market Trend

Increasing Adoption of Oral Antidiabetic Drugs

Opportunities

Rising Spending on Research and Development for Innovative Drugs

Challenges

Safety Issues Pertaining to Some Diabetic Drugs

Enquire for customization in Report @: https://www.advancemarketanalytics.com/enquiry-before-buy/162818-global-anti-diabetic-medication-market In this research study, the prime factors that are impelling the growth of the Global Anti-diabetic Medication market report have been studied thoroughly in a bid to estimate the overall value and the size of this market by the end of the forecast period. The impact of the driving forces, limitations, challenges, and opportunities has been examined extensively. The key trends that manage the interest of the customers have also been interpreted accurately for the benefit of the readers. The Anti-diabetic Medication market study is being classified by Type (Insulin (Rapid acting analog, Long-acting analog, Premixed insulin, Short-acting analog, and Intermediate-acting insulin), Drug class (Alpha glucosidase inhibitors, Biguanides, Sulphonylureas, GLP-1 (Glucagon-like peptide) agonists, DPP-IV (Dipeptidyl Peptidase) inhibitors, Meglitinides, SGLT-II (Sodium-Glucose Transport Proteins) inhibitors, and Thiazolidinedione)), Application (Prevent and Treatment Diabetes, Obesity Treatment, Cardiovascular Protection, Others), Route of Administration (Insulin Syringe/ Insulin Pen, Insulin Pump, Intravenous Infusion, Oral, Others), End User (Pediatric, Adult, Geriatric) The report concludes with in-depth details on the business operations and financial structure of leading vendors in the Global Anti-diabetic Medication market report, Overview of Key trends in the past and present are in reports that are reported to be beneficial for companies looking for venture businesses in this market. Information about the various marketing channels and well-known distributors in this market was also provided here. This study serves as a rich guide for established players and new players in this market. Get Reasonable Discount on This Premium Report @ https://www.advancemarketanalytics.com/request-discount/162818-global-anti-diabetic-medication-market Extracts from Table of Contents Anti-diabetic Medication Market Research Report Chapter 1 Anti-diabetic Medication Market Overview Chapter 2 Global Economic Impact on Industry Chapter 3 Global Market Competition by Manufacturers Chapter 4 Global Revenue (Value, Volume*) by Region Chapter 5 Global Supplies (Production), Consumption, Export, Import by Regions Chapter 6 Global Revenue (Value, Volume*), Price* Trend by Type Chapter 7 Global Market Analysis by Application ………………….continued This report also analyzes the regulatory framework of the Global Markets Anti-diabetic Medication Market Report to inform stakeholders about the various norms, regulations, this can have an impact. It also collects in-depth information from the detailed primary and secondary research techniques analyzed using the most efficient analysis tools. Based on the statistics gained from this systematic study, market research provides estimates for market participants and readers. Contact US : Craig Francis (PR & Marketing Manager) AMA Research & Media LLP Unit No. 429, Parsonage Road Edison, NJ New Jersey USA – 08837 Phone: +1 201 565 3262, +44 161 818 8166 sales@advancemarketanalytics.com

[novaglobalhealthcare]

What Are My Options for Type 2 Diabetes Medications?

There are different types, or classes, of medications that work in different ways to lower blood glucose (also known as blood sugar) levels. Some options are taken by mouth and others are injected. Some of the commonly used classes of non-insulin medications include:

Metformin

Dipeptidyl peptidase 4 (DPP-4) inhibitors

Glucagon-like peptide 1 (GLP-1) and dual GLP-1/gastric inhibitory peptide (GIP) receptor agonists

Sodium-glucose cotransporter 2 (SGLT2) inhibitors

Sulfonylureas

Thiazolidinediones (TZDs)

Metformin

Metformin (Glucophage) is classified as a biguanide medication and is the only available medication in this class. Metformin lowers blood glucose levels primarily by decreasing the amount of glucose produced by the liver. Metformin also helps lower blood glucose levels by making muscle tissue more sensitive to insulin so blood glucose can be used for energy.

It is usually taken two times a day. A side effect of metformin may be diarrhea, but this is improved when the drug is taken with food.

DPP-4 Inhibitors

DPP-4 inhibitors help improve A1C (a measure of average blood glucose levels over two to three months) without causing hypoglycemia (low blood glucose). They work by preventing the breakdown of naturally occurring hormones in the body, GLP-1 and GIP. These hormones reduce blood glucose levels in the body, but they are broken down very quickly so it does not work well when injected as a drug itself.

By interfering in the process that breaks down GLP-1 and GIP, DPP-4 inhibitors allow these hormones to remain active in the body longer, lowering blood glucose levels only when they are elevated. DPP-4 inhibitors do not cause weight gain and are usually very well tolerated.

There are four DPP-4 inhibitors currently on the market in the U.S.:

Alogliptin (Nesina)

Linagliptin (Tradjenta)

Saxagliptin (Onglyza)

Sitagliptin (Januvia)

GLP-1 and Dual GLP-1/GIP Receptor Agonists

As noted in the description for DPP-4 inhibitors, GLP-1 and GIP are natural hormones in the body that help maintain glucose levels. Use of GLP-1 and dual GLP-1/GIP receptor agonists is another strategy to help use these hormones to improve blood glucose management in people with type 2 diabetes.

These medications have similar effects to the GLP-1 and GIP produced in the body but are resistant to being broken down by the DPP-4 enzyme. These medications can result in large benefits on lowering blood glucose and body weight. Some agents in this class have also been shown to prevent heart disease. Most of these medications are injected, with the exception of one that is taken by mouth once daily, called semaglutide (Rybelsus).

Injectable GLP-1 receptor agonists currently on the market include:

Dulaglutide (Trulicity)

Exenatide (Byetta)

Exenatide extended-release (Bydureon)

Liraglutide (Victoza)

Lixisenatide (Adlyxin)

Injectable semaglutide (Ozempic)

One dual GLP-1/GIP receptor agonist is currently on the market called tirzepatide (Mounjaro). How often you need to inject these medications varies from twice daily to once weekly, depending on the medication. The most common side effect with these medications is nausea and vomiting, which is more common when starting or increasing the dose.

SGLT2 Inhibitors

Glucose in the bloodstream passes through the kidneys where it can either be excreted in the urine or reabsorbed back into the blood. Sodium-glucose cotransporter 2 (SGLT2) works in the kidney to reabsorb glucose. A new class of medication, SGLT2 inhibitors, block this action, causing excess glucose to be eliminated in the urine.

By increasing the amount of glucose excreted in the urine, people can see improved blood glucose, some weight loss, and small decreases in blood pressure. Bexagliflozin (Brenzavvy), canagliflozin (Invokana), dapagliflozin (Farxiga), and empagliflozin (Jardiance) are SGLT2 inhibitors that have been approved by the Food and Drug Administration (FDA) to treat type 2 diabetes. SGLT2 inhibitors are also known to help improve outcomes in people with heart disease, kidney disease, and heart failure.

For this reason, these medications are often used in people with type 2 diabetes who also have heart or kidney problems. Because they increase glucose levels in the urine, the most common side effects include genital yeast infections.

Sulfonylureas

Sulfonylureas have been in use since the 1950s and they stimulate beta cells in the pancreas to release more insulin. There are three main sulfonylurea drugs used today, glimepiride (Amaryl), glipizide (Glucotrol and Glucotrol XL), and glyburide (Micronase, Glynase, and Diabeta). These drugs are generally taken one to two times a day before meals.

All sulfonylurea drugs have similar effects on blood glucose levels, but they differ in side effects, how often they are taken, and interactions with other drugs. The most common side effects with sulfonylureas are low blood glucose and weight gain.

TZDs

Rosiglitazone (Avandia) and pioglitazone (Actos) are in a group of drugs called thiazolidinediones. These drugs help insulin work better in the muscle and fat and reduce glucose production in the liver.

A benefit of TZDs is that they lower blood glucose without having a high risk for causing low blood glucose. Both drugs in this class can increase the risk for heart failure in some individuals and can also cause fluid retention (edema) in the legs and feet.

[phonemantra-blog]

What Are the Benefits of Metformin? Metformin is a widely prescribed medication for the management of type 2 diabetes. It belongs to a class of drugs called biguanides, which work by reducing the amount of glucose produced by the liver and improving insulin sensitivity in the body. In addition to its primary use in diabetes treatment, metformin has shown several other health benefits. Weight Management One of the notable benefits of metformin is its potential to aid in weight loss and weight management. Many individuals with type 2 diabetes struggle with obesity, and metformin can help address this issue. It works by reducing appetite and promoting a feeling of fullness, leading to decreased calorie intake. Metformin also enhances the body's ability to burn fat, resulting in improved weight loss outcomes. Improved Insulin Sensitivity Metformin is known to enhance insulin sensitivity, making it a valuable tool in managing diabetes. By improving the body's response to insulin, metformin helps regulate blood sugar levels more effectively. This can lead to better glycemic control and a reduced risk of complications associated with diabetes, such as cardiovascular disease and kidney damage. Cardiovascular Health Studies have suggested that metformin may have positive effects on cardiovascular health. It has been shown to reduce the risk of heart disease and stroke in individuals with type 2 diabetes. Metformin achieves this by improving lipid profiles, reducing inflammation, and enhancing blood vessel function. These cardiovascular benefits make metformin a valuable medication for individuals at risk of heart-related complications. Polycystic Ovary Syndrome (PCOS) Management Metformin is commonly prescribed to women with polycystic ovary syndrome (PCOS), a hormonal disorder that affects fertility and metabolism. It helps regulate menstrual cycles, reduce insulin resistance, and lower androgen levels in women with PCOS. These effects can improve ovulation and increase the chances of successful conception in women trying to get pregnant. Potential Cancer Prevention Emerging research suggests that metformin may have potential in cancer prevention and treatment. Studies have shown that metformin can inhibit the growth of certain cancer cells and reduce the risk of developing certain types of cancer, including breast, colon, and prostate cancer. However, more research is needed to fully understand the mechanisms and effectiveness of metformin in cancer prevention. Anti-Aging Effects Some studies have indicated that metformin may have anti-aging effects on cellular and molecular levels. It activates certain enzymes that promote longevity and delay the onset of age-related diseases. While the exact mechanisms are still being explored, these findings suggest that metformin may have broader health benefits beyond its primary use in diabetes management. Safety and Affordability [caption id="attachment_80571" align="aligncenter" width="640"] what are the benefits of metformin[/caption] Metformin is generally considered safe and well-tolerated, with a long history of use in clinical practice. It is available in generic form, making it a cost-effective option for individuals with diabetes. The widespread availability and affordability of metformin contribute to its popularity as a first-line treatment for type 2 diabetes. Frequently Asked Questions about the Benefits of Metformin 1. What is metformin? Metformin is a medication commonly used to treat type 2 diabetes. 2. How does metformin work? Metformin works by reducing the amount of glucose produced by the liver and improving the body's response to insulin. 3. What are the benefits of taking metformin? Some benefits of taking metformin include: Lowering blood sugar levels Improving insulin sensitivity Reducing the risk of heart disease Helping with weight loss Lowering the risk of certain cancers 4. Can metformin help with weight loss? Yes, metformin can help with weight loss in individuals with diabetes or prediabetes by reducing appetite and improving insulin sensitivity. 5. Does metformin have any side effects? Some common side effects of metformin include nausea, diarrhea, stomach upset, and a metallic taste in the mouth. However, not everyone experiences these side effects. 6. Can metformin be used for gestational diabetes? Metformin is not typically the first-line treatment for gestational diabetes. However, in certain cases, it may be prescribed by a healthcare provider. 7. How long does it take for metformin to start working? The effects of metformin can be seen within a few days to a week of starting the medication, but it may take several weeks to reach its full benefits. 8. Is metformin safe for long-term use? Metformin is generally considered safe for long-term use when prescribed and monitored by a healthcare professional. However, it is important to discuss any concerns with your doctor. 9. Can metformin be used by people without diabetes? Metformin is primarily used to treat diabetes and prediabetes, so it is not typically prescribed for individuals without these conditions. 10. Are there any drug interactions with metformin? Yes, certain medications can interact with metformin, so it is important to inform your doctor about all the medications you are taking to avoid any potential interactions.

[thewitfire]

Mechanism of Action of Metformin in Cancer Treatment

Mechanism of Action of Metformin in Cancer Treatment: Metformin is a biguanide derivative, is primarily known for its role in the management of Type 2 diabetes mellitus. However, over the past decade, this drug has garnered attention for its potential anti-cancer properties. This article aims to provide a comprehensive overview of the mechanisms through which Metformin exerts its anti-cancer…

[weblink-india40]

Disinfectant Spray Exporters – Its important aspects as a cleaning agent

A disinfectant is a substance or process that is used mainly on non-living objects (such as hard surfaces) to kill germs, such as viruses, bacteria, and other microorganisms that can source infection and disease. Disinfectants are a significant part of infection control measures to decrease the risk of bacterial and viral transmission.

A disinfectant spray is a liquid chemical disinfectant supplied by the disinfectant spray exporters in a bottle or container with a spray function generally operated by a handle or trigger button. Disinfectant sprays are used nearly anywhere and hard surfaces need to be kept clean and free of harmful bacteria and viruses.

Some important aspects of the disinfectant sprays

Disinfectant sprays generally require a “dwell time” on surfaces to be operative. This means that once sprayed over the anticipated area, the disinfectant spray must continue in contact with the surface for some time to efficiently disinfect it. To confirm maximum disinfection, check the label of your disinfectant spray for its stated dwell time and follow the instructions provided.

Medical and clinical surroundings such as hospitals, surgeries, and veterinary practices use high-impact long-lasting disinfectant sprays. Other disinfection products that can be used anywhere comprise PDI Universal Disinfecting Wipes, which are dosed with a 2-step detergent and disinfectant that kills possibly infectious agents in seconds.

How does disinfectant spray work?

Disinfectant sprays hold antimicrobial agents that work by ending microorganisms living on surfaces.

Examples of chemicals usually used in disinfectant sprays comprise:

Alcohol

Chlorine or chlorine compounds

Formaldehyde

Glutaraldehyde

Quaternary ammonium compounds

Phenolics

Hydrogen peroxide

Iodophors

Peracetic acid

Disinfectant sprays that comprise these chemicals are advanced to kill potentially infectious agents and reduce their number in a specific area.

What is disinfectant spray used for?

Common disinfectant spray uses comprise:

Domestic disinfectant spray uses:

To make hygienic kitchen countertops, chopping boards, cupboard door handles, etc.

To disinfect domestic fridges and clean bins.

To clean bathrooms, comprising sinks, taps, plugholes, showers, toilet roll holders, toilet seats, basins, and handles.

To disinfect corner points in living rooms such as blind pulls, TV remotes, door handles, and light switches.

To disinfect office articles such as office chairs, computer mice, keyboards, phones, and mobile devices.

Professional disinfectant spray uses:

Hospitals and medical treatment environments, comprising ambulances and first-aid treatment areas

Care homes

Commercial kitchens

Factories

Hospitality businesses such as restaurants and hotels

Airports and commercial planes

Two important parts of the disinfectant spray

Does disinfectant spray clean completely?

It’s significant to understand that while disinfectant sprays are formulated to kill bacteria and germs, disinfecting an area with disinfectant spray does not essentially clean dirty surfaces or remove germs. Some disinfectant sprays also act as a sterilizing cleaner, like our Steroclenz Rapid product, which will disinfect an area while lifting and eliminating debris, dried liquid, and dirt and cleaning it entirely.

Does disinfectant spray kill viruses?

This mainly depends on the type of disinfectant spray you use, so always check the manufacturer’s direction and the label. In general, disinfectant sprays work by abolishing the bacterium genome and preventing it from duplication. Disinfectant sprays comprising polymeric biguanide hydrochloride, such as Steroclenz Rapid, can kill bacteria, fungi, parasites and firm viruses with certainty.

[edwinscotte9947]

Metformin HCl Extended Release (Generic Glucophage XR)

Metformin HCl Extended Release (ER), commonly known as Generic Glucophage XR, is an oral medication used to manage Type 2 Diabetes. It belongs to the biguanide class of drugs and is designed to help control high blood sugar in adults. The extended-release formulation is beneficial for individuals who prefer once-daily dosing, as it releases the drug slowly into the bloodstream over time.

Metformin ER works by:

Decreasing glucose production in the liver.

Improving insulin sensitivity, allowing glucose to be more effectively used by the body’s cells.

Reducing glucose absorption from food.

For patients looking for affordable options to manage their diabetes, DiRx offers Metformin HCl Extended Release (Generic Glucophage XR) at competitive prices, delivered right to your doorstep without requiring insurance. Visit DiRx to learn more about how you can save on your prescriptions.

How Does Metformin HCl Extended Release (Glucophage XR) Work?

Metformin HCl ER is designed to release its active ingredient gradually throughout the day, ensuring more consistent blood sugar control over 24 hours. The mechanism of action includes:

Inhibiting the liver’s glucose production: This limits the amount of glucose that enters the bloodstream.

Improving the body's response to insulin: This allows cells to absorb glucose more efficiently.

Reducing glucose absorption in the intestines: It ensures that less sugar from food is absorbed into the bloodstream.

This extended-release version is especially beneficial for those seeking a more convenient dosing schedule, as it can typically be taken once a day. You can purchase Metformin HCl ER (Glucophage XR) easily and affordably through DiRx, where you don’t need insurance to access FDA-approved medications. Visit DiRx today to explore your options.

Why Choose DiRx for Metformin HCl ER?

DiRx provides affordable access to FDA-approved generic medications like Metformin HCl ER, allowing patients to save significantly on their prescription costs. Here’s why you should choose DiRx:

[ahopkins1965]

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J Res Med Sci. 2014 Jul; 19(7): 658–664. 

 

PMCID: PMC4214027

PMID: 25364368

Metformin: Current knowledge

Hamid Nasri and Mahmoud Rafieian-Kopaei1

Author information Article notes Copyright and License information PMC Disclaimer

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Abstract

Diabetes mellitus is a group of metabolic disorders in which the blood glucose is higher than normal levels, due to insufficiency of insulin release or improper response of cells to insulin, resulting in high blood pressure. The resultant hyperglycemia produces sever complications. Metformin drug has been shown to prevent diabetes in people who are at high risk and decrease most of the diabetic complications. Recent reports on metformin, not only indicate some implications such as renoprotective properties have been suggested for metformin, but some reports indicate its adverse effects as well that are negligible when its benefits are brought into account. We aimed here to review the new implications of metformin and discuss about the concerns in the use of metformin, referring to the recently published papers.

Keywords: Diabetes, diabetes mellitus, diabetic nephropathy, glucose, metformin, new applications, polycystic ovary syndrome, renoprotection

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INTRODUCTION

Diabetes mellitus is a group of metabolic disorders in which the blood glucose is higher than normal levels, due to insufficiency of insulin release or improper response of cells to insulin, resulting in high blood pressure. The resultant hyperglycemia produces the classical symptoms of polyuria, polydipsia and polyphagia. It may also cause nerve problems, kidney problems, and blindness, loss of limbs, and sexual dysfunction, increase in heart attack or stroke.[1] Metformin (a biguanide derivative), by controlling blood glucose level decreases these complications. Metformin works by helping to restore the body's response to insulin. It decreases the amount of blood sugar that the liver produces and that the intestines or stomach absorb.[2] Metformin, other than hypoglycemic activity, has been taken with diet and exercise changes to prevent diabetes in people who are at high risk for becoming diabetic. It is also used in women with polycystic ovarian syndrome. Metformin may make menstrual cycles more regular and increase fertility.[3] Metformin was first synthesized and found to decrease the blood glucose level in the 1920s; however, it was not used for a long time. The use of metformin was rekindled in 1957, when the results of a clinical trial were published confirming its effect on diabetes. Metformin is now widely prescribed as an anti-diabetic drug; however, there have been serious concerns about its adverse effects, especially ketoacidosis.[4] Recently, not only some implications have been discovered for metformin, but also there are reports indicating that its adverse effects are negligible when its benefits are brought into account.[3] Theoretically, its use has been prohibited in a large group of patients with type 2 diabetes mellitus due to the risk of lactic acidosis. However, it has been shown that several diabetic patients who are considered to be at risk have received metformin with no increased risk of lactic acidosis.[2,3,4,5] Furthermore, recently some papers have been published indicating renoprotective properties for metformin. We aimed here to review the new implications of metformin and discuss about the concerns in the use of metformin, referring to the recently published papers.

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NEW AND OLD IMPLICATIONS AND THE MECHANISMS OF ACTION

Diabetes mellitus

Metformin is primarily used for the treatment of type 2 diabetes mellitus, particularly in obese.patients. Metformin has been shown to reduce diabetes mortality and complications by thirty percent compared to insulin, glibenclamide and chlorpropamide.[5]

Metformin reduces serum glucose level by several different mechanisms, notably through nonpancreatic mechanisms without increasing insulin secretion. It increases the effects of insulin; hence, it is termed “insulin sensitizer”. Metformin also suppresses the endogenous glucose production by the liver, which is mainly due to a reduction in the rate of gluconeogenesis and a small effect on glycogenolysis. Moreover, metformin activates the enzyme adenosine monophosphate kinase (AMPK) resulting in the inhibition of key enzymes involved in gluconeogenesis and glycogen synthesis in the liver while stimulating insulin signaling and glucose transport in muscles. AMPK regulates the cellular and organ metabolism and any decrease in hepatic energy, leads to the activation of AMPK. This study to an extent has put forth to explain the mechanism of metformin action on liver gluconeogenesis.[6,7]

Furthermore, metformin increases the peripheral glucose disposal that arises largely through increased non-oxidative glucose disposal into skeletal muscle. It usually does not cause hypoglycemia and this cause to be considered as a unique anti-diabetic drug.[8]

Treatment of diabetes with metformin is associated with less weight gain compared with insulin and sulfonylureas. Weight gain helps in better glucose control. In a study it was shown that, over a 10-year treatment period, the patients treated with metformin gained about one kg, the patients treated with glibenclamide gained about three kg, and the patients treated with the insulin gained six kg weight.[9]

Pre-diabetes

The chance of developing type 2 diabetes mellitus may decrease in people at risk for this disease; however, dieting and intensive physical exercise may work significantly better for this purpose. In a large study in the United States, participants were given placebo, lifestyle intervention or metformin, and followed for three years. The lifestyle modifications included a 16-lesson training on exercise and dieting followed by monthly sessions for individuals with the aim of decreasing the body weight by 7%. These patients under this group were engaged in a physical activity for about 150 minutes/week. The incidence of diabetes mellitus in this group was by 58%, and in metformin group by 31%. After ten years, the incidence of the disease was lower by 34% in the patients on diet and exercise and 18% in the metformin group.[10]

Gestational diabetes

Several trials have suggested that metformin is as safe and effective as insulin for the treatment of gestational diabetes,[11] and it has been suggested that the mothers who have used metformin instead of insulin might be healthier in the neonatal period.[12] However, evidence is still lacking on the long term safety of metformin for both children and mothers.[13]

Polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) is frequently associated with resistance to insulin and since 1994, metformin has been proposed as a treatment for PCOS.[14] In 2004, National Institute for Health and Clinical Excellence recommended to prescribe metformin for women with PCOS and a body mass index above 25 for anovulation and infertility when other therapies have failed to produce acceptable results.[15] However, several subsequent reviews did not show promising results and did not recommend it further or at least as a first-line medication,[16] except for women with glucose intolerance.[17] The guidelines usually suggest clomiphene to be the first treatment and recommend lifestyle modification independent from drug therapy.

A systematic review using comparative trials of clomiphene and metformin found equal results for infertility[18] and A BMJ editorial suggested that metformin should be used as a second choice, if clomiphene treatment fails.[19] Furthermore, a large review using 27 clinical trials found that metformin was not associated with any increase in the number of live births; however, it improved ovulation rates, especially when it was used in combination with clomiphene.[20]

Further, a review recommended metformin as a first choice because of positive effects on insulin resistance, hirsutism, anovulation and obesity, which are often associated with polycystic ovary syndrome.[21]

The different trial designs might be the reasons for the contradictory results. For example, considering live birth rate instead of pregnancy as the endpoint might have biased a few trials against metformin.[22] Another explanation is that metformin may have different efficacy in different populations.

Cancer protection

A large case-control study has suggested that metformin might protect patients against pancreatic cancer. In this study, the risk of pancreatic cancer in metformin group was 62% lower than in placebo group who did not use metformin. The participants having sulfonylureas or insulin were found to have a 2.5-fold and 5-fold higher risk of pancreatic cancer, respectively, in comparison to placebo group.[23] Several studies have suggested that diabetic patients using metformin might lower the risk of cancer compared to those using other anti-diabetic drugs.[24,25] However, the results need confirmation in controlled trials.[26]

Metformin has shown a strong antiproliferative effects on colon, pancreatic, breast, ovarian, prostate and lung cancer cells. Preclinical studies have also shown reliable anti-tumoral effects in different animal models. A clinical trial has demonstrated beneficial effect in colon and breast cancers.[27]

The mechanism of this action is not clear. Other anti-diabetic drugs have not shown the same anticancer activities; hence, the anticancer effect of metformin should not be related to anti-diabetic activity of this drug. Metformin possesses antioxidant activity.[28] Antioxidants have been shown to have various beneficial effects such as anticancer,[29,30,31,32] antidiabetes[33] and antiatherosclerosis[34,35] properties. Therefore, some beneficial effects of metformin might be related to its antioxidant activity.

HIV-associated diabetes

The use of some of antiretroviral drugs in HIV-infection has been associated with glucose tolerance, insulin resistance, hyperinsulinemia and type 2 diabetes mellitus. Low HDL, Hypertriglyceridemia and high risk of cardiovascular diseases have been reported in these patients. These metabolic alterations are frequently associated with loss of subcutaneous fat and increased visceral fat.[36,37]

Antiretroviral therapies with protease inhibitors inhibit glucose transporter (GLUT)-4 mediated glucose transport.[38] They are likely to be, in part, responsible for the insulin resistance and body composition changes in HIV-infected patients. Metformin has been shown to reduce visceral adiposity and insulin resistance after 8 weeks of drug therapy at dose of 850 mg, 3 times per day.[39]

Nephrotoxicity prevention

Recent studies have suggested that metformin may have therapeutic or renoprotective effects against nephrotoxic agents.[40,41] It has also been shown to have a good efficacy in diabetic nephropathy.[40,41,42,43,44] Furthermore, it significantly decreases albuminuria in patients with diabetes mellitus.[41,42,43,44] However, the exact mechanism beyond these effects is still unknown. Recent studies have shown that therapeutic effect of metformin is mediated through its action on adenosine monophosphate (AMP)-activated kinase in tissues.[43,44,45,46,47,48] Various studies have shown that metformin is capable of decreasing intracellular reactive oxygen species (ROS).[45,46,47,48,49] It protects tubular injury through regulation of oxidative stress and restoring the biochemical alterations on renal tubules. Metformin may also protect the podocytes in diabetic nephropathy.[47,48,49,50,51]

Various studies have shown that AMPK activation of metformin is secondary to its effect on the mitochondria as the primary target.[52] Recent studies have demonstrated a direct or mediated mitochondrial effect for metformin.[53] When metformin is used alone, its beneficial effect is due to the mild inhibition of the mitochondrial respiration.[54,55]

The effect of mitochondria in programmed cell death is usually associated with the release of apoptotic signaling molecules.[56] Moreover, ROS production by mitochondria may also lead to cell degradation.[57]

Mitochondria represents as one of the major cellular sources of ROS generation,[50] and a great number of tissue pathologies, which induce oxidative stress.[58,59] These findings may show the critical role of mitochondria in these conditions.[58,59]

The nephrotoxicity of aminoglycosides and most of other renotoxic agents has been attributed to ROS.[60] In certain conditions, intracellular ROS may reach a toxic level, resulting in oxidative damage and malfunctioning of the organ.[54]

We conducted a study on male Wistar rats to test the potential properties of metformin in protecting the kidney from gentamicin-induced acute renal failure, and to find out by postponing the treatment with metformin in acute renal failure exerts similar benefits as on gentamicin nephrotoxicity in rats.[61] Metformin not only had preventive effect but also exerted ameliorative activity against gentamicin nephrotoxicity. Hence, it might be beneficial in patients under treatment with this drug.[49]

Metformin has also shown to have beneficial effect on renal function and structure after unilateral ischemia-reperfusion in rats.[62] The authors in this study have concluded that metformin has tissue protection with the activation of endothelial nitric oxide synthase and AMPK.[61]

Various studies have shown that ROS overproduction might be the key starting events, which cause development of complications of diabetes.[63] However, the exact mechanisms that cause hyperglycemia and diabetic nephropathy are not elucidated.[64] It has been shown that nucleic acids can be affected by oxidative stress, thereby modifying the bases in DNA. When DNA is damaged the affected cells start a response such as cell cycle delay, DNA repair or apoptosis induction. ROS generation by oxidative stress causes cell death.[65] Apoptosis is implicated in the pathogenesis of diabetic nephropathy. ROS is an inducer of apoptosis in various cell types including podocytes.[66]

Metformin is able to restore the podocytes in diabetic rats and diabetes-induced podocyte loss in diabetic nephropathy has been attenuated to ROS.[67] Podocyte apoptosis is associated with increased albuminuria. Phosphorylation of AMPK is reduced in the kidney of diabetic rats. Therefore, metformin may exert some of its effects by improving the renal oxidative stress.[67] These findings are in agreement with other studies showing beneficial antioxidant properties of metformin in diabetic rats.[68]

These findings may encourage the clinical use of metformin along with nephrotoxic drugs as well as for prevention of diabetic nephropathy.

Side effects

Metformin has not significant adverse effects; however, it may cause a serious condition called lactic acidosis with the following symptoms: Dizziness, severe drowsiness, muscle pain, tiredness, chills, blue/cold skin, fast/difficult breathing, slow/irregular heartbeat, stomach pain with diarrhea, nausea or vomiting.[1,41,43,69]

Lactic acidosis usually occurs due to drug overdose or in some contraindicated conditions. It is more likely to occur in patients with certain medical conditions, including a serious infection, liver or kidney disease, recent surgery, any conditions that cause a low level of oxygen in the blood or poor circulation (such as recent stroke, congestive heart failure, recent heart attack), heavy alcohol use, dehydration, X-ray or scanning procedures that require an injectable iodinated contrast drug and those older than 80 years.[1,41,43,70]

Nausea, vomiting, stomach upset, diarrhea, weakness, or a metallic taste in the mouth may occur.

Metformin usually does not cause hypoglycemia; however, low blood sugar may occur if this drug is used with other anti-diabetic drugs. Hypoglycemia is more likely to occur with heavy exercise, drinking large amounts of alcohol, or not consuming enough calories from food.

Symptoms of hyperglycemia include polydipsia, polyuria, rapid breathing, flushing, confusion, drowsiness, and fruity breath odor.[1,41,43,71,72]

Serious allergic reaction to this drug is rare; however, this product may contain inactive ingredients, which can cause allergic reactions or other problems. High fever, diarrhea, vomiting, diuretics or excess sweating may cause dehydration and increase the risk of lactic acidosis. Older adults may be at greater risk for side effects such as low blood sugar or lactic acidosis.[1,41,43,62,71]

Gastrointestinal intolerance is one of the most frequently occurred and lactic acidosis is a rare, but causes serious adverse effects.[73,74] Incidence of myocardial infarction (MI) is also an important event but seen less in metformin compared with sulfonylurea agents.[75] Metformin induced lactic acidosis is a rare but important and fatal adverse event.

A population-based study demonstrated that about one-fourth of patients prescribed metformin had contraindications to its use. However, contraindications rarely resulted in discontinuation of metformin usage.[76] These data have been confirmed by several other studies in different countries.[77,78]

Furthermore, in a recent review article, based on 347 observational cohort studies and prospective comparative trials, no evidence indicating metformin to be associated with increased levels of lactate or increased risk of lactic acidosis in comparison to other antihyperglycaemic drugs has been reported.[7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71,72,73,74,75,76,77,78,79] It should be noted that in this report, all clinical trials excluded the risk patients. Therefore, the scenario might be rather different, in real population.

In a study sample of 19,691 type 2 diabetes mellitus (DM), patients with established atherothrombosis participating in study, the two-year mortality rate was significantly less in patients treated with metformin compared with the patients not treated with metformin.[80,81]

Therefore, it might be necessary to reconsider the list of contraindications in the use of metformin.

However, considering the high prevalence of stable renal impairment, congestive heart failure and/or coronary artery disease in elderly patients, the benefit-risk balance of metformin treatment are of particular important and more valuable data especially relevant to the elderly population are still required. In this regard, benefit-risk ratios are needed without deprivation of patients at risk.

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METFORMIN DURING PREGNANCY AND LACTATION

It has been shown that pregnancy may alter the function of drug-metabolizing enzymes and drug transporters in a gestational stage. The activities of several hepatic cytochrome P450 enzymes such as CYP2D6 and CYP3A4 are increased, whereas the activity of some others, such as CYP1A2, may be decreased. The activities of some renal transporters, including organic-cation transporter and P-glycoprotein increase during pregnancy. However, significant gaps still exist in our understanding of the spectrum of drug metabolism and transport genes affected, gestational age-dependent changes in the activity of encoded drug metabolizing and transporting processes, and the mechanisms of pregnancy-induced alterations.[52,82]

The pharmacokinetics of metformin is also affected by pregnancy, which is related to the changes in renal filtration and net tubular transport, which can be estimated roughly by the use of creatinine clearance. At the time of delivery, the fetus is exposed to variable concentrations of metformin from negligible to as high as maternal concentrations. However, infant exposure to metformin through the breast milk is low.[83]

Metformin appears to be effective and safe for the treatment of gestational diabetes mellitus, particularly for overweight or obese women. It has been suggested that metformin is safe during pregnancy. However, as metformin crosses the placenta, its use during pregnancy raises concerns regarding potential adverse effects on the mother and fetus. Furthermore, patients with multiple risk factors for insulin resistance may not meet their treatment goals with metformin alone and may require supplementary drugs such as insulin. However, there are potential advantages for the use of metformin over insulin in gestational diabetes mellitus with respect to maternal weight gain and neonatal outcomes. Furthermore, the use of metformin throughout pregnancy in women with polycystic ovary syndrome decreases the rates of early pregnancy loss and preterm labor; hence protecting against fetal growth restriction. There have been no demonstrable teratogenic effects, intrauterine deaths or developmental delays with the use of metformin. Therefore, the evidence supports the efficacy and safety of metformin during pregnancy with respect to immediate pregnancy outcomes. However, because there are no guidelines for the continuous use of metformin in pregnancy, the duration of treatment is based on clinical judgment and experience on a case-by-case basis.[84,85,86,87,88,89] Recently, the Endocrin Society has not only confirmed the use of metformin during pregnancy but also has recommended it as a first-line treatment of cutaneous manifestations, for prevention of pregnancy complications, or for the treatment of obesity.[85,86] It should be noted that not all references allow the use of metformin in the first trimester of pregnancy.[90] Therefore, it is suggested that metformin therapy be used for glycemic control only for those women with gestational diabetes who do not have satisfactory glycemic control despite medical nutrition therapy and who refuse or cannot use insulin or glyburide in the first trimester.

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CONCLUSION

Metformin is an oral anti-diabetic drug in the biguanide class for the treatment of type 2 diabetes mellitus, in particular, in overweight and obese people and those with normal kidney function.

Metformin has several benefits in patients with type 2 diabetes mellitus, including decreased hyperinsulinemia, weight reduction, augmented fibrinolysis, improved lipid profiles and enhanced endothelial function.

Although the use of metformin in diabetes has its safety concerns, its benefits and the recent results indicate that the nephroprotective activity against nephrotoxic agents on metformin and its recent good safety records have led researchers to consider the use of this drug more and more in insulin resistant states even before the development of hyperglycemia.

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AUTHORS’ CONTRIBUTIONS

All authors have contributed in designing the study. Both of them have assisted in preparation of the first draft of the manuscript or revising it critically for important intellectual content. They have read and approved the content of the manuscript and confirmed the accuracy or integrity of any part of the work.

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Footnotes

Source of Support: Nil

Conflict of Interest: None declared.

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Articles from Journal of Research in Medical Sciences : The Official Journal of Isfahan University of Medical Sciences are provided here courtesy of Wolters Kluwer -- Medknow Publications

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