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   2013| September-October  | Volume 17 | Issue 5  
    Online since August 29, 2013

 
 
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REVIEW ARTICLES
Hypoglycemia: The neglected complication
Sanjay Kalra, Jagat Jyoti Mukherjee, Subramanium Venkataraman, Ganapathi Bantwal, Shehla Shaikh, Banshi Saboo, Ashok Kumar Das, Ambady Ramachandran
September-October 2013, 17(5):819-834
DOI:10.4103/2230-8210.117219  PMID:24083163
Hypoglycemia is an important complication of glucose-lowering therapy in patients with diabetes mellitus. Attempts made at intensive glycemic control invariably increases the risk of hypoglycemia. A six-fold increase in deaths due to diabetes has been attributed to patients experiencing severe hypoglycemia in comparison to those not experiencing severe hypoglycemia Repeated episodes of hypoglycemia can lead to impairment of the counter-regulatory system with the potential for development of hypoglycemia unawareness. The short- and long-term complications of diabetes related hypoglycemia include precipitation of acute cerebrovascular disease, myocardial infarction, neurocognitive dysfunction, retinal cell death and loss of vision in addition to health-related quality of life issues pertaining to sleep, driving, employment, recreational activities involving exercise and travel. There is an urgent need to examine the clinical spectrum and burden of hypoglycemia so that adequate control measures can be implemented against this neglected life-threatening complication. Early recognition of hypoglycemia risk factors, self-monitoring of blood glucose, selection of appropriate treatment regimens with minimal or no risk of hypoglycemia and appropriate educational programs for healthcare professionals and patients with diabetes are the major ways forward to maintain good glycemic control, minimize the risk of hypoglycemia and thereby prevent long-term complications.
  54 11,428 1,987
BRIEF COMMUNICATIONS
Glucocorticoid-induced myopathy: Pathophysiology, diagnosis, and treatment
Anu Gupta, Yashdeep Gupta
September-October 2013, 17(5):913-916
DOI:10.4103/2230-8210.117215  PMID:24083177
Glucocorticoid-induced myopathy is the most common type of drug-induced myopathy. Nearly 60% of patients with Cushing's syndrome have muscle weakness. Glucocorticoid-induced muscle atrophy affects mainly fast-twitch glycolytic muscle fibers (type IIb fibers). This brief review will discuss the pathophysiology behind glucocorticoid-induced myopathy, along with diagnostic features and treatment.
  44 8,592 1,348
REVIEW ARTICLES
Emerging risk factors for cardiovascular diseases: Indian context
Sushil Gupta, Ramesh Gudapati, Kumar Gaurav, Manoj Bhise
September-October 2013, 17(5):806-814
DOI:10.4103/2230-8210.117212  PMID:24083161
Cardiovascular disease (CVD) is globally considered as the leading cause of death with 80% of CVD related deaths being reported from low and middle income countries like India. The relatively early onset age of CVD in India in comparison to Western countries also implies that most productive ages of the patient's life are lost fighting the disease. Conventional cardiovascular risk is attributed to lifestyle changes and altered metabolic activity. This forms the basis of a 10-year risk prediction score inspired by the Framingham study. Since South Asians display considerable heterogeneity in risk factors as compared to developed countries, there is a need to identify risk factors which would not only help in primary prevention but also prevent their recurrence. We reviewed published data on novel risk factors and their potential to identify cardiovascular risk at an early stage, with special emphasis on the Indian population. Emerging risk factors were reviewed to identify their potential to prevent CVD progression independently as well as in association with other cardiovascular risk factors. The most commonly studied emerging cardiovascular risk factors included coronary artery calcium score, lipoprotein (a), apolipoproteins, homocysteine, thrombosis markers like fibrinogen, and plasminogen activator inhibitor 1, carotid intima-media thickness, genotypic variations, non-alcoholic fatty liver disease, C-reactive protein, platelets, and birth weight levels. Nonetheless, more studies on large sample size can ascertain the utility of these risk factors in estimation and analysis of cardiovascular risk especially in the Indian context.
  22 11,049 1,975
Metabolic pancreatitis: Etiopathogenesis and management
Sunil Kumar Kota, S.V.S. Krishna, Sandeep Lakhtakia, Kirtikumar D Modi
September-October 2013, 17(5):799-805
DOI:10.4103/2230-8210.117208  PMID:24083160
Acute pancreatitis is a medical emergency. Alcohol and gallstones are the most common etiologies accounting for 60%-75% cases. Other important causes include postendoscopic retrograde cholangiopancreatography procedure, abdominal trauma, drug toxicity, various infections, autoimmune, ischemia, and hereditary causes. In about 15% of cases the cause remains unknown (idiopathic pancreatitis). Metabolic conditions giving rise to pancreatitis are less common, accounting for 5%-10% cases. The causes include hypertriglyceridemia, hypercalcemia, diabetes mellitus, porphyria, and Wilson's disease. The episodes of pancreatitis tend to be more severe. In cases of metabolic pancreatitis, over and above the standard routine management of pancreatitis, careful management of the underlying metabolic abnormalities is of paramount importance. If not treated properly, it leads to recurrent life-threatening bouts of acute pancreatitis. We hereby review the pathogenesis and management of various causes of metabolic pancreatitis.
  18 6,803 1,035
ORIGINAL ARTICLES
Evaluation of skin and subcutaneous tissue thickness at insulin injection sites in Indian, insulin naïve, type-2 diabetic adult population
Sunil M Jain, Kirnesh Pandey, Alok Lahoti, P Kiran Rao
September-October 2013, 17(5):864-870
DOI:10.4103/2230-8210.117249  PMID:24083168
Context: Skin thickness of type-2 diabetic insulin naïve adult patients. Background: We have limited data on skin and subcutaneous tissue thickness of Indian type-2 diabetic population. Objective of this study was to assess skin and subcutaneous tissue thickness in insulin naïve type-2 diabetic patients as this information may be useful for insulin injection technique. Aims: To assess the skin and subcutaneous tissue thickness at insulin injection sites in insulin naïve, type-2 diabetic adult population across different body mass index (BMI). Settings and Design: Observational study carried out at our institute. Materials and Methods: One hundred and one insulin naïve type-2 diabetic subjects underwent skin thickness measurement using ultrasound at insulin administration sites. Skin and subcutaneous tissue thickness were measured and prints taken. Though, the sample size to be taken for the study was not calculated, the results obtained clearly show that the power of the study was 80%. Results: At arm and thigh, the mean skin thickness was more in males as compared to females in the BMI range <23 kg/m 2 (P < 0.05). At abdomen, skin thickness was more in males in the BMI range 19-23 kg/m 2 (P < 0.05). Across all the BMIs, mean skin plus subcutaneous thickness at arm was more in females (P < 0.05) except for BMI >25 kg/m 2 where thickness in males was comparable. At thigh, the skin plus subcutaneous tissue thickness was more in females (P < 0.05), across all BMI ranges. At abdomen, thickness was more in females for the BMI ranges 17-19 kg/m 2 and 23-25 kg/m 2 , while it was comparable across all other BMI ranges (P > 0.05). Conclusions: Skin and subcutaneous tissue thickness can be estimated by BMI. In general it is higher in females.
  15 3,307 457
Evaluation of left ventricular mass and function, lipid profile, and insulin resistance in Egyptian children with growth hormone deficiency: A single-center prospective case-control study
Kotb Abbass Metwalley, Hekma Saad Farghaly, Heba Ahmed Abd El-Hafeez
September-October 2013, 17(5):876-882
DOI:10.4103/2230-8210.117234  PMID:24083170
Background: Growth hormone deficiency (GHD) in adults is associated with a cluster of cardiovascular risk factors that may contribute to an increased mortality for cardiovascular disease. In children, relatively few studies have investigated the effect of GHD and replacement therapy on cardiac performance and metabolic abnormalities that may place them at a higher risk of cardiovascular disease (CVD) at an early age. Aim: This study was aimed to assess the left ventricular function, lipid profile, and degree of insulin resistance in Egyptian children with GHD before and after 1 year of GH replacement therapy. Settings and Design: Prospective case-control study, single-center study. Materials and Methods: Thirty children with short stature due to GHD were studied in comparison to 20 healthy age- and sex-matched children. All subjects were subjected to history, clinical examination, auxological assessment, and echocardiography to assess the left ventricular function. Blood samples were collected for measuring IGF-1, lipid profile (Total, LDL, HDL cholesterol, triglyceride, and atherogenic index (AI), fasting blood sugar, and fasting insulin levels. In addition, basal and stimulated GH levels were measured in children with suspected GHD. Statistical Analysis Used: Student's t-test was used for parametric data, and the Mann-Whitney U-test was used for non-parametric data. Results: Total, LDL cholesterol, triglyceride, AI, and insulin were significantly higher in children with GHD than in healthy controls at baseline. After 12 months of GH replacement therapy, total, LDL cholesterol, triglyceride, AI and insulin were significantly decreased, while homeostatic model assessment for insulin resistance index (HOMA-IR) was significantly increased compared to both pre-treatment and control values. At baseline, the left ventricular mass (LVM) and left ventricular mass index (LVMi) were significantly lower in GHD children than in controls. After 12 months of GH replacement therapy, LVM and LVMi in GHD patients were significantly increased compared to pre-treatment values. Conclusions: GHD in children is associated with a significantly reduced cardiac mass and impairment of lipid profile. GH replacement therapy exerts beneficial effects both on cardiac mass and lipid metabolism by normalizing cardiac size and improving the lipid profile. On the contrary, an increase in insulin resistance is observed after 12 months GH treatment. The study suggests that children with GH deficiency should have echocardiography and lipid profile monitoring before and during treatment with GH.
  10 1,381 268
CASE REPORTS WITH REVIEW OF LITERATURE
Pancreatic paraganglioma: An extremely rare entity and crucial role of immunohistochemistry for diagnosis
Mondita Borgohain, Gayatri Gogoi, Dipak Das, Manjusha Biswas
September-October 2013, 17(5):917-919
DOI:10.4103/2230-8210.117217  PMID:24083178
Paragangliomas are rare neuroendocrine neoplasms arising in extra-adrenal chromaffin cells of autonomic nervous system and histologically akin to chemodectomas. They are rare, affecting about 1 in 2,000,000 population. It is a generic term applied to tumors of paraganglia regardless of the location. In rare instances, paragangliomas present around and involve the pancreas, thereby mimicking any one of the more common primary pancreatic lesions. Pancreatic paraganglioma is an extremely rare tumor. It grows slowly, so radical resection is recommended to achieve curability with good prognosis. These neoplasms present considerable diagnostic difficulty not only for the clinician and radiologist but also for the pathologist. Here, we report a case of a 55-year-old woman who presented with a left-sided abdominal swelling for 3 months duration, initially having clinical suspicion of an ovarian tumor. The radiological imaging revealed a lesion in the tail of pancreas with a differential diagnosis of pancreatic carcinoma and metastatic tumor. Only after exploratory laparotomy, the diagnosis was made as a rare case of pancreatic paraganglioma on the basis of histological examination and immunohistochemistry.
  9 1,793 330
ENDOCRINOLOGY AND GENDER
Vulvodynia: An unrecognized diabetic neuropathic syndrome
Bharti Kalra, Sanjay Kalra, Sarita Bajaj
September-October 2013, 17(5):787-789
DOI:10.4103/2230-8210.117193  PMID:24083157
Vulvar pain syndromes, including vulvodynia, are a common source of morbidity in women and cause much physical and psychological suffering. This brief communication postulates the hypothesis that unexplained vulvar pain may be hitherto undescribed manifestation of painful sensory diabetic neuropathy. It describes the clinical characteristics of vulvodynia and highlights the similarities between this condition and diabetic neuropathy. The hypothesis calls for women presenting with vulvar pain to be screened for diabetes, as well as women with diabetes to be questioned about vulvar symptomatology. The paper hopes to stimulate extensive research in this important, but so far neglected, field of women's endocrine health.
  8 2,607 354
REVIEW ARTICLES
Importance of achieving the composite endpoints in diabetes
Ambika Gopalakrishnan Unnikrishnan, Arpandev Bhattacharyya, Manash Pratim Baruah, Binayak Sinha, Mala Dharmalingam, Paturi V Rao
September-October 2013, 17(5):835-843
DOI:10.4103/2230-8210.117225  PMID:24083164
Well-conducted randomized controlled trials are instrumental in providing vital data on safety and efficacy of new molecules under consideration for approval. However acquiring such data involves huge cost and focused scientific endeavor. Selection and reporting of endpoints of a therapy is essential to assess the effect(s) of an intervention on overall disease control and guidelines have suggested the use of composite endpoint (CEP) in clinical trial design over individual endpoints to demonstrate the compound effect. Composite endpoints have been preferred for their ability to assess the net clinical benefit of an intervention, avoid misinterpretation associated with competing risks, avoid the challenge of using a single outcome to validate the study objectives and reduce the sample size requirements in trials on patients treated for diabetes. Concerns for misinterpretation or difficulty in interpretation of trial results involving CEPs arise when differences in the components with respect to either clinical importance or event rates, or magnitude of treatment effect exist and when there's a possibility of biases due to competing risk. Suggestions for construction of composite endpoints and reporting the results of trials involving CEPs have been presented to improve the interpretations of overall effect of new interventions.
  8 1,975 338
Reproductive outcomes of female patients with congenital adrenal hyperplasia due to 21-hydroxylase defi ciency
Mouna Feki Mnif, Mahdi Kamoun, Faten Hadj Kacem, Fatma Mnif, Nadia Charfi, Basma Ben Naceur, Nabila Rekik, Mohamed Abid
September-October 2013, 17(5):790-793
DOI:10.4103/2230-8210.117196  PMID:24083158
Fertility in women with congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency (21-OHD) appears to be reduced, especially in women with the classic salt-wasting type. Several factors have been suggested to contribute to this subfertility such as androgen excess, adrenal progesterone hypersecretion, consequences of genital reconstructive surgery, secondary polycystic ovaries syndrome, and psychosexual factors. In contrast to this subfertility, pregnancies are commonly normal and uneventful. Adequate glucocorticoid therapy and improvement of surgical and psychological management could contribute to optimize fertility in CAH female patients, even among women with the classic variant. This review provides current information regarding the reproductive outcomes of women with CAH due to 21-OHD and the fertility and pregnancy issues in this population.
  7 4,835 734
EDITORIALS
The intestinal calcistat: Determinant of clinical vitamin D deficiency
MK Garg, Sanjay Kalra, Namita Mahalle
September-October 2013, 17(5):780-783
DOI:10.4103/2230-8210.117187  PMID:24083155
  5 1,156 329
ORIGINAL ARTICLES
Progression of puberty after initiation of androgen therapy in patients with idiopathic hypogonadotropic hypogonadism
Bindu Kulshreshtha, Rajesh Khadgawat, Nandita Gupta, Ariachery Ammini
September-October 2013, 17(5):851-854
DOI:10.4103/2230-8210.117245  PMID:24083166
Background: Onset of puberty in boys usually occurs by 14 years of age. Some boys may exhibit delayed sexual maturation till about 17-18 years of age. However, pubertal onset beyond 18 years of age is exceedingly rare. Materials and Methods: Patients diagnosed as idiopathic hypogonadotropic hypogonadism (IHH) who had onset of puberty (increase in testicular volume >10 ml) while on androgen therapy were studied. These patients were evaluated prospectively. Results: There were nine subjects that were included in the study. The pre-therapy testicular volumes ranged from 3 to 6 ml. Luteinizing hormone (LH) levels increased from 1.2 ± 0.96 to 2.8 ± 1.0 IU/L, follicular stimulating hormone (FSH) levels increased from 1.5 ± 0.79 to 3.5 ± 1.9 IU/L, and testosterone increased from 0.36 ± 0.16 to 3.4 ± 2.1 ng/ml. Three out of nine patients had testosterone levels below 3 ng/ml. Conclusion: Our present study indicates that pubertal development can occur in patients presenting with hypogonadotropic hypogonadism after 18 years of age. However, acquired pubertal status may be subnormal
  5 1,506 348
REVIEW ARTICLES
The other side of Turner's: Noonan's syndrome
Pankaj Agarwal, Rajeev Philip, Manish Gutch, KK Gupta
September-October 2013, 17(5):794-798
DOI:10.4103/2230-8210.117197  PMID:24083159
Noonan Syndrome (NS) is an autosomal dominant disorder characterized by short stature, typical face dysmorphology, and congenital heart defects. NS is a clinical diagnosis. Establishing the diagnosis can be very difficult, especially in adulthood. There is a great variability in expression, and the phenotype becomes less pronounced with increasing age.
  5 4,195 726
CASE REPORTS
Lithium-induced parathyroid dysfunction: A new case
C Gopalakrishnan Nair, Riju Menon, Pradeep Jacob, Misha Babu
September-October 2013, 17(5):930-932
DOI:10.4103/2230-8210.117223  PMID:24083184
Lithium salts are widely used in psychiatric practice and are known to induce thyroid dysfunction. Lithium-induced parathyroid dysfunction is rare. We are reporting a case of hyperparathyroidism in a 28-year-old female patient who was on lithium carbonate for 2 years, when she developed osteopenia and girdle girdle-type muscle weakness. Biochemical parameters showed hyperparathyroidism with shift of calcium creatinine clearance ratio to 0.013, indicating an error in threshold of calcium sensing receptor. The patient eventually required parathyroidectomy and the histology of the gland showed atypical features.
  4 1,773 259
Bilateral adrenal infarction in Crohn's disease
Ashish Khandelwal, J Satheesh Krishna, Kanika Khandelwal, Vivek Virmani, John Ryan
September-October 2013, 17(5):933-935
DOI:10.4103/2230-8210.117227  PMID:24083186
Adrenal infarction is an uncommon cause of adrenal insufficiency. We herein present unique occurrence of bilateral adrenal infarction detected on imaging in a young female with known history of Crohn's disease. The patient responded well to steroids and is on follow up. To our knowledge, this is the first case reported in English literature of adrenal infarct associated with Crohn's disease as extraintestinal manifestation.
  4 1,341 217
ORIGINAL ARTICLES
Endocrine complications after busulphan and cyclophosphamide based hematopoietic stem cell transplant: A single tertiary care centre experience
Abhay Gundgurthi, MK Garg, Velu Nair, Rajeev Pakhetra, Satyanarayan Das, Sanjeevan Sharma, Manoj K Dutta, Sandeep Kharb, Rajan Kapoor
September-October 2013, 17(5):855-863
DOI:10.4103/2230-8210.117248  PMID:24083167
Introduction: Endocrine complications are common after hematopoietic stem cell transplant (HSCT). Although HSCT is performed at various centers in India, no study is available for endocrine dysfunctions among them. This study was carried out with the objective to evaluate endocrine dysfunction among patients undergone HSCT in the past. Materials and Methods: We carried out a cross-sectional study in a 50 post-HSCT recipients (39 allogenic, 11 autologous). All relevant data were collected from patient's records. Samples for hormonal estimation were collected and stimulation tests for cortisol and growth hormone were interpreted based on peak values achieved during insulin tolerance test. Results: The mean age of patients was 26.3 ± 16.9 years (range 4-74). Adrenal insufficiency (AI) was present in 60%, hypergonadotropic hypogonadism (HH) in 60%, growth hormone deficiency (GHD) in 54%, hypothyroidism in 4%, hyperprolactinemia in 4%, new onset diabetes after transplant in 4%, and impaired fasting glucose in 6%. Multiple endocrine complications were common. GHD was present in 77% of children (n = 22) although height standard deviation score was not statistically different compared to those who didn't have GHD. HH was present in 36% of children. In adults (n = 28), 36% had GHD, all females had HH, and 89% of males had HH. Germ cell dysfunction with compensated Leydig cell dysfunction was the most common pattern of HH in males. Fifteen patients had graft versus host disease (GVHD). GVHD had no bearing on development of endocrine deficiencies. AI was related to duration after and type of transplant, but was unrelated to steroid intake. Conclusions: Endocrine manifestations are common after HSCT; they can occur as early or late complications. All HSCT recipients should have endocrine evaluation as per prevailing guidelines.
  4 2,817 303
Effect of two different doses of oral cholecalciferol supplementation on serum 25-hydroxy-vitamin D levels in healthy Indian postmenopausal women: A randomized controlled trial
Niti Agarwal, Ambrish Mithal, Vibha Dhingra, Parjeet Kaur, Madan Mohan Godbole, Manoj Shukla
September-October 2013, 17(5):883-889
DOI:10.4103/2230-8210.117237  PMID:24083171
Aim: To compare the effect of two different doses (500 and 1000 IU/day) of oral vitamin D3 (cholecalciferol) on serum 25-hydroxy vitamin D [25(OH)D] levels in apparently healthy postmenopausal Indian women. Materials and Methods: Serum 25(OH)D, calcium with albumin, phosphorus, and alkaline phosphatase were measured in 92 apparently healthy postmenopausal women. The subjects were randomly assigned to one of the three groups and received supplementation for 3 months each. Each group received 1000 mg calcium carbonate daily while groups B and C received 500 and 1000 IU of cholecalciferol in addition, respectively. The tests were repeated after 3 months. Results: At baseline, 83.7% subjects had vitamin D deficiency (≤20 ng/mL). The difference in the percentage change in mean serum 25(OH)D levels from baseline in group A (-30.5 ± 5.3%), group B (+8.9 ± 19.7%), and in group C (+97.8 ± 53.3%) was statistically significant (P < 0.001) between the three groups. Serum 25(OH)D level >20 ng/mL was achieved in 4.7% (1/21), 16% (4/25), and 66.67% (12/18) subjects in groups A, B, and C, respectively. No significant change was found in serum calcium, phosphorus, and alkaline phosphatase levels at 3 months in either of the groups from baseline. Conclusions: Standard dose of cholecalciferol available in "calcium tablets" (250 IU per 500 mg calcium carbonate) is not adequate for achieving optimum serum 25(OH)D levels in Indian postmenopausal women. Higher dose of vitamin D supplementation with 1000 IU/day (500 IU per 500 mg calcium carbonate) daily is superior to the standard dose therapy. For achievement of optimum serum 25(OH)D levels (>30 ng/mL) in Indian postmenopausal women, still higher doses of vitamin D are likely to be required.
  4 2,498 529
Association of metabolic syndrome with schizophrenia
Sarita Bajaj, Anurag Varma, Anubha Srivastava, Anand Kumar Verma
September-October 2013, 17(5):890-895
DOI:10.4103/2230-8210.117238  PMID:24083172
Background: Metabolic syndrome (MetS) is associated with mental illnesses. It is a major predictor of mortality and morbidity in patients of such mental illnesses. This study was undertaken to study the association of MetS and schizophrenia. Objectives: To study the association of MetS in patients of schizophrenia. Materials and Methods: Adult schizophrenic patients diagnosed as per Diagnostic and Statistical Manual -IV Third R evisioncriteria visiting the psychiatric Out Patient Day during the study period were evaluated for prevalence of MetS as per the criteria of the international diabetes federation. Fifty patients of schizophrenia with age-and sex-matched 50 controls were enrolled for the study. Results: MetS was found to be 28% in patient group and 12% in control group (P < 0.05). Fourteen patients were found to have MetS out of 38 patients who were on antipsychotics for >6 months. All the 14 patients having MetS were taking second-generation antipsychotics (SGAs) ( P < 0.05). Conclusion: The study showed a higher prevalence of MetS in schizophrenia than in general population. MetS was present only in patients taking SGAs and prevalence of MetS had a positive correlation with duration of treatment. The study points toward urgent need for consultation - liaisoning between Diabetologist and Psychiatrists.
  4 1,050 315
Evaluation of only the chin or lower abdomen for predicting hirsutism
Homeira Rashidi, Zohreh T Parizi, Mehdi Mohammadi
September-October 2013, 17(5):896-898
DOI:10.4103/2230-8210.117239  PMID:24083173
Background: Hirsutism is defined as the growth of terminal hair in a male pattern in women; it affects 5-15% of women. Objective: The aim of this study is evaluation of only the chin or lower abdomen for predicting hirsutism. Materials and Methods: In this cross-sectional diagnostic study, we randomly selected 695 women aged 15-45 years. The examiners scored the subjects on a scale of 0 - 4 for terminal hair growth on nine different body areas according to the Ferriman-Gallwey (FG) scoring system in a form given to the examiners before the examination. An FG score of 8 or more was considered diagnostic of hirsutism. If the sum of the FG scores for the chin or lower abdomen was 2 or more, the test result was assumed to be positive. Statistical analysis was performed using the MacNemar test, and a P value of less than 0.05 was considered to be statistically significant. Results: The age group with the highest prevalence rate was 21-25 years. From the 695 subjects examined, 81 subjects (11.7%) had an FG score of 8 or more with a resultant prevalence rate of 11.7% for hirsutism. In our study population, 39% of the patients had an FG score of 2 or more for the chin or lower abdomen, and 61% of the patients had an FG score of less than 2 for the chin or lower abdomen. Conclusion: Evaluating terminal hair growth on the chin or lower abdomen for predicting hirsutism seems to be an acceptable screening method.
  4 1,102 241
CASE REPORTS
Malignant thyroglossal duct cyst with synchronous occult thyroid gland papillary carcinoma
R Senthilkumar, JF Neville, R Aravind
September-October 2013, 17(5):936-938
DOI:10.4103/2230-8210.117229  PMID:24083187
A 52-year-old male was referred to our department with complaints of a painless midline neck swelling. Clinico-radiological evaluation suggested a 6 × 5 cm thyroglossal cyst with non-palpable nodules in isthmus and right lobe of thyroid gland. FNAC of the thyroglossal cyst was suggestive of papillary carcinoma. He underwent Sistrunk's operation, total thyroidectomy, and central compartment neck dissection. Co-existence of papillary carcinoma of thyroid gland and thyroglossal cyst is a rare presentation and in this report, we describe our management and propose an evidence-based algorithm to assist decision-making in the management of these patients in future.
  3 2,474 303
ORIGINAL ARTICLES
Comparison of the world health organization and the International association of diabetes and pregnancy study groups criteria in diagnosing gestational diabetes mellitus in South Indians
Sivagnanam Nallaperumal, Balaji Bhavadharini, Manni Mohanraj Mahalakshmi, Kumar Maheswari, Ramesh Jalaja, Anand Moses, Ranjit Mohan Anjana, Mohan Deepa, Harish Ranjani, Viswanathan Mohan
September-October 2013, 17(5):906-909
DOI:10.4103/2230-8210.117241  PMID:24083175
Aim: We aimed to compare the International Association of Diabetes and Pregnancy Study Groups (IADPSG) and the World Health Organization (WHO) criteria to diagnose gestational diabetes mellitus (GDM) in Chennai, India. Materials and Methods: We reviewed the retrospective data of 1351 pregnant women who underwent screening for GDM at four selected diabetes centers at Chennai (three private and one government). All women underwent an oral glucose tolerance test using 75g glucose load and fasting, 1-h, and 2-h samples were collected. The IADPSG and WHO criteria were compared for diagnosis of GDM. Results: A total of 839 women had GDM by either the IADPSG or the WHO criteria, of whom the IADPSG criteria identified 699 and the WHO criteria also identified 699 women as having GDM. However, only 599/839 women (66.6%) were identified by both criteria. Thus, 140/839 women (16.7%) were missed by both the IADPSG and the WHO criteria. 687/699 (98.2%) of the women with GDM were identified by the WHO criteria. In contrast, each value of IADPSG criteria i.e., fasting, 1 h, and 2 h identified only 12.5%, 14%, and 22%, respectively. Conclusions: A single WHO cut-point of 2 h > 140 mg/dl appears to be suitable for large-scale screening for GDM in India and other developing countries.
  3 2,679 640
REVIEW ARTICLES
Psychosocial management of diabetes in pregnancy
Bharti Kalra, GR Sridhar, K Madhu, Yatan Pal Singh Balhara, Rakesh Kumar Sahay, Sanjay Kalra
September-October 2013, 17(5):815-818
DOI:10.4103/2230-8210.117216  PMID:24083162
This consensus based national guideline addresses the need for psychological, psychiatric and social assessment, as well as management, in antenatal women with diabetes. It builds upon the earlier Indian guidelines on psychological management of diabetes, and should be considered as an addendum to the parent guideline.
  3 1,623 413
BRIEF COMMUNICATIONS
Anesthetic techniques and parathyroid hormone levels: Predictor of surgical decisions
Sukhminder Jit Singh Bajwa
September-October 2013, 17(5):910-912
DOI:10.4103/2230-8210.117214  PMID:24083176
Endocrine surgeries have always been challenging and throw numerous challenges to the surgeons, anesthesiologists, and the endocrinologists. A thorough knowledge of the pathophysiological aspects associated with endocrinopathies is mandatory for the attending anesthesiologist. Parathyroid surgery is a very delicate procedure that requires immense and meticulous preparation during the perioperative period for achieving a clinical outcome. Parathyroid hormone (PTH) levels during intra-operative period can influence the decision making in surgery. Anesthetic techniques also play a significant role in the secretion of PTH during perioperative period, which can be decisive in re-assessment of surgical procedure on operation table. The present communication briefly outlines the various anesthetic techniques, which influence the secretion of PTH and also influence surgical decision making.
  2 1,005 224
EDITORIALS
Defining vitamin D deficiency, using surrogate markers
MK Garg, Sanjay Kalra, Namita Mahalle
September-October 2013, 17(5):784-786
DOI:10.4103/2230-8210.117189  PMID:24083156
  2 1,317 392
LETTERS TO THE EDITOR
Serum lipids and diabetic retinopathy
V Mohan
September-October 2013, 17(5):945-945
DOI:10.4103/2230-8210.117203  PMID:24083191
  2 722 226
Primary hyperparathyroidism in a case of chronic myelogenous leukemia
Nasim Valizadeh, Faramarz Herfehdoust, Neda Valizadeh, Sara Vossoghian
September-October 2013, 17(5):942-943
DOI:10.4103/2230-8210.117201  PMID:24083189
  2 995 172
CASE REPORTS
Acute mania after thyroxin supplementation in hypothyroid state
Rohit Verma, Ankur Sachdeva, Yogendra Singh, Yatan P. S. Balhara
September-October 2013, 17(5):922-923
DOI:10.4103/2230-8210.117220  PMID:24083180
The current literature variedly ascribes depressive and manic symptoms to hypo- and hyperthyroid state, respectively, reporting mania in hypothyroidism as an unusual entity. More unusual is precipitation of manic state in hypothyroid subjects after thyroxine supplementation for which studies report otherwise treating manic symptoms in hypothyroid state with thyroxine. We report a case of a patient whose acute mania appears to have been precipitated by thyroxine supplementation in hypothyroidism state. This case underscores the importance of thyroid screening in patients with mood and psychotic disorders, as well as the potency of thyroxine in producing manic symptoms.
  1 1,466 302
EDITORIALS
Adaptation to vitamin D deficiency: Age specific clinical presentations
Ashraf Soliman, Sanjay Kalra
September-October 2013, 17(5):775-779
DOI:10.4103/2230-8210.117185  PMID:24083154
  1 1,547 426
LETTERS TO THE EDITOR
Thyroid disorders in pregnancy: An overview of literature from Pakistan
Rafia Afzal
September-October 2013, 17(5):943-945
DOI:10.4103/2230-8210.117202  PMID:24083190
  1 919 246
Endocrine and diabetes research from SAARC (South Asian Association for Regional Cooperation) countries
K. V. S. Hari Kumar, Anil Misra
September-October 2013, 17(5):950-951
DOI:10.4103/2230-8210.117213  PMID:24083196
  1 928 188
ORIGINAL ARTICLES
Determinants of developing diabetes mellitus and vascular complications in patients with impaired fasting glucose
Faranak Sharifi, Yahya Jaberi, Fatemeh Mirzamohammadi, Hamid Mirzamohammadi, Nouraddin Mousavinasab
September-October 2013, 17(5):899-905
DOI:10.4103/2230-8210.117240  PMID:24083174
Aims: To detect the risk factors of diabetes mellitus (DM) and cardiovascular complications in subjects with impaired fasting glucose (IFG). Materials and Methods: One hundred and twenty three subjects with proved IFG in Zanjan Healthy Heart Study (2002-2003) were recalled and participated in this study (2009-2010). Demographic and laboratoryinformation of the participants were collected.Ischemic heart disease (IHD) was assessed by the exercise tolerance test (ETT). All the subjects with abnormal ETT or documented past history of IHD confirmed by angiographic evaluation. Ophthalmic complications including cataract, glaucoma, and diabetic retinopathy were estimated by an ophthalmologist. Results: Incidence of DM was 19.5%. All the diabetic and pre-diabetic patients had at least one of the other components of metabolic syndrome. Obesity (P: 0.04, OR: 1.8, 95%CI: 1.2-9) and low physical activity (P < 0.001, OR: 9.6, 95%CI: 3.4-32) were the only independent prognostic risk factors for progression to DM in patients with IFG. Total incidence of IHD was 14.6% and had a strong correlation with sex (P: 0.01, OR: 1.8, 95%CI: 1.2-1.5), age (P < 0.001, OR: 23, 95%CI: 2.1-67) and cigarette smoking (P < 0.001, OR: 36.5, 95%CI: 3.9-337). Non-proliferative diabetic retinopathy was shown in 2 (1.6%) subjects who were all women. Conclusion: Obesity and low physical activity are the main factors of developing DM and its macrovascular complications in subjects with IFG.
  1 1,539 349
Differences in traditional and non-traditional risk factors with special reference to nutritional factors in patients with coronary artery disease with or without diabetes mellitus
Namita P Mahalle, MK Garg, Mohan V Kulkarni, Sadanand S Naik
September-October 2013, 17(5):844-850
DOI:10.4103/2230-8210.117235  PMID:24083165
Introduction: There is an increase in awareness about the role of nutritional factors in chronic non-communicable diseases. We therefore conducted this study with an aim to assess the relationship between nutritional factor (vitamin B12 and homocysteine [Hcy]) and its association with insulin resistance and inflammatory markers, and differences in traditional and non-traditional risk factors among diabetics and non-diabetics in known cases of coronary artery disease (CAD). Materials and Methods: Three hundred consecutive patients with known coronary disease on coronary angiography, who were >25 years old were included in this study. All cases were interviewed using a questionnaire. Blood samples were analyzed for insulin, vitamin B12, Hcy and inflammatory markers (highly sensitive C-reactive protein [hsCRP], interleukin-6 [IL-6], Tumor necrosis factor-alfa [TNF-α]). Insulin resistance was calculated with homeostasis model assessment of insulin resistance (HOMA-IR). Results: Mean age of the patients was 60.95 ± 12.3 years. Body mass index and waist hip ratio were comparable in both groups. Triglyceride, very low-density lipoprotein and HbA1C were significantly higher and high-density lipoprotein (HDL) was significantly lower in patients with diabetes. Patients with diabetes had significantly high levels of IL-6, hsCRP and TNF-α compared with non-diabetic patients. Insulin resistance was twofold higher in diabetic patients. Serum vitamin B12 levels were significantly lower and Hcy was significantly higher in the diabetic group compared with the non-diabetic patients. HbA1C, HOMA-IR and Hcy levels were positively correlated with inflammatory markers in the total study population and in the non-diabetic patients; but, in diabetic patients, HbA1C and Hcy showed this relation. Conclusions: Vitamin B12 deficiency is common in the diabetic population. Hcy levels were higher in diabetics compared with non-diabetics, and were related to glycemic level and insulin resistance in diabetic patients. Patients with diabetes had higher traditional risk factors than patients without diabetes in known patients with CAD. Glycemic status was associated with insulin resistance and inflammatory markers.
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CASE REPORTS
Short fourth and fifth metacarpals in a case of idiopathic primary hypoparathyroidism
Neda Valizadeh, Alireza Mehdizadeh, Surena Nazarbaghi
September-October 2013, 17(5):924-926
DOI:10.4103/2230-8210.117221  PMID:24083181
Shortening of metacarpals is a useful diagnostic marker in patients with pseudohypoparathyroidism type Ia (PHP-Ia) with Albright's hereditary osteodystrophy (AHO) phenotype or pseudopseudohypoparathyroidism (PPHP). There are very rare reports of metacarpals shortening in idiopathic primary hypoparathyroidism (IPH) cases in the literature. Here we described a young woman with IPH who presented with hypocalcaemia and generalized tonic-clonic seizure. She had shortening of forth and fifth metacarpals which was prominent in her right hand. Based on our finding and other previous case reports we conclude that metarpals shortening is not a specific finding of PHP-Ia or PPHP and it may be found in IPH cases.
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Local recurrence as a first sign of parathyroid malignancy! Need to redefine the criteria for diagnosis of parathyroid carcinoma
PV Pradeep, Vydehi Venkata Bheemaraju
September-October 2013, 17(5):927-929
DOI:10.4103/2230-8210.117222  PMID:24083183
Pathological criteria alone do not make an accurate diagnosis of parathyroid carcinoma in cases of well-defined organ contained lesion without local and distant metastasis. Intra-operative appearance of pale, grayish, firm tumor is highly suggestive of parathyroid carcinoma, even though this finding is not included in the pathological criteria for diagnosing a malignancy. Gross features of the tumor also should be added to the pathological criteria so as to ensure an accurate assessment of the biological behavior of the parathyroid tumor.
  - 1,364 214
Concurrent parathyroid carcinoma and adenoma: A rare presentation of a rarer disease entity
Shamita Chatterjee, Udipta Ray, Shahana Gupta, Arghya Basu
September-October 2013, 17(5):939-941
DOI:10.4103/2230-8210.117231  PMID:24083188
Parathyroid carcinoma is a rare disease. But multiglandular parathyroid neoplasm is even rarer. A high level of suspicion, on the basis of clinical, hematological tests and intraoperative findings is necessary to treat this disease entity, particularly in the absence of palpable neck masses. Preoperative localization is important. Bilateral neck exploration should be done routinely and all 4 glands seen to avoid missing out other pathological glands.
  - 1,457 246
CASE REPORTS WITH REVIEW OF LITERATURE
A young diabetic with suicidal risk: Rare disease with a rarer presentation
Rajeev Philip, P Prem Patidar, Pankaj Agarwal, KK Gupta
September-October 2013, 17(5):920-921
DOI:10.4103/2230-8210.117218  PMID:24083179
Rare genetic or inherited forms of diabetes can mimic immune mediated type 1 diabetes. Early age of onset and associated features help to differentiate these diseases from type 1 diabetes. Wolfram syndrome, an inherited neuro degenerative disorder, presents as insulin dependent diabetes mellitus, diabetes insipidus, optic atrophy and deafness. But less well described features like psychiatric manifestations can be the presentation of this disease. We present such a case. Wolfram syndrome should be considered as a differential diagnosis in insulin dependent diabetic children who present with neuropsychiatric problems.
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ERRATUM
Erratum

September-October 2013, 17(5):926-926
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Erratum

September-October 2013, 17(5):932-932
  - 427 96
LETTERS TO THE EDITOR
Diabetes education: "Personal" family member or "impersonal" diabetes educator?
Jaikrit Bhutani, Sukriti Bhutani, JK Bhutani
September-October 2013, 17(5):945-946
DOI:10.4103/2230-8210.117204  PMID:24083192
  - 673 186
Newer therapies in the operative management of phaeochromocytoma
Sukhminder Jit Singh Bajwa
September-October 2013, 17(5):946-947
DOI:10.4103/2230-8210.117206  PMID:24083193
  - 601 175
Raised CA19.9 and hepatic space occupying lesion after teriparatide therapy in a case of polyostotic fibrous dysplasia
Aditi Pandit, Sandeep Kharb, MK Garg
September-October 2013, 17(5):947-949
DOI:10.4103/2230-8210.117209  PMID:24083194
  - 776 196
Alström syndrome: A rare association of retinitis pigmentosa with insulin resistance syndrome
Irfan Yousuf Wani, Ashraf Ganie, Iqra Mehraj, Yasser Yousuf Wani, Muzafar Naik
September-October 2013, 17(5):949-950
DOI:10.4103/2230-8210.117211  PMID:24083195
  - 966 212
ORIGINAL ARTICLES
Bibliometric analysis of Indian Journal of Endocrinology and Metabolism
Garima Bhutani, Jyoti Kaushal, Sushila Godara
September-October 2013, 17(5):871-875
DOI:10.4103/2230-8210.117251  PMID:24083169
Background: Bibliometric analysis of the journal is a method to assess the research impact or research influence of that journal. This information can also be used to evaluate the influence/performance of a researcher and to provide a comparison between researchers. This work was aimed at performing bibliometric analysis of Indian Journal of Endocrinology and Metabolism (IJEM). Materials and Methods: The publications of year 2011-12 of IJEM were analyzed. Total number of articles published, type of articles, their authorship, and the coverage of various subspecialties was studied. The publications were also classified as Indian or foreign, from endocrine or nonendocrine departments and from academic or nonacademic institutions according to the institution of first author. Results and Conclusions: A total of 10 main issues and 7 supplementary issues were published in IJEM in year 2011 and 2012. These included a total of 605 publications, which depict a dramatic increase in the number of publications in last 2 years as compared to the previous years. Taking collectively, review articles were published in majority. Maximum number of articles was dealing with pancreas and metabolic disorders followed by thyroid. Other endocrine organs were given almost similar importance. Publications were largely originating from endocrine departments and from academic institutions. Although maximum number of articles were from India, but the publications from other countries are also on an increase. Thus, the widespread coverage of this journal suggests that IJEM has begun to represent global face of Indian endocrinology.
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