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   2015| January-February  | Volume 19 | Issue 1  
    Online since December 12, 2014

 
 
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BRIEF COMMUNICATIONS
Assessment of insulin sensitivity/resistance
Manish Gutch, Sukriti Kumar, Syed Mohd Razi, Kumar Keshav Gupta, Abhinav Gupta
January-February 2015, 19(1):160-164
DOI:10.4103/2230-8210.146874  PMID:25593845
Insulin resistance is one pretty troublesome entity which very commonly aggravates metabolic syndrome. Many methods and indices are available for the estimation of insulin resistance. It is essential to test and validate their reliability before they can be used as an investigation in patients. At present, hyperinsulinemic euglycemic clamp and intravenous glucose tolerance test are the most reliable methods available for estimating insulin resistance and are being used as a reference standard. Some simple methods, from which indices can be derived, have been validated e.g. homeostasis model assessment (HOMA), quantitative insulin sensitivity check index (QUICKI). For the clinical uses HOMA-insulin resistance, QUIKI, and Matsuda are suitable, while HES, McAuley, Belfiore, Cederholm, Avignon and Stumvoll index are suitable for epidemiological/research purposes. With increasing number of these available indices of IR, it may be difficult for clinicians to select the most appropriate index for their studies. This review provides guidelines that must be considered before performing such studies.
  77 7,247 2,008
Insulin-derived amyloidosis
Yashdeep Gupta, Gaurav Singla, Rajiv Singla
January-February 2015, 19(1):174-177
DOI:10.4103/2230-8210.146879  PMID:25593849
Amyloidosis is the term for diseases caused by the extracellular deposition of insoluble polymeric protein fibrils in tissues and organs. Insulin-derived amyloidosis is a rare, yet significant complication of insulin therapy. Insulin-derived amyloidosis at injection site can cause poor glycemic control and increased insulin dose requirements because of the impairment in insulin absorption, which reverse on change of injection site and/or excision of the mass. This entity should be considered and assessed by histopathology and immunohistochemistry, in patients with firm/hard local site reactions, which do not regress after cessation of insulin injection at the affected site. Search strategy: PubMed was searched with terms "insulin amyloidosis". Full text of articles available in English was reviewed. Relevant cross references were also reviewed. Last search was made on October 15, 2014.
  23 1,757 415
REVIEW ARTICLES
Thyroid disorders and polycystic ovary syndrome: An emerging relationship
Rajiv Singla, Yashdeep Gupta, Manju Khemani, Sameer Aggarwal
January-February 2015, 19(1):25-29
DOI:10.4103/2230-8210.146860  PMID:25593822
As the prevalence of these endocrine dysfunctions increases, the association of polycystic ovary syndrome (PCOS) and autoimmune thyroid disease is increasingly being recognised. While the causality of this association is still uncertain, the two conditions share a bidirectional relationship. The exact nature of this link has not been elucidated yet. Both syndromes share certain common characteristics, risk factors, and pathophysiological abnormalities. Simultaneously, certain etiopathogenetic factors that operate to create these dysfunctions are dissimilar. Polycystic appearing ovaries are a clinical feature of hypothyroidism, though hypothyroidism should be excluded before diagnosing PCOS. Adiposity, increased insulin resistance, high leptin, evidence of deranged autoimmunity, all of which are present in both disease states, seem to play a complex role in connecting these two disorders. This brief communication explores the nature of the relationship between PCOS and hypothyroidism. It reviews current data and analyses them to present a unified pathophysiological basis, incorporating these complex relationships, for the same.
  20 7,206 1,479
BRIEF COMMUNICATIONS
Maternal serum biomarkers for risk assessment in gestational diabetes. A potential universal screening test to predict GDM status
Srinivasa R Nagalla, Caryn K Snyder, John E Michaels, Mary J Laughlin, Charles T Roberts, Madhuri Balaji, V Balaji, V Seshiah, Paturi V Rao
January-February 2015, 19(1):155-159
DOI:10.4103/2230-8210.140226  PMID:25593844
The prevalence of gestational diabetes mellitus (GDM) is increasing because of the worldwide obesity/diabetes epidemic. The complications of untreated GDM affect both the mother and baby and include complications during pregnancy as well as increased risk of subsequent type-2 diabetes in mothers and offspring. Standard tests for hyperglycemia in diabetes, such as fasting glucose and hemoglobin (HbA1c), are currently not recommended for GDM screening. Instead, an oral glucose tolerance test is specified, which is invasive, time-consuming, and not easily accessible to many at-risk populations. In this study, we describe a multi-analyte maternal serum profile test that incorporates novel glycoprotein biomarkers and previously described GDM-associated markers. In screening for GDM by multi-analyte panel, the detection rate was 87% at a false-positive rate of 1%.
  12 3,122 631
REVIEW ARTICLES
Incretin response in Asian type 2 diabetes: Are Indians different?
Awadhesh Kumar Singh
January-February 2015, 19(1):30-38
DOI:10.4103/2230-8210.146861  PMID:25593823
Incretin-based therapy has clearly emerged as one of the most sought out strategy in managing type 2 diabetes, primarily because they generally do not causes hypoglycemia and possess weight-neutral or weight losing properties. Efficacy-wise too, these agents, are more or less similar to commonly used drugs metformin and sulfonylureas. Interestingly, some studies recently suggested that glycemic response to these incretin-based therapies could also differ ethnicity-wise. Subsequently, meta-analysis from these studies also suggested that Asians may have better response to these incretin-based therapies. This review will be an attempt to critically analyze those studies available in literature and to address as to why East-Asians and South-Asians may have different incretin response compared to non-Asians.
  12 2,438 785
ORIGINAL ARTICLES
Relationship of salivary cortisol and anxiety in recurrent aphthous stomatitis
Lakshmi Kavitha Nadendla, Venkateswarlu Meduri, Geetha Paramkusam, Koteswara Rao Pachava
January-February 2015, 19(1):56-59
DOI:10.4103/2230-8210.131768  PMID:25593827
Background and Objectives: Recurrent aphthous stomatitis (RAS) is one of the most frequently encountered oral mucosal disorders. Despite extensive amount of research, the etiology of RAS remains unclear. Psychological-emotional factors were considered as one of the major predisposing factors. The aim of the study was to assess the levels of anxiety and salivary cortisol levels in patients with RAS and also to determine the association and relationship of salivary cortisol levels to variations of stress. Materials and Methods: A total of 30 patients suffering with RAS, along with the same number of age and sex matched healthy controls were included in the study. Saliva was collected from all the subjects at 9.00 am to avoid diurnal variations of cortisol levels. Salivary cortisol levels were measured by competitive enzyme linked immunosorbent assay. Anxiety levels of both groups were measured by using Hamilton's anxiety scale. Student's t-test was used to compare the anxiety and salivary cortisol levels between both groups. Results: The mean salivary cortisol level of the RAS group showed a very highly significant difference (P = 0.000) from the controls. The mean anxiety scores of the RAS group showed a very highly significant difference (P = 0.000) from the controls. The values of Pearson correlation coefficient between anxiety and salivary cortisol was 0.980 and one with a P value of 0.000 showing that there is a highly positive correlation between anxiety and salivary cortisol. Conclusion: Results suggest that anxiety may be involved in the pathogenesis of RAS. Thus besides traditional treatment of RAS patients, our findings suggest that psychological support is also needed.
  9 2,313 524
Endocrine alterations in HIV-infected patients
Sujit Kumar Tripathy, Ritesh Kumar Agrawala, Anoj Kumar Baliarsinha
January-February 2015, 19(1):143-147
DOI:10.4103/2230-8210.146870  PMID:25593842
Aims and objectives: To study the frequency of thyroid, adrenal and gonadal dysfunction in newly diagnosed HIV-infected patients and to correlate them at different levels of CD4 cell counts. Materials and Methods: Forty-three HIV-positive cases were included in the study group. Cases were divided into three groups on the basis of CD4 cell count. Serum free T3, free T4, TSH, Cortisol, FSH, LH, testosterone and estradiol were estimated by the radioimmunoassay method. Hormone levels between cases were compared and their correlation with CD4 count was analyzed. Results: Prevalence of gonadal dysfunction (88.3%) was the most common endocrine dysfunction followed by thyroid (60.4%) and adrenal dysfunction (27.9%). Secondary hypogonadism (68.4%) was more common than primary (31.6%). Low T3 syndrome, that is, isolated low free T3, was the most common (25.6%) thyroid dysfunction followed by secondary hypothyroidism (16.2%) and subclinical hypothyroidism (11.6%). Adrenal excess (16.3%) was more common than adrenal insufficiency (11.6%). The difference in hormonal dysfunction between male and female was statistically insignificant (P > 0.05). 27.9% of patients had multiple hormone deficiency. There was negligible or no correlation between CD4 count and serum hormone level. Conclusion: In our study, endocrine dysfunction was quite common among HIV-infected patients but there was no correlation between hormone levels and CD4 count. Endocrine dysfunctions and role of hormone replacement therapy in HIV-infected patient needs to be substantiated by large longitudinal study, so that it will help to reduce morbidity, improve quality of life.
  9 2,449 577
Primary hyperparathyroidism presenting as hypercalcemic crisis: Twenty-year experience
Dependra Narayan Singh, Sushil Kumar Gupta, Niraj Kumari, Narendra Krishnani, Gyan Chand, Anjali Mishra, Gaurav Agarwal, Ashok Kumar Verma, Saroj Kanta Mishra, Amit Agarwal
January-February 2015, 19(1):100-105
DOI:10.4103/2230-8210.131763  PMID:25593835
Context: To study hyperparathyroid-induced hypercalcemic crisis (HIHC). Aims: We see very advanced cases of primary hyperparathyroidism (PHPT) and therefore, we sought to determine the incidence of HIHC in our surgically-treated PHPT patients, clinical presentation, and short- and long-term results with the use of bisphosphonate therapy and expeditious parathyroidectomy over a 20-year period at a single institution. Settings and Design: Retrospective review of PHPT patients at Department of Endocrine Surgery, a tertiary care referral center. Materials and Methods: Retrospective review of 177 patients of advanced PHPT who underwent parathyroidectomy at a single institution from 1989 to 2010. All patients with serum calcium ≥14 mg/dl (≥3.5 mmol/l) were included in HIHC group. Statistical Analysis: Analysis of variance (ANOVA) was used to determine differences between groups. Data is expressed as mean ± standard error of the mean (SEM); P values less than 0.05 were considered significant. Results: We observed a higher incidence of HIHC (n = 37, 21%) with higher incidence of pancreatitis (n = 5, 13.5%). Crisis patients had heavier (6,717 mg) glands. Use of bisphosphonate therapy in seven crisis patients resulted in quicker lowering of serum calcium (mean: 4.5 vs 14.6 days in other crisis patients, P = 0.027) permitting early surgery. The incidence of postoperative hypocalcemia was not higher in these patients. Although the parathyroid adenoma was common pathology in both the groups, the incidence of parathyroid carcinoma was higher in crisis group (10.8%). Outcome with regards to postoperative eucalcemia was similar in both groups. Conclusions: Crisis patients are at risk of developing pancreatitis. Bisphosphonate therapy has the potential to quickly lower the serum calcium permitting early surgery without added risk of postoperative hypocalcemia. Successful and sustained eucalcemia with excellent long-term survival is possible with use of bisphosphonates and semi-emergent, focused parathyroidectmy.
  9 1,823 437
BRIEF COMMUNICATIONS
Glucagon-like peptide 1 and dysglycemia: Conflict in incretin science
Awadhesh Kumar Singh
January-February 2015, 19(1):182-187
DOI:10.4103/2230-8210.146881  PMID:25593851
Although GLP-1 (glucagon like peptide-1) based therapies (GLP-1 agonists and dipeptidyl peptidase-4 inhibitors) is currently playing a cornerstone role in the treatment of type 2 diabetes, dilemma does exist about some of its basic physiology. So far, we know that GLP-1 is secreted by the direct actions of luminal contents on the L cells in distal jejunum and proximal ileum. However, there is growing evidence now, which suggest that other mechanism via "neural" or "upper gut" signals may be playing a second fiddle and could stimulate GLP-1 secretion even before the luminal contents have reached into the proximities of L cells. Therefore, the contribution of direct and indirect mechanism to GLP-1 secretion remains elusive. Furthermore, no clear consensus exists about the pattern of GLP-1 secretion, although many believe it is monophasic. One of the most exciting issues in incretin science is GLP-1 level and GLP-1 responsiveness. It is not exactly known as to what happens to endogenous GLP-1 with progressive worsening of dysglycemia from normal glucose tolerance to impaired glucose to frank diabetes and furthermore with increasing duration of diabetes. Although, conventional wisdom suggests that there may be a decrease in endogenous GLP-1 level with the worsening of dysglycemia, literature showed discordant results. Furthermore, there is emerging evidence to suggest that GLP-1 response can vary with ethnicity. This mini review is an attempt to put a brief perspective on all these issues.
  8 1,229 360
ORIGINAL ARTICLES
Impact of the Pro12Ala polymorphism of the PPARγ2 gene on diabetes and obesity in a highly consanguineous population
Abdulbari Bener, M Zirie, AOAA Al-Hamaq, Z Nawaz, N Samson, R Mohammad
January-February 2015, 19(1):77-83
DOI:10.4103/2230-8210.131766  PMID:25593831
Background: The peroxisome proliferator-activated receptors (PPARs) are members of the nuclear hormone receptor subfamily of transcription factors. It has been reported that they play important roles in obesity and the development of type 2 diabetes mellitus (T2DM). Materials and Methods: This case-control study was carried out among 764 Qatari patients with diabetes and 764 healthy subjects above 20 years of age at Primary Healthcare Clinics (PHCs) from January 2011 to December 2012. Face-to-face interviews were based on a questionnaire that included variables such as age, sex, sociodemographic status, body mass index (BMI) and other clinical parameters. The Pro12Ala in the PPARγ2 gene was detected on the LightCycler using two specific probes. Univariate and multivariate statistical analysis were performed. Results: The study revealed that in the diabetes group, Pro/(10.2% vs 9.4%; P = 0.606) and Ala/Ala (1.4% vs 0.9%; P = 0.343) were higher than in controls, whereas Pro/Pro (88.4% vs 89.7%;P = 0.413) was lower in diabetes patients, but no significant difference was observed among the genotype groups. In obese patients with diabetes, Pro/Pro (89% vs 89.9%;P = 0.792) and Pro/Ala (8.9% vs 10.1%;P = 0.671) were lower than in obese healthy subjects. No homozygous Ala/Ala was found in obese healthy subjects, whereas 6 Ala/Ala homozygotes were in obese diabetes group. But in diabetes group, obese patients had higher homozygous of Pro/Pro (89.3% vs 87.8%;P = 0.523) and Ala/Ala (1.8% vs 1.2%;P = 0.771) compared to non-obese patients. Conclusion: The current study did not reveal an association between the Pro12Ala polymorphism of the PPAR γ2 gene and type 2 diabetes (T2D) in Qatari's population.
  7 1,506 273
Aldose reductase C-106T gene polymorphism in type 2 diabetics with microangiopathy in Iranian individuals
Majid Reza Sheikh Rezaee, Ahmad Ahmadzadeh Amiri, Mohammad Bagher Hashemi-Soteh, Fatemeh Daneshvar, Roghaye Emady-Jamaly, Reza Jafari, Behyar Soleimani, Hamed Haghiaminjan
January-February 2015, 19(1):95-99
DOI:10.4103/2230-8210.131762  PMID:25593834
Background: Aldose reductase (AR) is the rate-limiting enzyme in the glucose metabolism, which has been implicated in the pathogenesis of diabetic microvascular complications (MVCs). Frequent C-106T polymorphism in the promoter of the AR gene may change the expression of the gene. Aims: The aim of the following study is to study the association between AR C106T genotypes and diabetic MVCs in Iranian population. Materials and Methods: We included 206 type 2 diabetic patients categorized into two groups according to the presence or absence of diabetic microangiopathy. The cases of interest were diabetic neuropathy, retinopathy and nephropathy identified during clinical and or laboratory examination. In addition, 114 age- and sex-matched individuals were selected to serve as a control group. AR genotyping was done using an amplification gel electrophoresis. Results: The frequency of CC genotype was specifically higher in subjects with diabetic retinopathy as compared to those without it (53.2% vs. 38.1%, P = 0.030). Patients with diabetic microangiopathy in general; however, did not differ significantly between AR genotype groups. Conclusion: The C-106T polymorphism in the AR gene is likely a risk factor for development of only retinal complication of diabetes microvascular in Iranian individuals.
  7 1,646 292
A randomized placebo-controlled trial of the efficacy of denosumab in Indian postmenopausal women with osteoporosis
Shailesh Pitale, Mathew Thomas, Gaurav Rathi, Vaishali Deshmukh, Prasanna Kumar, Sanjay Reddy, Naresh Shetty, Atul Kakar, Sushrut Babhulkar, Bharat Mody, Jacob Chacko, Sudeep Acharya, Sadhna Joglekar, Vipul Halbe, Barbara G Kravitz, Brian Waterhouse, Antonio J Nino, Lorraine A Fitzpatrick
January-February 2015, 19(1):148-154
DOI:10.4103/2230-8210.146871  PMID:25593843
Introduction: Osteoporosis is a serious condition affecting up to 50% of Indian postmenopausal women. Denosumab reduces bone resorption by targeting the receptor activator of nuclear factor-κB ligand. This study assessed the efficacy and safety of denosumab in Indian postmenopausal women with osteoporosis. Materials and Methods: In this double-blind, multicenter, phase 3 study, 250 Indian postmenopausal women aged 55 to 75 years (T-score <-2.5 and >-4.0 at the lumbar spine or total hip; serum 25(OH) D levels ≥20 ng/mL) were randomized to receive one subcutaneous dose of denosumab 60 mg or placebo. All subjects received oral calcium ≥1000 mg and vitamin D 3 ≥ 400 IU daily. The primary end point was mean percent change in bone mineral density (BMD) at the lumbar spine from baseline to Month 6. Secondary end points included mean percent change from baseline in BMD at total hip, femoral neck, and trochanter at Month 6 and median percent change from baseline in bone turnover markers at Months 1, 3, and 6. Results: Total 225 subjects (denosumab = 111, placebo = 114) completed the six-month study. Baseline demographics were similar between groups. A 3.1% (95% confidence interval, 1.9%, 4.2%) increase favoring denosumab versus placebo was seen for the primary end point (P < 0.0001). Denosumab demonstrated a significant treatment benefit over placebo for the secondary end points. There were no fractures or withdrawals due to adverse events. Conclusions: Consistent with results from studies conducted in other parts of the world, denosumab was well tolerated and effective in increasing BMD and decreasing bone turnover markers over a six-month period in Indian postmenopausal women.
  6 2,596 522
REVIEW ARTICLES
Amadori albumin in diabetic nephropathy
Km. Neelofar, Jamal Ahmad
January-February 2015, 19(1):39-46
DOI:10.4103/2230-8210.146863  PMID:25593824
Nonenzymatic glycation of macromolecules in diabetes mellitus (DM) is accelerated due to persistent hyperglycemia. Reducing sugar such as glucose reacts non enzymatically with free €- amino groups of proteins through series of reactions forming Schiff bases. These bases are converted into Amadori product and further into AGEs. Non enzymatic glycation has the potential to alter the biological, structural and functional properties of macromolecules both in vitro and in vivo. Studies have suggested that amadori as well as AGEs are involved in the micro-macro vascular complications in DM, but most studies have focused on the role of AGEs in vascular complications of diabetes. Recently putative AGE-induced patho-physiology has shifted attention from the possible role of amadori-modified proteins, the predominant form of the glycated proteins in the development of the diabetic complications. Human serum albumin (HSA), the most abundant protein in circulation contains 59 lysine and 23 arginine residues that could, in theory be involved in glycation. Albumin has dual nature, first as a marker of intermediate glycation and second as a causative agent of the damage of tissues. Among the blood proteins, hemoglobin and albumin are the most common proteins that are glycated. HSA with a shorter half life than RBC, appears to be an alternative marker of glycemic control as it can indicate blood glucose status over a short period (2-3 weeks) and being unaffected by RBCs life span and variant haemoglobin, anemia etc which however, affect HbA1c. On the other hand, Amadori albumin may accumulate in the body tissues of the diabetic patients and participate in secondary complications. Amadori-albumin has potential role in diabetic glomerulosclerosis due to long term hyperglycaemia and plays an important role in the pathogenesis of diabetic nephropathy. This review is an approach to compile both the nature of glycated albumin as a damaging agent of tissues and as an intermediate diagnostic marker and its potential role in diabetic nephropathy.
  6 3,974 624
ORIGINAL ARTICLES
Association of depression with common carotid artery intima media thickness and augmentation index in a large Urban South Indian population- The Chennai Urban Rural Epidemiology Study (CURES - 138)
Subramani Poongothai, Rajendra Pradeepa, Karunakaran Indulekha, Jayagopi Surendar, Viswanathan Mohan
January-February 2015, 19(1):136-142
DOI:10.4103/2230-8210.146869  PMID:25593841
AIM: The aim of the study was to assess the relationship of depression with carotid intima media thickness and augmentation index in Asian Indians. Research Design and Methods : For this study, 1505 subjects were randomly selected from a population based study conducted in Chennai, South India. Right common carotid artery intima medial thickness [IMT] was determined using high-resolution B-mode ultrasonography. Augmentation index [AI] was measured using the Sphygmocor apparatus. Depressive symptoms were assessed using a previously validated instrument, the Patient Health Questionnaire -12 (PHQ -12). Results : Of the 1505 subjects included in this study, depressive symptoms were present in 16.6% (n = 250) of the subjects. The mean IMT and AI values among subjects with depression were significantly higher than those without depression [0.83 ± 0.43 mm vs 0.73 ± 0.12 mm, P < 0.001] and IMT was higher in females with depression while AI was higher in males with depression. However, both IMT and AI were higher among those with depression in both genders. In multiple logistic regression model, depressive symptoms were associated with IMT even after adjusting for age, gender, body mass index, fasting plasma glucose, serum cholesterol and hypertension (Odds ratio [OR] =2.17, 95% Confidence intervals [CI]:1.01- 4.63, P = 0.047) but in the case of AI, the significance was lost in the adjusted model (OR = 1.01, 95% CI: 0.991-1.02, P = 0.445). Conclusion: Among Asian Indians, presence of depressive symptoms was associated with carotid intima media thickness and Augmentation index, even after adjusting for potential confounders.
  5 2,656 261
BRIEF COMMUNICATIONS
A dialogue-based approach to patient education
Natasja K Jensen, Regitze Pals
January-February 2015, 19(1):168-170
DOI:10.4103/2230-8210.146876  PMID:25593847
In recent years, the need for person-centered patient education has become evident. To translate this approach into practice, new theoretically and empirically sound methods and models are required. This brief communication introduces a newly developed toolkit that has shown promise in facilitating person-centered education and active involvement of patients. Two health education models constituting the underlying basis for the toolkit are also presented.
  4 1,595 241
EDITORIAL
Endemic or epidemic? Measuring the endemicity index of diabetes
Sanjay Kalra, Arun Kumar, Prashant Jarhyan, Ambika Gopalakrishnan Unnikrishnan
January-February 2015, 19(1):5-7
DOI:10.4103/2230-8210.144633  PMID:25593819
  4 3,225 329
ORIGINAL ARTICLES
Assessment of thyroid and gonadal function in liver diseases
Sandeep Kharb, MK Garg, Pankaj Puri, Karninder S Brar, Aditi Pandit, Sharad Srivastava
January-February 2015, 19(1):89-94
DOI:10.4103/2230-8210.131761  PMID:25593833
Introduction: Liver is involved with the synthesis of carrier proteins and metabolism of various hormones and liver diseases may, therefore, be associated with various endocrine disturbances. This study was conducted to assess thyroid and gonadal function in subjects with acute hepatitis (AH), chronic liver disease (CLD), and those who had undergone liver transplantation (LT). Materials and Methods: Patients with AH, CLD with Child-Pugh stage A (CLD-1) and Child-Pugh stage B or C (CLD-2), and LT seen at our tertiary level hospital were assessed clinically, biochemically, and for thyroid and gonadal functions besides 25 healthy controls. Results: Thyroid dysfunction and hypogonadism were present in 14 (16%) and 24 (28%) patients with liver diseases respectively. Among thyroid dysfunction, the commonest was sick euthyroid syndrome six (7%), followed by subclinical hypothyroidism in three patients (3.5%), subclinical hyperthyroidism and thyrotoxicosis in two patients each (2.3%) and overt hypothyroidism in one patient. Among patients with LT and AH groups, the only abnormality was significantly lower total T3 compared with healthy controls. The CLD2 group had significantly lower levels of all thyroid hormones compared with controls and CLD1 group. Hypogonadism was commonest in patients with CLD-2 (14; 50%) followed by LT (3; 33%), CLD-1 (4; 20%), and AH (3; 14%). Hypogonadism was predicted by older age, lower levels of serum albumin, total cholesterol, and triglycerides and higher levels of plasma glucose, serum bilirubin, aspartate transaminases, and international normalized ratio. Gonadal functions showed recovery following LT. Conclusions: Thyroid dysfunction and hypogonadism form an important part of the spectrum of acute and CLD, and patients with LT. Deterioration of synthetic functions of liver disease predicts presence of hypogonadism.
  4 2,716 514
REVIEW ARTICLES
Adrenal imaging (Part 1): Imaging techniques and primary cortical lesions
Ananya Panda, Chandan J Das, Ekta Dhamija, Rakesh Kumar, AK Gupta
January-February 2015, 19(1):8-15
DOI:10.4103/2230-8210.146858  PMID:25593820
Adrenal glands can be affected by a variety of lesions. Adrenal lesions can either be primary, of adrenal origin, or secondary to other pathologies. Primary adrenal lesions can further be either of cortical or medullary origin. Functioning adrenal lesions can also give clues to the histologic diagnosis and direct workup. Over the years, various imaging techniques have been developed that have increased diagnostic accuracy and helped in better characterization of adrenal lesions non-invasively. In the first part of the two part series, we review adrenal imaging techniques and adrenal cortical tumors such as adenomas, adrenocortical tumors, adrenal hyperplasia and oncocytomas.
  4 3,882 881
EDITORIAL
Postpartum screening after gestational diabetes mellitus: Aiming for universal coverage
Nikhil Tandon, Yashdeep Gupta, Sanjay Kalra
January-February 2015, 19(1):1-4
DOI:10.4103/2230-8210.144634  PMID:25593818
  3 2,042 458
ORIGINAL ARTICLES
Effectiveness and safety of fixed dose combination of acarbose/metformin in Indian Type 2 diabetes patients: Results from observational GLOBE Study
Banshi Saboo, Gundam Chandrasekhara Reddy, Subhashchander Juneja, Ashok Kumar Kedia, Pravin Manjrekar, Rahul Rathod
January-February 2015, 19(1):129-135
DOI:10.4103/2230-8210.146868  PMID:25593840
Primary objective - evaluate effectiveness and safety of acarbose/metformin fixed dose FDC on glycemic control in Indian T2DM patients in real life clinical setting. Secondary objective - evaluate safety and satisfaction of treatment. Materials and Methods: Open-label, prospective, multicentre, single-arm, non-interventional study. Patients included were aged ≥18 years with T2DM on Acarbose (25/50 mg) and Metformin (500 mg) FDC. Glycemic parameters were recorded during observation. Results: Total 9364 patients were enrolled in the study (mean age, 50.7 years and 60.1% were male). Mean (SD) FBG and PPG was significantly reduced by 42.4 (32.6) mg/dl (P < 0.0001) and 80.2 (49.7) mg/dl (P < 0.0001) respectively at the end of observation. Mean (SD) HbA1c reduced by -1.0% (0.8) to 7.3% (0.7) at the last follow-up visit (P <0.0001). Majority of patients (97.5%) and physicians (98.42%) were satisfied with acarbose/metformin FDC treatment. Also, significant reduction in body weight by -1.7 (2.2) kg was observed (P < 0.0001). Patients with known T2DM and newly diagnosed showed a similar glycemic control (P < 0.0001). Drug-related adverse events were reported by only 1.4% patients mostly gastrointestinal. Conclusions: Acarbose/metformin FDC was efficacious, safe well accepted in routine clinical practice. It was well-tolerated without significant risk of hypoglycemia and can be used in early T2DM management
  3 3,549 467
LETTERS TO THE EDITOR
Goiter in Ancient Greek art
Konstantinos Laios, Gregory Tsoucalas, Marianna Karamanou, George Androutsos
January-February 2015, 19(1):190-190
DOI:10.4103/2230-8210.146883  PMID:25593855
  2 975 223
ORIGINAL ARTICLES
Association between serum albumin and glycated hemoglobin in Asian Indian subjects
Shalbha Tiwari, Manish Bothale, Imtiaz Hasan, Mahesh J Kulkarni, Mehmood G Sayyad, Rita Basu, Ananda Basu, Ambika Gopalakrishnan Unnikrishnan
January-February 2015, 19(1):52-55
DOI:10.4103/2230-8210.144631  PMID:25593826
Background: Protein glycation plays a signifi cant role in diabetic complications. Glycated hemoglobin (HbA1c) is a known predictor of diabetes and its complications. Albumin, found to be profoundly glycated in diabetes, and its level could regulate plasma protein as well as hemoglobin glycation. Aim: We aimed to evaluate the association between variations in albumin level with HbA1c in the Asian Indian population. Materials and Methods: We screened data of 929 subjects who have had a simultaneous measurement of fasting plasma glucose (FPG), HbA1c and albumin levels via the same blood collection. Data were analyzed by SPSS for 610 subjects who met the study criteria. Results: There was a signifi cant negative correlation between HbA1c and albumin concentration (r = −0.284; P < 0.001). Univariate analysis showed the statistically signifi cant decrease of average HbA1c but not for fasting plasma glucose (FPG) across increasing tertiles of albumin. Stepwise multiple regression model showed a signifi cant correlation between HbA1c and serum albumin (P < 0.05), FPG (P < 0.001), hemoglobin (Hb) (P < 0.001) and serum globulin (P < 0.05). FPG was the strongest predictor (63.4%) of variation of HbA1c. The albumin concentration (r = −0.114) accounted for 0.3% (P < 0.05) of the total variance in HbA1c independent of age, body mass index, FPG, Hb, creatinine, total protein and globulin. It was also observed that HbA1c decreases with increasing albumin concentration in those having FPG between 100 to <126 mg/dl. Conclusion: Serum albumin negatively correlates with HbA1c in Asian Indians independent of other variables. This study suggests that predicting diabetes and its complication based on the HbA1c needs to be further investigated in Indian subjects.
  2 2,395 475
Evaluation of glutathione S-transferase T1 deletion polymorphism on type 2 diabetes mellitus risk in Zoroastrian females in Yazd, Iran
Mohammadhosain Afrand, Saeedhossein Khalilzadeh, Nasrollah Bashardoost, Mohammad Hasan Sheikhha
January-February 2015, 19(1):124-128
DOI:10.4103/2230-8210.146867  PMID:25593839
Background: There has been much interest in the role of free radicals and oxidative stress in the pathogenesis of diabetes mellitus (DM). The aim of this study was to assess the possible association between genetic polymorphisms of the glutathione S-transferase-Theta (GSTT1) and the risk of the development of DM in Zoroastrian females in Yazd, Iran. Materials and Methods: This was a case-control study in which GSTT1 polymorphism was genotyped in 51 randomly selected DM patients and 50 randomly selected healthy controls among Zoroastrian females whose ages ranged from 40 to 70. Results: The frequencies of GSTT1 null genotype and GSTT1 present were 72% and 28%, respectively, in control samples, while in patients with type 2 diabetes (T2DM), the frequencies of GSTT1 null genotype and GSTT1 present were 27.5% and 72.5%, respectively. There were higher levels of triglyceride (TG), fasting blood sugar (FBS), total cholesterol (TC), low-density lipoprotein (LDL), Urea, and high-density lipoprotein (HDL) in cases of GSTT1 null genotype compared to the GSTT1 present genotype in controls. Conclusions: Our results indicated that healthy subjects had a higher frequency of the GSTT1 null genotype than patients with T2DM. However, we observed no significant association between the GSTT1 null genotype and T2DM in the current study.
  2 1,703 276
Status of iodine nutrition among pregnant mothers in selected districts of Uttarakhand, India
Umesh Kapil, Neha Sareen, Vanisha S Nambiar, Preetika Khenduja, Shubhra Pande
January-February 2015, 19(1):106-109
DOI:10.4103/2230-8210.131764  PMID:25593836
Background: Uttarakhand state is a known endemic area for iodine deficiency. Objective: The present study was conducted with an objective to assess the iodine nutritional status amongst pregnant mothers (PMs) in districts: Pauri (P), Nainital (N) and Udham Singh Nagar (USN) of Uttarakhand state. Materials and Methods: Thirty clusters from each district were selected by utilizing the population proportionate to size cluster sampling methodology. A total of 1727 PMs from P (481), N (614) and USN (632) were included. The clinical examination of the thyroid of each PM was conducted. Urine and salt samples were collected from a sub samples of PMs enlisted for thyroid clinical examination. Results: The total Goiter rate was found to be 24.9 (P), 20.2 (N) and 16.1 (USN)%. The median urinary iodine concentration (UIC) levels were found to be 110 μg/L (P), 117.5 μg/L (N) and 124 μg/L (USN). The percentage of PMs consuming salt with iodine content of 15 ppm and more was found to be 57.9 (P), 67.0 (N) and 50.3 (USN). Conclusion: The findings of the present study revealed that the PMs in all three districts had low iodine nutritional status as revealed by UIC levels of less than 150 μg/L.
  2 1,794 292
Clinical experience of switching from biphasic human insulin to biphasic insulin aspart 30 in Indian patients with type 2 diabetes in the A 1 chieve study
AK Das, Sanjay Kalra, Shahid Akhtar, Raman Shetty, Ajay Kumar
January-February 2015, 19(1):110-115
DOI:10.4103/2230-8210.131759  PMID:25593837
Aim: The aim of the following study is to evaluate the safety and effectiveness of switching from biphasic human insulin (BHI) to biphasic insulin aspart 30 (BIAsp 30) in Indian patients with type 2 diabetes as a sub-analysis of the 24-week, non-interventional A 1 chieve study. Materials and Methods: Indian patients switching from BHI to BIAsp 30 based on the physicians' decisions were included. The primary outcome was the incidence of serious adverse drug reactions (SADRs), including major hypoglycemic events; secondary outcomes included changes in hypoglycemia in the 4 weeks preceding baseline and week 24 and changes from baseline to week 24 in glycated hemoglobin A 1c (HbA 1c ), fasting plasma glucose (FPG), postprandial plasma glucose (PPPG), body weight and quality of life (QoL). Results: Overall, 1976 patients (mean ± standard deviation age, 55.1 ± 10.6 years and diabetes duration, 10.1 ± 5.3 years) on a mean pre-study BHI dose of 0.44 ± 0.18 U/kg were included. The mean BIAsp 30 dose was 0.43 ± 0.17 U/kg at baseline and 0.44 ± 0.17 U/kg at week 24. No SADRs were reported. The proportion of patients reporting overall hypoglycemic events reduced significantly from baseline to week 24 (15.0% vs. 2.9%, P < 0.0001). The mean HbA 1c level improved significantly from 9.1 ± 1.4% at baseline to 7.5 ± 1.0% at week 24, along with improvements in FPG, post-breakfast PPPG and QoL (P < 0.001). The mean body weight decreased from 69.3 ± 10.8 kg at baseline to 69.1 ± 10.4 kg at week 24 (P = 0.003). Conclusion: Switching from BHI to BIAsp 30 therapy was well-tolerated and was associated with improved glycemic control.
  2 1,917 308
Correlations among obesity-associated gene polymorphisms, body composition, and physical activity in patients with type 2 diabetes mellitus
Sanae Saitoh, Taeko Shimoda, Yukie Hamamoto, Yutaka Nakaya, Shigeru Nakajima
January-February 2015, 19(1):66-71
DOI:10.4103/2230-8210.131757  PMID:25593829
Context: Various studies have focused on the correlation between β2-adrenergic receptor (β2AR), the β3-adrenergic receptor (β3AR), and the uncoupling protein 1 (UCP1) polymorphisms and obesity in patients with type 2 diabetes mellitus (T2DM). Aims: We examined the correlation between these polymorphisms and body composition variables and between body composition and lifestyle variables in Japanese T2DM patients. Materials and Methods: Of the 48, T2DM outpatients in Kanagawa prefecture recruited for participation, 32 (6 men and 26 women) met the study criteria and were enrolled. Obesity-related gene polymorphisms were identified in 3 genes β3AR, UCP1, and β2AR using the SMart amplification process. Body composition variables were measured using a body composition analyzer. Data regarding food and nutrient consumption, family history, and lifestyle factors were collected via administration of questionnaires. Results: Because significant differences in body composition variables were found between men and women, statistical analysis was performed with data from the 25 female subjects only. On the basis of results of genetic testing, the subjects were divided into genotype groups for two-group and three-group comparison. The β3AR, UCP1, and β2AR polymorphisms and body composition significantly correlated with the percentage of subcutaneous fat in both arms as compared with the wild type or hetero groups with β3AR polymorphisms. However, physical activity correlated with several body composition variables. Conclusions: These results suggest that obesity in T2DM patients is not the result of presence of an obesity-related gene polymorphism but rather the absence of daily physical activity.
  2 2,316 330
Central adiposity is significantly higher in female compared to male in Pakistani type 2 diabetes mellitus patients
Omer Akhter, Faraz Fiazuddin, Ayesha Shaheryar, Warda Niaz, Danial Siddiqui, Safia Awan, Nanik Ram, Jaweed Akhter
January-February 2015, 19(1):72-76
DOI:10.4103/2230-8210.131767  PMID:25593830
Background: Type 2 diabetes mellitus (DM) rates are increasing rapidly in South Asians. Cardiovascular complications are more frequent and occur earlier in our patients than patients in many other ethnic groups. Reasons for this are not fully understood. Aims: The aim of this study is to evaluate the body total and central fat percentage in type 2 Diabetes Mellitus patients and to check correlation with BMI, waist circumference and metabolic profile. Settings and Design: A cross-sectional study conducted at endocrine clinic, Aga Khan University Hospital Karachi, Pakistan, from May to December 2012. Materials and Methods: Patients of either gender with type 2 diabetes mellitus were randomly selected. A separate proforma for each patient was recorded for demographics, risk factors, bioelectrical impedance measurement for body fat and investigations. Statistical Analysis: Correlation between body fat and other covariate were compared by Pearson correlation coefficient test. A P < 0.05 was considered significant. SPSS19.0 was used to analyze the data. Results: One hundred and seventy five patients (95 male and 80 female) with mean age of 54.1 ± 12 years were evaluated. Mean duration of diabetes was 8.1 years, mean HbA1c was 8.1% and 53.7% were on oral agents and rest were on insulin with or without oral agents. Hypertension was present in 65.7%, 13.7% had known coronary artery disease and 2.3% had cerebrovascular disease. Mean BMI in males was 29.1 ± 4.74 kg/m 2 and females 31.7 ± 5.3 kg/m 2 . Mean waist circumference in males was 107.3 ± 16.6 cm and 103 ± 12 cm in females. Total body fat percentage (%BF) in males was 30.9 ± 7.1% and females 40 ± 8.2% with 89% of the total cohort having total body fat percentage above the normal, less than 25% central fat percentage was 13.3 ± 5.2% in males and 14.6 ± 5.5% in females with 79.4% of cohort having increased central fat (normal <9%). Total and central body fat correlated with BMI (r = 0.68, P < 0.001) and waist circumference (r = 0.66, P < 0.001) but not with HbA1c, triglyceride level or with fasting or random blood glucose levels. Women had significantly higher total body fat percentage compared to men (P < 0.001) although central fat percentage was similar in both sexes. Conclusions: High body fat percentage, waist circumference are seen especially in woman and central body fat percentage in both sexes among patients with type 2 diabetes mellitus in Pakistan. Body fat percentage should be measured and followed as this may be an important contributing factor to the high macrovascular complication rate in this part of world.
  2 1,855 335
REVIEW ARTICLES
Adrenal imaging (Part 2): Medullary and secondary adrenal lesions
Ekta Dhamija, Ananya Panda, Chandan J Das, AK Gupta
January-February 2015, 19(1):16-24
DOI:10.4103/2230-8210.146859  PMID:25593821
Adrenal malignancies can be either primary adrenal tumors or secondary metastases, with metastases representing the most common malignant adrenal lesion. While imaging cannot always clearly differentiate between various adrenal malignancies, presence of certain imaging features, in conjunction with appropriate clinical background and hormonal profile, can suggest the appropriate diagnosis. The second part of the article on adrenal imaging describes adrenal medullary tumors, secondary adrenal lesions, bilateral adrenal lesions, adrenal incidentalomas and provides an algorithmic approach to adrenal lesions based on current imaging recommendations.
  2 8,038 917
ORIGINAL ARTICLES
No impact of dietary iodine restriction in short term development of hypothyroidism following fixed dose radioactive iodine therapy for graves disease
Jubbin Jagan Jacob, Charles Stephen, Thomas V Paul, Nihal Thomas, Regi Oommen, Mandalam S Seshadri
January-February 2015, 19(1):60-65
DOI:10.4103/2230-8210.131769  PMID:25593828
Background: The increased incidence of autoimmune thyroid disease with increasing dietary iodine intake has been demonstrated both epidemiologically and experimentally. The hypothyroidism that occurs in the first year following radioactive iodine therapy is probably related to the destructive effects of the radiation and underlying ongoing autoimmunity. Objective: To study the outcomes at the end of six months after fixed dose I, 131 therapy for Graves' disease followed by an iodine restricted diet for a period of six months. Materials and Methods: Consecutive adult patients with Graves' disease planned for I 131 therapy were randomized either to receive instructions regarding dietary iodine restriction or no advice prior to fixed dose (5mCi) I 131 administration. Thyroid functions and urinary iodine indices were evaluated at 3 rd and 6 th month subsequently. Results: Forty seven patients (13M and 34F) were assessed, 2 were excluded, 45 were randomized (Cases 24 and Controls 21) and 39 patients completed the study. Baseline data was comparable. Median urinary iodine concentration was 115 and 273 μg/gm creat (p = 0.00) among cases and controls respectively. Outcomes at the 3 rd month were as follows (cases and controls); Euthyroid (10 and 6: P = 0.24), Hypothyroid (3 and 5: P = 0.38) and Hyperthyroid (7 and 8: P = 0.64). Outcomes at the end of six months were as follows (cases and controls); Euthyroid (10 and 5: P = 0.12), Hypothyroid (3 and 5: P = 0.38) and Hyperthyroid (7 and 9: P = 0.43). Of the hypothyroid patients 5 (cases 1 and controls 4: P = 0.13) required thyroxine replacement. Conclusions: There was no statistical significant difference in the outcome of patients with dietary iodine restriction following I 131 therapy for Graves' disease.
  1 1,432 278
Long-term carbimazole pretreatment reduces the efficacy of radioiodine therapy
C Shivaprasad, KM Prasanna Kumar
January-February 2015, 19(1):84-88
DOI:10.4103/2230-8210.146865  PMID:25593832
Introduction: Data from several studies suggest that pretreatment with antithyroid drugs (ATD) before 131 I increases the risk of treatment failure. This effect has been demonstrated more consistently with propylthiouracil than with carbimazole (CMZ) or methimazole (MMI). Men with Graves' disease (GD) have a lower rate of remission with 131 I compared to women and the impact of long-term ATD pretreatment on the success of 131 I is unknown. The objective of our study was to compare the efficacy of fixed doses of radioiodine between patients with and without long-term CMZ pretreatment. Materials and Methods: We performed a retrospective study on 335 male patients with GD treated with 131 I from 1998 to 2008. 148 patients had been pretreated with CMZ, and the remaining 187 patients received 131 I without pretreatment. We compared the success rate of a single dose of 131 I, between patients with and without long-term CMZ pretreatment. Results: The success rate of a single dose of 131 I was significantly higher in patients without pretreatment than in patients who were pretreated with CMZ (91.4% vs. 82.3%, P = 0.01). The rate of hypothyroidism in the first 6 months after 131 I therapy was significantly higher in patients without pretreatment (55.1% vs. 44.6%, P = 0.05). There was also a trend for higher cumulative rate of hypothyroidism at last follow-up in nonpretreated patients (78.1% vs. 69.7%). Conclusion: Male patients with Graves' hyperthyroidism pretreated with CMZ have lower efficacy with 131I therapy compared to nonpretreated patients. CMZ pretreatment given for a prolonged period reduces the efficacy of 131 I therapy.
  1 1,647 347
BRIEF COMMUNICATIONS
Development of culturally sensitive dialog tools in diabetes education
Nana Folmann Hempler, Bettina Ewers
January-February 2015, 19(1):178-181
DOI:10.4103/2230-8210.146880  PMID:25593850
Person-centeredness is a goal in diabetes education, and cultural influences are important to consider in this regard. This report describes the use of a design-based research approach to develop culturally sensitive dialog tools to support person-centered dietary education targeting Pakistani immigrants in Denmark with type 2 diabetes. The approach appears to be a promising method to develop dialog tools for patient education that are culturally sensitive, thereby increasing their acceptability among ethnic minority groups. The process also emphasizes the importance of adequate training and competencies in the application of dialog tools and of alignment between researchers and health care professionals with regards to the educational philosophy underlying their use.
  - 2,156 293
Endocrine and metabolic disease: Confocal microscopy as a diagnostic aid
Jaikrit Bhutani, Raja Chandra Chakinala, Sukriti Bhutani, Shruti Sachdeva
January-February 2015, 19(1):171-173
DOI:10.4103/2230-8210.146877  PMID:25593848
Diabetes is a systemic disease associated with many complications. These can be prevented and managed effectively if detected promptly. Confocal microscopy (CFM) is a diagnostic tool which has the potential to help in early detection of disease and timely management. CFM has the potential to serve as an excellent noninvasive modality for in vivo imaging and morphological analysis, which can aid us in assessing and monitoring various infectious and pathological diseases at the cellular level. Besides ophthalmological indications, CFM has shown good sensitivity and specificity for identifying those at risk of neuropathy and foot ulceration, monitoring evolution and therapeutic response in a wide range of neuropathies apart from diabetic neuropathy. Through this communication, we aim to sensitize the endocrinologists towards cerebral cavernous malformation as a biomarker to evaluate potential outcomes and therapies in human diabetic neuropathy.
  - 906 208
Mountford Joseph Bramley: A pioneering thyroidologist and the first principal of Asia's oldest medical college
Subhankar Chatterjee, Adrija Datta, Pranab Chatterjee
January-February 2015, 19(1):165-167
DOI:10.4103/2230-8210.146875  PMID:25593846
Mountford Joseph Bramley was one of the educationists whose sincere efforts are undeniable in the making of modern India. After achieving the Member of the Royal College of Surgeons diploma, he joined the Malta Garrison as a Hospital Assistant and was soon promoted to the rank of Assistant Surgeon of the Rifle Brigade. Following his arrival in India in 1826, he held several important medical posts in the British service. He was one of the early researchers to investigate the role of iodine in the causation of goitre. He was appointed as the first Principal of the Medical College of Bengal, the oldest medical college in Asia, in 1835. Bramley was an educationist from the very core of his heart, and he always wished for the betterment of his students. He died early at the age of 34 years. His legacy as a pioneer in the fields of medical education and endocrinology, specifically thyroidology, has largely been shrouded in a miasma of time.
  - 2,117 202
LETTERS TO THE EDITOR
Bladder dysfunction in women with type 2 diabetes mellitus
Sim Sai Tin, Viroj Wiwanitkit
January-February 2015, 19(1):191-191
DOI:10.4103/2230-8210.146884  PMID:25593856
  - 779 216
Seizure as a presenting manifestation of vitamin D dependent rickets type 1
Mahmood Dhahir Al-Mendalawi
January-February 2015, 19(1):188-188
DOI:10.4103/2230-8210.131772  PMID:25593852
  - 981 191
Neonatal thyroid screening: Relationship between cord blood thyroid stimulating hormone levels and thyroid stimulating hormone in heel prick sample on 4 th to 7 th day-of-life
Mahmood Dhahir Al-Mendalawi
January-February 2015, 19(1):188-189
DOI:10.4103/2230-8210.131773  PMID:25593853
  - 988 209
Cut-offs for stretched penile length in neonates
Devi Dayal, Anil Kumar Bhalla
January-February 2015, 19(1):189-189
DOI:10.4103/2230-8210.146882  PMID:25593854
  - 1,362 250
ORIGINAL ARTICLES
Feasibility, efficacy, and safety of a simple insulin infusion protocol in a large volume cardiac surgery unit in India
Beena Bansal, Ambrish Mithal, Pravin Carvalho, Yatin Mehta, Naresh Trehan
January-February 2015, 19(1):47-51
Aim: Inpatient hyperglycemia management is essential, but difficult to achieve especially in a large volume cardiac surgery setup, thus necessitating use of nurse-led insulin protocols. A rapid flux of nurses dealing with a huge workload has been a cause for traditionally not using nurse-led protocols in most Indian institutes. The challenges we faced were to have a simple protocol for the nurses to accept it without compromising on glycemic control. Therefore, this observational study was planned to measure the efficacy and safety of the insulin infusion protocol in cardiac surgery patients. Materials and Methods: Insulin protocol was implemented, using seven fixed columns of infusion with the nurse making decisions to initiate and titrate doses based on simple rules. Blood glucose (BG) data captured from blood gas analyzers (glucometrics) in the intervention group (i.e., after protocol implementation) were compared to control group (i.e., before the protocol implementation). Results: The mean BG for the first 48 h was lower in the intervention group as compared to control group, without an increase in the episodes of hypoglycemia. The nurses found the protocol easy to understand, less time-consuming and there was no protocol deviation over 8 months after implementation. Conclusion: A small change in the process, allowing nurses to titrate insulin doses based on some rules and having seven fixed columns of insulin infusion rates, improved glycemic control and efficiency.
  - 1,873 262
Effects of acute organophosphate poisoning on pituitary target gland hormones at admission, discharge and three months after poisoning: A hospital based pilot study
Pinaki Dutta, Shruthi S Kamath, Ashish Bhalla, VN Shah, Anand Srinivasan, Prakamya Gupta, Surjit Singh
January-February 2015, 19(1):116-123
DOI:10.4103/2230-8210.131771  PMID:25593838
Background: Organophosphate compound (OPC) poisoning is common in the developing countries such as India. The acute and later effects of OPC poisoning on pituitary and target gland hormones is largely unknown. Materials and Methods: This prospective study was conducted at Postgraduate Institute of Medical Education and Research between January 2012 and March 2013. Fourteen patients (8 males, age 18-50 years) with acute OPC poisoning were included in the study based on the history and clinical features, documented decreased in plasma cholinesterase activity or presence of the OPC in gastric lavage/blood samples. The hormonal parameters were done at baseline, at the time of discharge and at three months of follow-up. Results: A total of 14 patients out of 46 with the mean age of 30.1 ± 10.3 years were finally eligible for the study. Hormonal alterations at admission were similar to sick euhormonal syndrome. Overall 7 of them had nine hormonal deficits at three months of follow up, 4 having sub normal basal cortisol level and two each had low testosterone and growth hormone and only one had thyroxine deficiency. Conclusion: Acute organophosphate poisoning results in endocrine dysfunction akin to sick euhormonal syndrome. However, in a small subset of patients, varying level of hormonal insufficiency may occur either at admission or later. These observations need re-validation in a larger group of patients with specific OPC.
  - 2,064 266
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