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   Table of Contents - Current issue
Coverpage
November-December 2019
Volume 23 | Issue 6
Page Nos. 591-654

Online since Monday, January 20, 2020

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EDITORIAL  

“Make in India”—Time for Indian Protocols p. 591
KVS Hari Kumar
DOI:10.4103/ijem.IJEM_644_19  
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REVIEW ARTICLE Top

Dynamic testing for evaluation of adrenal and gonadal function in pediatric and adult endocrinology: An overview p. 593
Alpesh Goyal, Suraj Kubihal, Yashdeep Gupta, Viveka P Jyotsna, Rajesh Khadgawat
DOI:10.4103/ijem.IJEM_553_19  
Dynamic tests are often considered as the backbone of endocrinology. These tests involve the use of an exogenous agent to manipulate the body's hormonal milieu for the diagnosis and characterization of an endocrine disorder. They are especially helpful in the evaluation of certain endocrine conditions, such as disorders of growth and pubertal maturation and disorders of sex development. A great deal of heterogeneity exists across clinicians with regard to the usage, methodology, and interpretation of these tests. This review outlines various dynamic tests used to evaluate adrenal and gonadal function in pediatric and adult endocrinology, along with their clinical application and interpretation.
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ORIGINAL ARTICLES Top

Prevalence of psychiatric comorbidity among patients of type 2 diabetes mellitus in a hilly state of North India p. 602
Neeraj Kanwar, Ravi C Sharma, Dinesh D Sharma, Ramesh , Kiran Mokta, Jatinder K Mokta
DOI:10.4103/ijem.IJEM_521_19  
Background: Psychiatric comorbidity with diabetes mellitus is common. Comorbidity of diabetes and psychiatric disorders can present in different patterns, which are associated with impaired quality of life, increased cost of care, poor treatment adherence, poor glycaemia control and increased emergency room visits. The present study was planned to assess the psychiatric comorbidity in type 2 diabetic patients at tertiary care hospital in a hilly state of North India. Objectives: To study the prevalence of psychiatric comorbidity among patients of type 2 diabetes mellitus and to study the association between psychiatric comorbidity, sociodemographic and clinical variables in such patients. Materials and Methods: A cross-sectional study was conducted after enrolling the eligible diabetic patients attending outpatient department services of medicine department, Indira Gandhi Medical College, Shimla. The Brief Illness Perception Questionnaire was used to assess the cognitive and emotional aspects of illness, Hamilton Depression Rating Scale for assessment of depression, Hamilton Anxiety Rating Scale for assessing severity of anxiety and Mini-International Neuropsychiatric Interview 6.0 for screening all major Axis I disorders. Results: Out of 320 patients of type 2 diabetes mellitus screened, 202 eligible patients were enrolled. Depression was the most common psychiatric comorbid illness present in (41.9%) patients. Depression was slightly higher in female patients and persons aged >50 years. Greater prevalence of depressive episodes was there in people with longer duration of diabetes. Conclusion: There were a significant percentage of diabetic patients having psychiatric illnesses. Their attitude towards these comorbidities may be changed by psychiatric counselling at regular intervals.
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The effect of educational program based on the extended theory of reasoned action on Self-Care behaviors in women with type 2 diabetes p. 609
Ali Khani Jeihooni, Zahra Khiyali, Forough Faghih, Pooyan Afzali Harsini, Milad Rahbar
DOI:10.4103/ijem.IJEM_439_19  
Background and Objective: The aim of this study is to determine the effect of educational program based on the extended theory of reasoned action on self-care behaviours in women with type 2 diabetes in Fasa. This quasi-experimental study was performed on 100 women with type 2 diabetes who referred to diabetes clinics in Fasa. Materials and Methods: Samples were randomly divided into experimental and control groups. The data were collected using a questionnaire based on the extended theory of reasoned action and self-care behaviours that were completed by both the control and experimental groups before and 3 months after the educational intervention. Data were analysed by SPSS software version 22, descriptive statistics tests, Chi-square test, independent T-test, and paired T-test. Results: The results of the study showed that after the educational intervention, the mean scores of all constructs of the extended theory of reasoned action in the experimental group were significantly increased compared to the control group (P <0.05). Conclusion: Also, the educational intervention had a significant effect on the promotion of patient's self-care behaviours in the experimental group and the HbA1c level decreased in the experimental group compared to the control group (P <0.05). In addition, it was found that the extended theory of reasoned action could be a suitable framework for designing educational interventions for promoting self-care behaviours in diabetic patients.
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The effect of educational intervention based on BASNEF model on self-medication behavior of type 2 diabetic patients p. 616
Ali Khani Jeihooni, Maryam Barati, Amin Kouhpayeh, Seyyed Mansour Kashfi, Pooyan Afzali Harsini, Milad Rahbar
DOI:10.4103/ijem.IJEM_436_19  
Background: Diabetes is one of the main reasons of the increase of morbidity and mortality around the world. Considering the burden of disease, self-medication can result in irrecoverable consequences. The aim of this study is to investigate the effect of educational intervention based on Beliefs, Attitudes, Subjective Norms and Enabling Factors (BASNEF) model on self-medication behaviors of type 2 diabetic patients in Fasa, Fars province, Iran, in 2017–2018. Materials and Methods: In this quasi-experimental study, 200 type 2 diabetic patients under cover of the diabetes center of Fasa were investigated (100 patients for experimental group and 100 patients for control group). A questionnaire investigating demographic information and BASNEF Model constructs (knowledge, attitude, enabling factors, subjective norms, and behavioral intention) was used for evaluating self-medication behaviors of patients before and 3 months after intervention. Results: The average age of experimental group was 53.25 ± 8.42 and the average age of control group was 54.18 ± 8.13. Three months after intervention, experimental group showed significant enhancement in knowledge, attitude, enabling factors, subjective norms, and behavioral intention and their self-medication behaviors reduced, while control group showed no significant changes in mentioned factors. Conclusion: The present study indicated the efficiency of BASNEF model on reduction of self-medication behaviors of diabetic patients. Hence, this model can act as a framework for designing and implementing educational interventions in this field.
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Cross-sectional Study on vitamin D levels in stress urinary incontinence in women in a tertiary referral center in India p. 623
Jai B Sharma, Vivek Kakkad, Sunesh Kumar, KK Roy
DOI:10.4103/ijem.IJEM_531_19  
Objective: To assess the levels of vitamin D in patients with Stress Urinary Incontinence (SUI) in gynecology clinic of All India Institute of Medical Sciences, New Delhi. Materials and Methods: This is a cross sectional study on a total of 40 women presenting to gynecology outpatient department with stress urinary incontinence diagnosed by history and examination. The women were divided with moderate, severe and very severe SUI confirmed by incontinence severity index (ISI) and pad test. Vitamin D (serum 25 OH D) levels were measured in all cases by electrochemiluminenscene Immunoassay (ECLIA) using Roche Elecsys 2010 and levels of =30 ng/ml were taken as sufficient while levels between 20-30 ng/ml as insufficient and <20 ng/ml as deficient. Statistical analysis was performed using ANOVA test with P value of <0.05 taken as significant. Results: Mean age of patients was 41.6 years. Mean parity was 2.73 and mean duration of symptoms was 4.14 years. Vitamin D levels ranged between 6-38 ng/ml with mean being 17.15±8.1 ng/ml. Levels were deficient (<20 ng/ml) in 30 (75%) women, insufficient (20-30ng/ml) in 7 (17.5%) women and sufficient (>30ng/ml) in 3 (7.57%) women. There was no significant correlation between severely of SUI and levels of vitamin D with Vit D being 19.18±5.76 ng/ml in moderate SUI, 16.96±9.03 ng/ml in severe SUI and 13.60 ± 2.09 ng/ml in very severe SUI. Conclusion: There was very high prevalence of vitamin D deficiency in SUI patients with 75% patients showing deficient levels and 17.5% showing insufficient levels in SUI patients. There is need to provide vitamin D supplementation in such women.
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Feasibility and outcome of community-based screening for cardiovascular disease risk factors in a remote rural area of South India: The Chunampet rural–Cardiovascular health assessment and management program p. 628
Ariarathinam Newtonraj, Kalaiselvi Selvaraj, Anil J Purty, Sunil K Nanda, Mark C Arokiaraj, Antony Vincent, Mani Manikandan
DOI:10.4103/ijem.IJEM_528_19  
Background: As committed by India in Global Action Plan, Sustainable Development Goals and National Health Policy 2017, India has the responsibility to provide accessible, affordable noncommunicable disease care to the people. Our study aimed to find out the burden of cardiovascular risk factors among hypertension and diabetic patients, through a community-based screening, in a remote rural area of South India. Methods: A special program named “Chunampet Rural–Cardiovascular Health Assessment and Management Program” (CR-CHAMP) was launched in August and September 2017 in a Rural Health Training Center (RHTC), functioning under a private medical college in South India. In this program, participants with hypertension (HT) and diabetes (DM) were line listed from 10 remote villages, and then history, initial biochemical, hormonal, and hematological screenings were done to assess the cardiovascular diseases (CVDs) risk factors among these patients, following which special consultation was offered in RHTC. Results: Out of 415 eligible patients with HT and DM, 389 were approached; among them, 328 were willing to participate and were screened initially; among them, 235 were attended special consultation. Higher CVD risk was found in 21%. Prevalence of chronic kidney disease was 14%, deranged lipid profile was more than 50%, metabolic syndrome was 49%, anemia was 68%, abnormal waist-hip ratio was 56%, abdominal obesity was 59%, and overweight and obesity using body mass index (BMI) was 59%. Females' participation was more in our community-based screening procedure (66%) than male participation (34%). Conclusion: CR-CHAMP demonstrated feasibility and value of implementing a screening program for high-risk individuals with HT and DM for CVD risk through existing primary care in a remote rural area of South India. This will help the National Program and policymakers to plan for interventions in the remote rural area in future.
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Indian growth references from 0-18-Year-Old children and adolescents - A comparison of two methods p. 635
Vaman Khadilkar, Anuradha V Khadilkar, Neha Kajale
DOI:10.4103/ijem.IJEM_555_19  
Background and Aims: For updating growth references, large datasets are usually required; collection of these data are expensive and cumbersome. Using a combination of regression equations, Preece Baines model and global LMS values, synthetic growth references for the target population can be generated. The objective of this study is to compare growth references created from continuous anthropometric data using LMS method versus those created synthetically from anthropometric means at key ages. Methods: De-identified data on 46421 children (26037 boys) from 0-18 years of age from several multicentric studies conducted by the authors' group (2007 to 2017) were included in this study; growth references were constructed using the LMS method. For the production of synthetic references, arithmetic means of heights and weights at key ages were used and global LMS values were used from literature. Results: There was no difference in the medians for height, weight and BMI between the references created by the two methods. The extreme percentile values for height were similar (P < 0.05). However, the spread of values for weight and BMI was narrower in the synthetic references. Conclusion: Growth references produced from continuous data differ from those produced synthetically using anthropometric means mainly at the extreme centiles for weight and body mass index; synthetic references take into consideration global trends over several decades.
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LETTERS TO THE EDITOR Top

A Cross-sectional study of stretched penile length in boys from West Bengal, India p. 645
Mahmood Dhahir Al-Mendalawi
DOI:10.4103/ijem.IJEM_551_19  
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Masked Klinefelter syndrome Highly accessed article p. 645
Karthik Balachandran
DOI:10.4103/ijem.IJEM_558_19  
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Impact of prime time soap operas on glycemic control p. 647
Sruti Chandrasekaran, Shiva Prakash Srinivasan
DOI:10.4103/ijem.IJEM_543_19  
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Imatinib-induced gynecomastia p. 648
Pragya Gupta, Kripa Elizabeth Cherian, Nitin Kapoor, Nambiathayil Aboobacker Fouzia, Thomas Vizhalil Paul
DOI:10.4103/ijem.IJEM_566_19  
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Calcium–calcitriol: A match made in heaven? Highly accessed article p. 649
Karthik Balachandran, Adlyne R Asirvatham, Shriraam Mahadevan
DOI:10.4103/ijem.IJEM_583_19  
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Vitamin D supplementation, insulin resistance, and cardiovascular risk factors: Who are likely to benefit the most? p. 650
Meha Sharma, Manoj Kumar, Deep Dutta
DOI:10.4103/ijem.IJEM_594_19  
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Reversible hair loss due to levothyroxine overdose p. 652
Chaitanya Yerawar, Prerana G Deokar, Bhaskar Noone
DOI:10.4103/ijem.IJEM_550_19  
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ERRATUM Top

Erratum: Diabetes management and the buddhist philosophy: Toward holistic care p. 654

DOI:10.4103/2230-8210.276225  
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