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   2019| September-October  | Volume 23 | Issue 5  
    Online since November 5, 2019

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Artificial Intelligence in Health Care: Focus on Diabetes Management
Ambika G Unnikrishnan
September-October 2019, 23(5):503-506
DOI:10.4103/ijem.IJEM_549_19  PMID:31803588
  2,963 210 1
Vitamin D, thyroid autoimmunity and cancer: An interplay of different factors
Deep Dutta, Meha Sharma, Sameer Aggarwal, Ritin Mohindra, Saptarshi Bhattacharya, Sanjay Kalra
September-October 2019, 23(5):507-513
DOI:10.4103/ijem.IJEM_526_19  PMID:31803589
Background and Aims: In spite of large volume of data linking Vitamin D with cardiovascular morbidity, autoimmunity, cancer, and virtually every organ system, Vitamin D and thyroid is a lesser-known aspect of Vitamin D in clinical practice. This article intends to highlight the current literature on the impact of Vitamin D status and supplementation on thyroid autoimmunity and cancer. Methods: References for this review were identified through searches of PubMed for articles published to from 1950 to August 2019 using the terms “thyroid” [MeSH Terms] AND “Vitamin D” [MeSH Terms] OR “thyroid” [All Fields] AND “Vitamin D” [All Fields]. Results: Significant inverse correlation was documented between anti-thyroid peroxidase antibody (TPOAb) and serum 25-hydroxy-Vitamin D (25OHD). TPOAb positivity is more prevalent in Vitamin D deficient individuals. A large volume of medical literature is available from observational studies linking Vitamin D with thyroid autoimmunity. Data from interventional studies documenting beneficial effects of Vitamin D on thyroid autoimmunity is also available, but lesser than that from observational studies. Short-term high dose oral Vitamin D supplementation reduces TPOAb titers. Certain Vitamin D receptor (VDR) gene polymorphism have been linked to increased occurrence of autoimmune thyroid disorders (AITD). Vitamin D deficiency, decreased circulating calcitriol has been linked to increased thyroid cancer. Certain VDR gene polymorphisms have been linked with increased as well as decreased occurrence of thyroid cancer. Data is scant on use of Vitamin D and its analogues for treating thyroid cancer. Conclusion: In spite of large volume of medical literature from observational studies linking Vitamin D with thyroid autoimmunity and cancer, meaningful concrete clinical data on impact of Vitamin D supplementation on hard clinical end points in these disorders is lacking, and should be the primary area of research in the next decade.
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Significance of vitamin D on the susceptibility of gestational diabetes mellitus – A meta-analysis
Prashant Tripathi, Yashwant Kumar Rao, Kiran Pandey, Kirti Amresh Gautam
September-October 2019, 23(5):514-524
DOI:10.4103/ijem.IJEM_184_19  PMID:31803590
Vitamin D plays an important role in glucose tolerance by stimulating insulin secretion and evidences suggest a contradictory result on the association between vitamin D status and risk of developing gestational diabetes mellitus (GDM). The present updated meta-analysis has been undertaken to find out the joined effect of vitamin D status on the risk of effect GDM considering previously published articles. Data were collected through literature search using electronic databases to retrieve relevant published research articles using various combinations of the following keywords, “vitamin D,” “vitamin D deficiency,” “cholecalciferol,” “25-hydroxyvitamin D,” “25(OH) D,” “gestational diabetes mellitus,” and “GDM.” A total of 36 studies including 7,596 GDM cases and 23,377 non-GDM controls were involved in this study. Overall, pooled meta-analysis showed that pregnant women diagnosed with GDM have 18% higher risk of GDM risk when compared with controls [odds ratio (OR) = 1.18, 95% confidence interval (CI) 1.10–1.25; P = 0.00] with high heterogeneity (I2 = 73.29). The mean difference was also significantly different between cases and controls (OR = −0.18, 95% CI − 0.22 to − 0.14; P = 0.00). Subgroup analysis showed significant results with age more than 30 years, Asian and European regions, and case–control, cross-sectional, and nested case–control study design. Low concentration of vitamin D is associated with the development of GDM. Although in future more studies especially systematically designed clinical trials based on vitamin D supplementation with large sample size on different population are needed to elucidate the exact concentration of vitamin D during pregnancy as well as before and after pregnancy.
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The impact of GE Lunar vs ICMR database in diagnosis of osteoporosis among South Indian subjects
Karthik Balachandran, Adlyne Reena Asirvatham, Shriraam Mahadevan
September-October 2019, 23(5):525-528
DOI:10.4103/ijem.IJEM_142_19  PMID:31803591
Objective: To study the effect of choosing ICMR reference values on the classification of bone mineral density in Indian patients. Design: Retrospective analysis of Dual Energy X-ray absorptiometry (DEXA) and clinical data. Patients: Totally, 316 patients aged more than 65 years attending a tertiary care hospital in South India who underwent DEXA scan were included in the study. Measurements: DEXA scan at femoral neck and lumbar spine. Results: A total of 316 patients were studied. The mean age was 61.98 ± 7.66 years. There were 46.84% females and 53.16% males. The average BMI was 26.37 ± 4.51. Of these patients, 46 had history of hip fracture (14.55%). The adoption of the ICMR normative data resulted in a significant increase in T scores in both the hip (+0.51, P < 0.05) and the spine (+1.64, P < 0.01). The adoption of ICMR normative values, resulted in reduction of osteoporosis prevalence from 26.58% to 5.06%. Conclusions: There is a clinically significant reduction in diagnosis of osteoporosis with the adoption of ICMR reference standard. Clinicians should be recommended to use raw BMD values in gm/cm2 in FRAX calculation and avoid the use of T scores, to avoid overestimation of fracture risk. If our results are replicated, the implications are enormous – Osteoporosis is currently being over diagnosed.
  902 104 -
Effect of high-dose vitamin D supplementation on beta cell function in obese Asian-Indian children and adolescents: A randomized, double blind, active controlled study
Shweta Varshney, Rajesh Khadgawat, Monita Gahlot, Deepak Khandelwal, Avneet Kaur Oberoi, RK Yadav, V Sreenivas, Nandita Gupta, Nikhil Tandon
September-October 2019, 23(5):545-551
DOI:10.4103/ijem.IJEM_159_19  PMID:31803595
Objective: Vitamin D deficiency has been found to be associated with insulin resistance. In an attempt to explore this association, we planned a study to investigate the effects of high-dose vitamin D supplementation on beta cell function in obese children and adolescents. Methods: A randomized, double blind, active-controlled study was carried out to investigate the effects of high dose (120,000 IU once a month) vitamin D supplementation in comparison to recommended daily allowance (12,000 IU/month) for 12 months. Beta cell function was assessed by disposition index. Inflammatory cytokines and cardiovascular risk factors were also assessed before and after supplementation. Results: A total of 189 obese children and adolescents were recruited. The mean serum 25OHD level of the study population was 8.36 ± 5.45 ng/ml. At baseline, 94.7% subjects were vitamin D deficient (<20 ng/mL). After 12 months of supplementation, serum 25OHD level in intervention group was 26.89 ± 12.23 ng/mL, while in control group, it was 13.14 ± 4.67 ng/mL (P < 0.001). No significant difference in disposition index as well as other parameters of insulin resistance, sensitivity, inflammatory cytokines, and pulse wave velocity was seen after supplementation. Conclusion: Vitamin D supplementation in doses of 120,000 IU per month for 12 months in obese Asian-Indian children and adolescents did not affect beta cell function as well as cardiovascular risk factors.
  834 104 1
Random blood glucose concentrations and their association with body mass index in Indian school children
Anuradha V Khadilkar, Nikhil Lohiya, Sejal Mistry, Shashi Chiplonkar, Vaman Khadilkar, Neha Kajale, Veena Ekbote, Smruti Vispute, Rubina Mandlik, Hemchand Prasad, Narendra Singh, Sanwar Agarwal, Sonal Palande, Dipali Ladkat
September-October 2019, 23(5):529-535
DOI:10.4103/ijem.IJEM_536_19  PMID:31803592
Objective and Aims: Overweight/obese children are at risk of developing type 2 diabetes mellitus. Random glucose elevations provide early warning signs of glycemic dysregulation. To assess random blood glucose (RBG) concentrations and risk factors associated with prediabetes in children aged 3-18 years from six Indian regions. Method: Multicenter, cross sectional, observational school-based study; multi-stage stratified random sampling was carried out. Height and weight measured; body mass index (BMI) was computed. RBG measured using a glucometer. National sample survey was used for dietary patterns. Data were analyzed using SPSS 25.0 for Windows. Setting: Study centers were from Maharashtra, Gujarat, Chhattisgarh, Assam, Tamil Nadu and Punjab from 40 selected schools. Participant: Children aged 3-18 years were measured. Results: Data on 14339 subjects (7413 boys) were analyzed. Prevalence of obesity was 5.8% and overweight-10.6%. Overall, 1% had low (<3 mmol/L), 93.7% in reference range (3.9-7.2 mmol/L) and 5.3% had elevated RBG (>7.2 mmol/L). With increasing mean BMI, there was increase in RBG concentrations. Children from Tamil Nadu were more likely to have RBG outside reference range compared to other regions (P < 0.05). Assam and Punjab had highest prevalence of RBG and BMI within reference range. Energy intake partly explained regional variations. Multivariate analysis showed male gender, urban residency, age >10 yrs (girls) and 13 yrs (boys), and overweight or obesity were predictive of prediabetes. Conclusion: Increased prevalence of overweight, obesity and prediabetes in Indian children are a matter of concern. Regional differences suggest that strategies to prevent obesity and combat perturbations in blood sugar may have to be customized.
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Disorders of sex development: A 10 years experience with 73 cases from the Kashmir Valley
Raiz Ahmad Misgar, Moomin Hussain Bhat, Shariq Rashid Masoodi, Mir Iftikhar Bashir, Arshad Iqbal Wani, Aejaz Ahsan Baba, Gowhar Nazir Mufti
September-October 2019, 23(5):575-579
DOI:10.4103/ijem.IJEM_271_19  PMID:31803600
Purpose: To present the clinical data, investigative profile, and management of patients with disorders of sex development (DSD) from the endocrine unit of a tertiary care university hospital. Materials and Methods: This retrospective study included 73 cases of DSD, evaluated and managed at Department of Endocrinology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Kashmir, over a period of 10 years from September 2008 to August 2018. Results: Twenty-nine patients (39.7%) had 46 XY DSD and twenty-nine patients (39.7%) had 46 XX. Sex chromosome DSD was diagnosed in 15 (20.5%) patients. Of 29 patients with 46 XY DSD, 17 (58.6%) had 5α-reductase type-2 deficiency (5α-RD) and 6 (20.7%) had complete androgen insensitivity syndrome. In our patients with 5α-RD, the history of consanguinity was documented in nine (52.9%) patients. Two patients had testosterone biosynthetic defect and one patient had partial androgen insensitivity syndrome. Of 29 patients with 46 XX DSD, 16 (55.1%) had congenital adrenal hyperplasia (CAH). Of 15 patients with sex chromosome DSD, 7 patients had Turner's syndrome, 7 had Klinefelter's syndrome, and 1 patient had mixed gonadal dysgenesis. Conclusion: In our study, equal number of patients had 46 XY DSD and 46 XX DSD. We are for the first time reporting from India that the most common cause of 46 XY DSD is 5α-RD, whereas CAH is the most common cause of 46 XX DSD as reported previously.
  681 94 -
A simple and reliable clinical indicator for rapid evaluation of neuropathy in busy diabetes clinics: “Hair loss sign”
Sarosh Katrak, Amit Chaudhari, Riddhi Patel, Satish Khadilkar
September-October 2019, 23(5):585-586
DOI:10.4103/ijem.IJEM_299_19  PMID:31803602
  662 85 -
Prediction of gestational diabetes from first trimester serum adiponectin levels in Indian Women
SV Madhu, Shivendu Bhardwaj, Rajat Jhamb, Himsweta Srivastava, Satender Sharma, Nishant Raizada
September-October 2019, 23(5):536-539
DOI:10.4103/ijem.IJEM_319_19  PMID:31803593
Introduction: The prediction of gestational diabetes mellitus (GDM) by serum adiponectin levels has shown promise in Western literature. This study looks at the first trimester serum adiponectin levels as a predictor of gestational diabetes in Indian women. Material and Methods: A total of 450 pregnant women were screened at 11--13 weeks of gestation and serum samples were stored. All the women underwent an oral glucose tolerance test to diagnose GDM by International Association of Diabetes and Pregnancy study Group criteria at 24--28 weeks of gestation. Amongst these, 45 women who had developed GDM were compared with 45 controls. The first trimester serum adiponectin levels were compared between the two groups. Results: Mean first trimester adiponectin in GDM and non-GDM group was 7.21 ± 2.49 μg/ml and 12.20 ± 2.91 μg/ml, respectively (P < 0.001). Logistic regression revealed that low adiponectin was the strongest independent risk factor followed by body mass index and HbA1c. Receiver operating characteristic curve revealed that a cut-off value of adiponectin of 9.10 μg/ml in the first trimester was associated with a sensitivity of 100% and specificity of 95.6% in predicting GDM. Conclusions: This is the first study from India which has studied the prediction of GDM by first trimester adiponectin levels. First trimester serum adiponectin may be a strong predictor of GDM in Asian Indian women.
  576 115 -
Carriers of the TCF7L2 rs7903146, rs12255372 risk alleles in the south Tamil Nadu T2DM patients present with early incidence and insulin dependence
Kumaravel Velayutham, Balaji Ramanathan, Jeyasudha Murugan, Arulvani Murugan, Vishali Thavamani, Rohini Gomathinayagam
September-October 2019, 23(5):563-569
DOI:10.4103/ijem.IJEM_540_19  PMID:31803598
Background and Aims: Metabolic abnormalities in T2DM (Type 2 diabetes mellitus) include classic manifestations such as impaired insulin secretion, synthesis and peripheral insulin resistance. The intronic variants rs7903146 and rs12255372 of the TCF7L2 (transcription factor 7-like 2) gene are strongly associated with risk of incidence of T2DM and impaired β-cell functions. Studies addressing the early T2DM onset, and early insulin dependence in T2DM patients of south Tamil Nadu are still lacking, and hence the present study focuses in determining the influence of the TCF7L2 polymorphisms in the incidence and disease course in the T2DM patients of south Tamil Nadu. Methods: Anthropometric measurements and biochemical parameters were carried out in early onset (Group A), early onset insulin dependent T2DM patients (Group B) and non-insulin dependent T2DM patients (Group C). PCR, allele specific PCR (ASP), PCR product sequencing strategies were utilized to determine the genotype and the impact of the TCF7L2 SNPs in the T2DM disease course. Results: Female T2DM patients with the CT/TT rs7903146 genotype (P = 0.005) and the rs12255372 GT/TT genotype (P = 0.036) exhibited a significantly low mean age for T2DM incidence. Correlation/regression analysis in the T2DM patients revealed that rs12255372 (P = 0.042) is associated with early onset in the Group C patients and the rs7903146 (P = 0.018), rs12255372 (P = 0.026) are associated with insulin dependence in the group B patients. Conclusion: Screening for the TCF7L2 polymorphisms will prevent T2DM incidence and enable life style changes, appropriate therapeutic strategies that would help combat the accelerated disease course in the T2DM patients.
  534 92 1
Serum fibroblast growth factor 21 levels in patients with hyperthyroidism and its association with body fat percentage
Aashish Reddy Bande, Pramila Kalra, Mala Dharmalingam, Chitra selvan, KM Suryanarayana
September-October 2019, 23(5):557-562
DOI:10.4103/ijem.IJEM_273_19  PMID:31803597
Background: Most of the actions of thyroid hormone (TH) on body metabolisms like maintenance of basal metabolic rate (BMR) and body fat are similar to that of fibroblast growth factor 21 (FGF21). We hypothesized that in patients with hyperthyroidism, the pathological changes in the BMR, body fat are mediated by TH through FGF21. Objectives: To study the association of serum FGF21 levels with hyperthyroidism and correlate body fat percentage with serum FGF21 levels in hyperthyroid patients. Study Design: Case-control prospective follow-up study. Methodology: A total of 68 hyperthyroid patients and age, sex-matched healthy controls who fulfilled the inclusion and exclusion criteria were studied. Among them, 45 cases were followed up at 3 to 6 months after the achievement of euthyroidism. Body fat percentage was calculated from Jackson and Pollock 3 site equation and Siri equation. BMR percentage was calculated by the Gale formula. Results: The mean age in years in the cases was similar to that of controls (36.14 ± 10.01 vs. 36.57 ± 10.53, P = 0.81).The serum FGF21 levels at baseline were significantly elevated in patients with hyperthyroidism compared to controls [median 406.6 pg/ml (interquartile range, 262.9–655.6) vs. 252.3 (125.1–341) P < 0.001] and declined dramatically following treatment with anti-thyroid drugs [405 (275.5–680.4) vs. 203.6 (154.6–230.6) P < 0.001]. Serum FGF21 levels negatively correlated with body fat percentage (r = –0.268, P = 0.002). After adjusting to various confounding factors, serum FGF21 was independently associated with hyperthyroidism and was significant. (OR [95%CI] 3.78 (1.046–13.666) P = 0.043). Conclusion: Serum FGF21 levels were elevated in hyperthyroid patients and decreased following treatment with anti-thyroid drugs. It was independently associated with hyperthyroidism. There may be a future therapeutic role of FGF21 inhibition in the reversal of these changes in addition to anti-thyroid drugs in patients with hyperthyroidism.
  538 81 -
The clinical spectrum of fibrocalculous pancreatic diabetes in Kashmir valley and comparative study of the clinical profile of fibrocalculous pancreatic diabetes and type 2 diabetes mellitus
Javaid Ahmad Bhat, Moomin Hussain Bhat, Raiz Ahmad Misgar, Mir Iftikhar Bashir, Arshad Iqbal Wani, Shariq Rashid Masoodi, Hamid Ashraf, Mona Sood
September-October 2019, 23(5):580-584
DOI:10.4103/ijem.IJEM_297_19  PMID:31803601
Background: Fibrocalculous pancreatic diabetes (FCPD) is a secondary form of diabetes, described from several tropical countries, including India. We described the existence of this entity in the subtropical region-the Kashmir valley of the Indian subcontinent and compared the clinical characteristics of these patients with type 2 diabetes mellitus (T2DM) patients. Aim: The present study aimed to compare the clinical characteristics of patients with FCPD and those with T2DM to identify the characteristics distinctive of FCPD. Materials and Methods: A total of 124 patients with FCPD were compared with 124 patients with T2DM matched for age and duration of diabetes. Biochemical parameters and microvascular and macrovascular complications were assessed in all patients. Multivariate regression analyses were performed to study the determinants of microvascular complications in both groups. Results: FCPD patients had significantly lower serum cholesterol, serum triglyceride, and serum calcium levels but higher glycosylated hemoglobin levels compared to T2DM patients. FCPD participants were significantly leaner. The prevalence of retinopathy, neuropathy, and nephropathy was similar between the two. Five T2DM patients had documented cardiovascular disease compared to one in FCPD patients (P < 0.05). Multiple logistic regression analysis revealed glycosylated hemoglobin and duration of diabetes to be significantly associated with retinopathy and nephropathy in T2DM. Among FCPD patients, glycosylated hemoglobin showed a strong association with retinopathy as well as nephropathy. BMI showed a significant negative association with nephropathy in FCPD patients. Age and age at onset showed a strong association with neuropathy in FCPD patients while the duration of diabetes showed the association with neuropathy (P = 0.015) in T2DM. Conclusion: There are several differences in the phenotype, biochemical parameters, and prevalence of diabetic complications between patients with FCPD and T2DM.
  546 62 2
Insulin autoantibody syndrome: Varying clinical presentations and response patterns of an underrecognized entity
PR Manjunath, Praveen V Pavithran, Nisha Bhavani, Harish Kumar, Vasantha Nair, Arun S Menon, Usha V Menon, Nithya Abraham, Prem Narayanan, Rony Ruben
September-October 2019, 23(5):540-544
DOI:10.4103/ijem.IJEM_335_19  PMID:31803594
Context: Insulin autoantibody syndrome (IAAS) is considered to be a rare cause of hyperinsulinaemic hypoglycaemia. Lack of familiarity with the varied clinical manifestations leads to underdiagnosis. Localization techniques aimed at insulin-secreting neoplasms and nesidioblastosis, which are expensive often are ordered when the correct diagnosis is not made. Aims: We describe the myriad of clinical manifestations associated with IAAS based on single centre experience. Settings and Design: Retrospective analysis of patients who got admitted with symptoms suggestive of hypoglycaemia and underwent mixed meal test and prolonged hypoglycaemic test from 2016 to 2019. Subjects and Methods: Retrospective data of 12 patients with IAAS who were diagnosed in the threeyear time period between 2016 and 2019 are included in this analysis. Clinical details, biochemical parameters and imaging modalities were analysed. Statistical Analysis: All analyses were performed with SPSS software (version 17). Results: Total of twelve patients 12 (5 male and 7 females) were identified as IAAS. Median age of presentation was 57 years. Median insulin levels and median C-peptide levels were 300 miu/ml and 18.5 ng/ml respectively. Only 3 (25%) patients had spontaneous resolution. Steroid induced remission occurred by 3 months in the remaining patients. Intermittent hyperglycaemia was seen in 9 (75%) patients. Implicatable drug use preceding the occurrence of the clinical symptoms was observed in five patients. Conclusion: IAAS is not uncommon in India. The diagnosis should be pursued in patients with hyperinsulinaemic hypoglycaemia especially when insulin levels are very high or when there is intermittent hyperglycaemia.
  463 100 -
Dual PPAR α/γ agonists: Continuing cardiac concerns
Karthik Balach
September-October 2019, 23(5):586-587
DOI:10.4103/ijem.IJEM_542_19  PMID:31803603
  491 66 -
Vitamin D insufficiency risk score for screening for Vitamin D insufficiency
Shobhit Garg, Aparajita Dasgupta, Bobby Paul, Swanya P Maharana
September-October 2019, 23(5):552-556
DOI:10.4103/ijem.IJEM_539_19  PMID:31803596
Background and Aims: Vitamin D Deficiency/Insufficiency (VDD/VDI) is now recognized as a pandemic. Vitamin D is a versatile yet crucial factor which is vital for many metabolic functions in our body. Till now there is no screening tool for VDD/VDI. The aim of this study is to develop and validate a screening tool Vitamin D Insufficiency Risk Score (VDIRS). Methods: This study was a rural community based cross-sectional study. It was done during May 2016 to April 2017 among 197 adults residing in rural West Bengal. After a thorough literature review and discussion with the field experts, four characteristics (BMI, Physical activity, Daily Sun exposure, Diet) were considered for VDIRS.Data was collected after taking informed consent. After interviewing every individual was examined for height, weight and blood was collected for vitamin 25-(OH) D. Weights were given to VDIRS characteristic according to Adjusted Odds' Ratio. Receiver Operating Characteristics (ROC) curves were utilized to validate and find out optimum cut off for VDIRS using Youden's index for VDD/VDI with the use of R software. Results: Only 133 (67.5%) had Vitamin D insufficiency. On ROC curves for VDIRS for VDI and VDD, AUC was 0.83 and 0.77 which signifies VDIRS as a good screening and predictive tool. A score of VDIRS ≥14 had sensitivity of 78.2% and specificity of 75.0% for VDI.Conclusion: Use of the VDIRS can make mass screening for undiagnosed VDI/VDD in India more cost effective. Researchers strongly believe and perceive a necessity of such validated score in the present scenario.
  476 80 -
Neurofibromatosis masquerading as disorder of sex development
Swayamsidha Mangaraj, Ipsita Mishra, Annada Prasad Patnaik, Arun Kumar Choudhury, Anoj Kumar Baliarsinha
September-October 2019, 23(5):588-589
DOI:10.4103/ijem.IJEM_332_19  PMID:31803604
  438 52 -
Preoperative glycated haemoglobin level and postoperative morbidity and mortality in patients scheduled for liver transplant
Mohd Qurram Parveez, Karthik Ponnappan, Manish Tandon, Ankur Sharma, Priyanka Jain, Akhil Singh, Chandra Kant Pandey, Varuna Vyas
September-October 2019, 23(5):570-574
DOI:10.4103/ijem.IJEM_208_19  PMID:31803599
Background: There is high prevalence of diabetes mellitus in patients of end stage liver disease and it has been implicated for complications in post-transplant patients. Glycated hemoglobin is now targeted as a modifiable preoperative risk factors for postoperative complications. Data describing the course and severity of postoperative liver transplant complication and their relation with pre-operative glycated hemoglobin level is sparse. In this study, we looked for co-relation between the preoperative HbA1c level and post-operative mortality and morbidity in patients scheduled for liver transplant. Materials and Methods: Retrospective data in 400 adult patients operated for liver transplant were retrieved. After exclusion, data were analyzed for 224 patients. Patients were divided into two groups on the basis of glycated hemoglobin levels (Group 1 (HbA1C ≥6.5) and Group 2 (HbA1C <6.5)). Results: Glycated hemoglobin levels were not associated with postoperative death during stay in intensive care unit, incidence of postoperative cardiovascular, renal, and central nervous complications. No difference was seen between 2 groups for need for renal replacement therapy, incidence of infections, rejection, need for re-exploration surgery and duration of intensive care unit and hospital stay. Glycated hemoglobin cannot predict 30 day survival (Area under curve {AUC} = 0.629, P value 0.05). Conclusion: Preoperative glycated hemoglobin level is not associated with postoperative morbidity and mortality in patients scheduled for liver transplant. Trial Registration Number: CTRI/2018/04/012966.
  401 53 -
Erratum: Lessons for the health-care practitioner from buddhism

September-October 2019, 23(5):590-590
  296 39 -