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2015| May-June | Volume 19 | Issue 3
Online since
March 5, 2015
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REVIEW ARTICLES
Forum for Injection Technique (FIT), India: The Indian recommendations 2.0, for best practice in Insulin Injection Technique, 2015
Nikhil Tandon, Sanjay Kalra, Yatan Pal Singh Balhara, Manash P Baruah, Manoj Chadha, Hemraj B Chandalia, Subhankar Chowdhury, Kesavadev Jothydev, Prasanna K. M. Kumar, Madhu S V, Ambrish Mithal, Sonal Modi, Shailesh Pitale, Rakesh Sahay, Rishi Shukla, Annamalai Sundaram, Ambika G Unnikrishnan, Subhash K Wangnoo
May-June 2015, 19(3):317-331
DOI
:10.4103/2230-8210.152762
PMID
:25932385
As injectable therapies such as human insulin, insulin analogs, and glucagon-like peptide-1 receptor agonists are used to manage diabetes, correct injection technique is vital for the achievement of glycemic control. The forum for injection technique India acknowledged this need for the first time in India and worked to develop evidence-based recommendations on insulin injection technique, to assist healthcare practitioners in their clinical practice.
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8,033
1,034
BRIEF COMMUNICATIONS
Sodium-glucose cotransporter-2 inhibition and the insulin: Glucagon ratio: Unexplored dimensions
Sanjay Kalra, Yashdeep Gupta, Shiva Patil
May-June 2015, 19(3):426-429
DOI
:10.4103/2230-8210.152793
PMID
:25932403
The sodium-glucose cotransporter 2 (SGLT-2) inhibitors are a novel class of glucose-lowering drugs which act by inhibiting the reabsorption of filtered glucose from the kidneys. Their effect on insulin and glucagon levels has recently been studied but is not fully explained. This communication proposes various hypotheses: A direct effect of SGLT-2 inhibition on the alpha cell receptors, a paracrine or intra-islet mediated effect on alpha cell sensitivity to glucose, and a calorie restriction mimetic action, to explain the impact of these drugs on the insulin glucagon ratio.
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2,592
806
ORIGINAL ARTICLES
Effect of Vitamin D supplementation on glycemic parameters and progression of prediabetes to diabetes: A 1-year, open-label randomized study
Mohammad Shafi Kuchay, Bashir Ahmad Laway, Mir Iftikhar Bashir, Arshad Iqbal Wani, Raiz Ahmad Misgar, Zaffar Amin Shah
May-June 2015, 19(3):387-392
DOI
:10.4103/2230-8210.152783
PMID
:25932396
Background:
Whether Vitamin D supplementation in prediabetes subjects prevents the development of diabetes is a matter of debate, and the results are inconsistent. This open-label, randomized study in subjects with prediabetes evaluated the effect of 12 months of Vitamin D supplementation on glycemic parameters and progression of prediabetes to diabetes in an ethnically homogeneous Kashmiri population.
Materials and Methods:
A total of 147 subjects were diagnosed as prediabetes out of which 137 subjects were randomized to receive in addition to standard lifestyle measures, either Vitamin D 60,000 IU weekly for 4 weeks and then 60,000 IU monthly (
n
= 69) or no Vitamin D (
n
= 68). Fasting plasma glucose (FPG), 2-h plasma glucose and A1C levels were estimated at 0, 6 and 12 months. Changes in FPG, 2-h plasma glucose, A1C level and the proportion of subjects developing diabetes were assessed among 129 subjects.
Results:
At 12 months, A1C levels were significantly lesser (5.7% ± 0.4%) in the Vitamin D supplemented group when compared with non-Vitamin D supplemented (6.0% ± 0.3%). Similarly, FPG (97 ± 7) and 2-h plasma glucose (132 ± 16) were significantly less in Vitamin D supplemented group as compared with non-Vitamin D supplemented group (FPG = 116 ± 6 and 2-h plasma glucose = 157 ± 25) at 12 months. Nine out of 65 in non-Vitamin D supplemented and seven out of 64 in the Vitamin D supplemented group developed diabetes.
Conclusions:
Vitamin D supplementation in prediabetes subjects significantly lowered FPG, 2-h plasma glucose and A1C levels.
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BRIEF COMMUNICATIONS
Improper sharp disposal practices among diabetes patients in home care settings: Need for concern?
Anindo Majumdar, Jayaprakash Sahoo, Gautam Roy, Sadishkumar Kamalanathan
May-June 2015, 19(3):420-425
DOI
:10.4103/2230-8210.152792
PMID
:25932402
In the recent years, outbreaks of blood-borne infections have been reported from assisted living facilities, which were traced back to improper blood glucose monitoring practices. Needle-stick injuries have been implicated in many such cases. This directly raises concerns over sharp disposal practices of diabetic patients self-managing their condition in home care settings. With India being home to a huge diabetic population, this issue, if neglected, can cause substantial damage to the health of the population and a marked economic loss. This article discusses the sharp disposal practices prevalent among diabetes patients, the importance of proper sharp disposal, barriers to safe disposal of sharps, and the options available for doing the same. For adopting an environmentally safe wholesome approach, disposal of plastics generated as a result of diabetes self-care at home is important as well. The article also looks at the possible long-term solutions to these issues that are sustainable in an Indian context.
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ORIGINAL ARTICLES
Prevalence of thyroid dysfunction among women during the first trimester of pregnancy at a tertiary care hospital in Haryana
Rajesh Rajput, Vasudha Goel, Smiti Nanda, Meena Rajput, Shashi Seth
May-June 2015, 19(3):416-419
DOI
:10.4103/2230-8210.152791
PMID
:25932401
Background:
Undetected and untreated thyroid disorders are associated with adverse maternal and fetal outcomes. There are limited data on the prevalence of newly diagnosed thyroid disease during pregnancy from India. Therefore, this study was designed to evaluate the prevalence of thyroid dysfunction, especially hypothyroidism during the first trimester of pregnancy.
Materials and Methods:
The present cross-sectional study was conducted at Department of endocrinology and antenatal clinic in the Obstetrics and Gynecology Pt. B.D. Sharma PGIMS, Rohtak over a period of 1-year. The total sample population comprised of 461 pregnant women with uncomplicated intrauterine singleton pregnancies in the first trimester of gestation without any history of thyroid disease or intake of any thyroid medication. Morning blood samples from the participants were analyzed for thyroid function tests, which included FT3, FT4, thyroid-stimulating hormone (TSH) and anti-thyroid peroxidase antibodies (TPO).
Results:
A total of 461 women were enrolled for this study. Mean maternal age was 23.79 ± 3.47 years. Median gestational age was 8 weeks 5 days. The median FT3, FT4 and TSH were 3.3 pg/mL, 1.25 ng/dL, and 1.40 mIU/L, respectively. Anti-TPO was elevated in 128 (27.8%) pregnant women. 99 (21.5%) women had sub-clinical hypothyroidism and 39 (39.4%) among them were positive for anti-TPO (
P
≤ 0.001). 2 (0.4%) of women had overt hyperthyroidism, whereas 15 (3.3%) of the women had sub-clinical hyperthyroidism.
Conclusion:
Considering the immense impact that maternal thyroid dysfunction has on maternal and fetal outcomes, prompt identification of thyroid dysfunction and its timely treatment is essential. Thus, universal screening of pregnant women for thyroid dysfunction should be considered especially in a country like India due to the high prevalence of thyroid dysfunction.
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Association of bilirubin and malondialdehyde levels with retinopathy in type 2 diabetes mellitus
Apoorva Dave, Pramila Kalra, BH Rakshitha Gowda, Malavika Krishnaswamy
May-June 2015, 19(3):373-377
DOI
:10.4103/2230-8210.152777
PMID
:25932393
Introduction:
Bilirubin as an antioxidant and malondialdehyde (MDA) as an oxidant have been shown to be associated with various complications of type 2 diabetes mellitus (DM).
Aims
and
Objectives:
The aim was to measure the levels of serum bilirubin and MDA in type 2 DM patients with and without diabetic retinopathy (DR) and to correlate them with severity of DR.
Materials
and
Methods:
A total number of 120 subjects out of which 40 were controls without type 2 DM and the rest 80 were type 2 DM patients were included in the study. Of those 80 diabetics, 44 patients did not have DR and 36 patients had DR.
Results:
The total bilirubin, direct bilirubin, indirect bilirubin were higher in controls as compared to cases (
P
= 0.017, 0.033, 0.024). Serum MDA levels were found to be higher in diabetics as compared to controls (
P
= 0.00). The values of all the three parameters, that is, total bilirubin, direct bilirubin and indirect bilirubin were lower in patients with retinopathy as compared to those without retinopathic changes (
P
= 0.00, 0.020, and 0.007). Subjects were assigned to quartiles based on serum total bilirubin concentration. The prevalence of DR was significantly lower among persons with the highest bilirubin quartile compared to those with the lowest quartile. The severity of DR was inversely proportional to the total bilirubin levels (
P
= 0.001). The multiple logistic regression analysis showed total bilirubin to be associated with prevalence of DR (
P
= 0.035).
Conclusions:
The levels of total bilirubin were significantly lower in patients with DR and also in the late stages of retinopathy as compared to those without retinopathy and in controls but MDA levels did not show any association with DR.
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405
REVIEW ARTICLES
Feminizing adrenocortical tumors: Literature review
Farida Chentli, Ilyes Bekkaye, Said Azzoug
May-June 2015, 19(3):332-339
DOI
:10.4103/2230-8210.152764
PMID
:25932386
Feminizing adrenal tumors (FAT) are extremely rare tumors prevailing in males. Clinical manifestations are gynecomastia and/or other hypogonadism features in adults. They are rarer in pediatric population and their main manifestation is peripheral sexual precocity. In women genital bleeding, uterus hypertrophy, high blood pressure and/or abdomen mass may be the only manifestations. On the biological point, estrogen overproduction with or without increase in other adrenal hormones are the main abnormalities. Radiological examination usually shows the tumor, describes its limits and its eventual metastases. Adrenal and endocrine origins are confirmed by biochemical assessments and histology, but that one is unable to distinguish between benign and malignant tumors, except if metastases are already present. Immunostaining using anti-aromatase antibodies is the only tool that distinguishes FAT from other adrenocortical tumors. Abdominal surgery is the best and the first line treatment. For large tumors (≥10 cm), an open access is preferred to coeliosurgery, but for the small ones, or when the surgeon is experienced, endoscopic surgery seems to give excellent results. Surgery can be preceded by adrenolytic agents such as ortho paraprime dichloro diphenyl dichloroethane (Mitotane), ketoconazole or by aromatase inhibitors, but till now there is not any controlled study to compare the benefit of different drugs. New anti-estrogens can be used too, but their results need to be confirmed in malignant tumors resistant to classical chemotherapy and to conventional radiotherapy. Targeted therapy can be used too, as in other adrenocortical tumors, but the results need to be confirmed.
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ORIGINAL ARTICLES
Efficacy and safety of low dose oral prednisolone as compared to pulse intravenous methylprednisolone in managing moderate severe Graves' orbitopathy: A randomized controlled trial
Ajitesh Roy, Deep Dutta, Sujoy Ghosh, Pradip Mukhopadhyay, Satinath Mukhopadhyay, Subhankar Chowdhury
May-June 2015, 19(3):351-358
DOI
:10.4103/2230-8210.152770
PMID
:25932389
Background:
High dose oral prednisolone (100 mg/day) in Graves' orbitopathy (GO) is limited by lesser response, and greater side-effects compared to intravenous (iv) methylprednisolone. Low dose oral prednisolone has not been evaluated in GO. This study aimed to evaluate the safety and efficacy of low dose oral prednisolone in GO.
Materials and Methods:
A total of 114 consecutive GO patients were screened of which 65 patients with previously untreated moderate-severe GO, clinical activity score (CAS) >2, without co-morbid states were randomized into treatment Group-A (iv methylprednisolone 0.5 g for 3 days/month for 4 months) and Group-B (oral prednisolone 1 mg/kg/day for 6 weeks then tapered stopped), and followed-up. Thirty-one patients in each group with at least 1-year follow-up were analyzed. Responders were defined as improvement in ≥ 1 major response criteria or ≥ 2 minor response criteria. The trial is registered at ctri.nic.in (CTRI/2013/12/004264).
Results:
At 1-year, 27/31 (87.10%) patients were responders in Group-A compared to 17/31 (54.84%) in Group-B (
P
= 0.005). There was a greater improvement in CAS score in patients of Group-A as compared to Group-B (
P
< 0.001). Responders (
n
= 44) had significantly higher baseline intra-ocular pressures and left eye proptosis as compared to nonresponders. Cox-regression revealed baseline T
4
levels, diplopia, and smoking history were predictive of remission. Low dose prednisolone was well tolerated, and the occurrence of adverse events were comparable in both groups.
Conclusions:
Low dose oral prednisolone is inferior to iv pulse methylprednisolone in managing GO, having a comparable side-effect profile. It can be a safe second line alternative in patients intolerant to pulse iv methylprednisolone.
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Knowledge of hypoglycemia and its associated factors among type 2 diabetes mellitus patients in a Tertiary Care Hospital in South India
Vanishree Shriraam, Shriraam Mahadevan, M Anitharani, Nalini Sirala Jagadeesh, Sreelekha Bhaskara Kurup, TA Vidya, Krishna G Seshadri
May-June 2015, 19(3):378-382
DOI
:10.4103/2230-8210.152779
PMID
:25932394
Introduction:
Hypoglycemia being the rate limiting complication in the attainment of strict glycemic control in diabetes management, in this study, we intended to study the knowledge of its symptoms, target blood levels during treatment and ways of prevention among type 2 diabetes patients attending Outpatient Department (OPD) of a medical college hospital.
Materials and Methods:
Every fifth patient attending the OPD during the 4 months between March and June 2013 was interviewed using a questionnaire.
Results:
The study included 366 type 2 diabetic patients, of which 76.5% were females. The target fasting and postprandial blood glucose levels while on treatment was known to 135 (36.9%) and 126 (34.4%) patients, respectively. The common symptoms of hypoglycemia known to the study subjects were dizziness (81.4%), weakness (73.8%), and drowsiness (72.1%). Overall, 242 (66.1%) diabetic patients had good knowledge on hypoglycemia (knowledge of at least three symptoms of hypoglycemia together with at least one precipitating factor and at least one remedial measure). Higher age, illiteracy, low socioeconomic status were associated with poor knowledge whereas treatment with insulin along with oral hypoglycemic agents was associated with good knowledge on hypoglycemia. Sex and duration of disease were not associated with knowledge on hypoglycemia.
Conclusion:
Although the knowledge on symptoms of hypoglycemia, precipitating factors, remedial measures are high in this study, the target blood levels, complications were known to just a third of them. There is a knowledge gap on important aspects of hypoglycemia among type 2 diabetic patients.
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REVIEW ARTICLES
Anti-thyroid drugs in pediatric Graves' disease
Mathew John, Rajasree Sundrarajan, S Sridhar Gomadam
May-June 2015, 19(3):340-346
DOI
:10.4103/2230-8210.152766
PMID
:25932387
Graves' disease is the most common cause of hyperthyroidism in children. Most children and adolescents are treated with anti-thyroid drugs as the initial modality. Studies have used Methimazole, Carbimazole and Propylthiouracil (PTU) either as titration regimes or as block and replacement regimes. The various studies of anti-thyroid drug (ATD) treatment of Graves' disease in pediatric patients differ in terms of the regimes, remission rate, duration of therapy for adequate remission, follow up and adverse effects of ATD. Various studies show that lower thyroid hormone levels, prolonged duration of treatment, lower levels of TSH receptor antibodies, smaller goiter and increased age of child predicted higher chance of remission after ATD. A variable number of patients experience minor and major adverse effects limiting initial and long term treatment with ATD. The adverse effects of various ATD seem to more in children compared to that of adults. In view of liver injury including hepatocellular failure need of liver transplantation associated with PTU, the use has been restricted in children. The rate of persistent remission with ATD following discontinuation is about 30%. Radioactive iodine therapy is gaining more acceptance in older children with Graves's disease in view of the limitations of ATD. For individual patients, risk-benefit ratio of ATD should be weighed against benefits of radioactive iodine therapy and patient preferences.
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ORIGINAL ARTICLES
Helicobacter
pylori
infection prevalence: Is it different in diabetics and nondiabetics?
Jamshid Vafaeimanesh, Mahmoud Parham, Mohammad Bagherzadeh
May-June 2015, 19(3):364-368
DOI
:10.4103/2230-8210.152773
PMID
:25932391
Background:
Helicobacter
pylori
(HP) infection plays a significant role in the development of gastrointestinal complications and has a significant role in systemic inflammation. It has some extragastrointestinal manifestations like endocrine diseases. In this study, we aimed to compare the prevalence of HP infection in diabetic and nondiabetic individuals.
Materials
and
Methods:
In this cross-sectional study, 218 nondiabetic and 211 diabetic patients referring to Shahid Beheshti Hospital of Qom between March 2013 and 2014 were studied. The patients were divided into two HP
+
and HP
−
groups based on serological immunoglobulin G antibody against HP and the association between diabetes, and HP infection was evaluated. Data were analyzed using independent
t
-tests, Chi-square, Fisher's exact and Mann-Whitney tests.
Results:
The prevalence of HP seropositive was 65.9% versus 50.5% in diabetic and nondiabetics, respectively, and the difference was statistically significant (
P
= 0.001).
Conclusions:
This study showed a higher prevalence of HP infection in diabetic patients.
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EDITORIALS
Triple fixed drug combinations in type 2 diabetes
Mathew John, Deepa Gopinath, Sanjay Kalra
May-June 2015, 19(3):311-313
DOI
:10.4103/2230-8210.152739
PMID
:25932383
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ENDOCRINOLOGY AND THE ARTS
Kumbhakarna
: Did he suffer from the disorder of the hypothalamus?
Om J Lakhani, Jitendra D Lakhani
May-June 2015, 19(3):433-434
DOI
:10.4103/2230-8210.152795
PMID
:25932405
Kumbhakarna
was brother of the evil
Raavana
in the mythological tale of
Ramayana.
According the legend,
Kumbhakarna
had an insatiable appetite and thirst and used to sleep for great lengths of time. He also had an uncontrollable temper, which was feared by many. It is our assessment that
Kumbhakarna
possibly suffered from hypothalamic obesity. Hypothalamic obesity can be defined as significant polyphagia and weight gain that occurs because of structural or function involvement of the ventromedial nucleus of the hypothalamus bilaterally. The characteristic features are obesity associated with polyphagia. Somnolence is present in 40% of cases. Sham rage is a characteristic behavioral abnormality seen in these patients. All these symptoms are described in the mythological text while describing
Kumbhakarna.
The episodic nature of
Kumbhakarna
's symptoms can also be explained by another hypothalamic syndrome called Klein-Levine syndrome. This syndrome is characterized by with periodic episodes of somnolence, hyperphagia and hypersexuality along with other behavioral and cognitive difficulties.
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ORIGINAL ARTICLES
Changes in bone mineral density and bone turnover markers in patients undergoing hematopoietic stem cell transplant
Aditi Pandit, MK Garg, N Kotwal, KS Brar, Abhay Gundgurthi, AK Sharma, Sanjeevan Sharma
May-June 2015, 19(3):393-398
DOI
:10.4103/2230-8210.152785
PMID
:25932397
Introduction:
Hematopoietic stem cell transplant (HSCT) is frequently complicated by endocrine abnormalities and loss of bone mass. This prospective study was conducted to evaluate the bone loss post-HSCT.
Materials and Methods:
A total of 50 patients was evaluated pretransplantation, and 25 had HSCT (17 males, 8 females; 19 allogenic, 6 autologous). Bone mineral density (BMD) and bone markers were measured at baseline, 3-6 months and 12 months.
Results:
The mean age and body mass index were 25.1 ± 16.3 years and 19.4 ± 4.5 kg/m
2
, respectively. There were 15 adults (60%), and 10 adolescents (40%). There was a significant decline in BMD from the baseline at total femur (−8.7%;
P
< 0.0001), femoral neck (−5.0%;
P
= 0.003), femoral trochanter (−6.0%;
P
= 0.001), and Ward's triangle (−9.9%;
P
< 0.0001) at 6 months posttransplantation. From the 6 months to 12 months, there was a significant improvement in BMD at above sites except at Ward's triangle. The decline in BMD was nonsignificant at the whole body (−0.3%,
P
= 0.748) and the lumbar spine (−2.7%,
P
= 0.130) at 6 months posttransplant. Younger patients with allogenic graft and steroid use are more likely to have significant loss of BMD at hip posttransplant. Serum osteocalcin decreased, and N-telopeptide increased at 3-6 months, which return to baseline at 1-year posttransplant.
Conclusions:
A significant bone loss is observed at 6 months in patients with post-HSCT. The bone loss occurs predominantly at cortical bone. There is recovery of bone mass at 12 months posttransplant except at Ward's triangle. Bone loss after HSCT is multifactorial.
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Categories of foot at risk in patients of diabetes at a tertiary care center: Insights into need for foot care
Shyam Kishore, Ashish D Upadhyay, Viveka P Jyotsna
May-June 2015, 19(3):405-410
DOI
:10.4103/2230-8210.152789
PMID
:25932399
Objective:
Diabetic foot ulcers and amputations are preventable. Aim of this study was to determine the distribution of categories of foot at risk in patients with diabetes, attending a tertiary care hospital and factors that affect it.
Materials
and
Methods:
Detail history and examination including neurological and vascular assessment were performed in 100 patients with diabetes attending a Tertiary Care Hospital. Foot at risk was classified according to the task force of foot care interest Group of American Diabetes Association. Category of foot at risk was correlated with demographic and clinical features.
Results:
Fifty-two percent patients had foot at risk-category 1 and 2. Loss of protective sensation (LOPS) was present in 33% (category 1). Peripheral arterial disease (PAD) was present in 19% (category 2). Both LOPS and PAD were present in 10% patients. 95% had never received foot care advice by health professionals, let alone prescriptive footwear or vascular consultation.
Conclusions:
This study brings forth that foot at risk of ulcer is rampant in patients with diabetes. There are lacunae in diabetic foot care at all levels of care. With the increase in diabetes, cost effective steps are required to improve foot care among diabetes in India. Considering the demographic profile of patients in our study, growing number of patients with diabetes, lack of time and staff allocated for foot care in our setup, audiovisual aids seems a good option to spread foot care awareness among diabetes.
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389
Hypothyroidism in diabetes mellitus patients in Eastern Nepal
Robin Maskey, Dhana Ratna Shakya, Jouslin Kishore Baranwal, Poonam Lavaju, Prahlad Karki, Shyam Krishna Poudel
May-June 2015, 19(3):411-415
DOI
:10.4103/2230-8210.152790
PMID
:25932400
Context:
The coexistence of diabetes mellitus (DM) with hypothyroidism is a known clinical observation.
Aims:
To estimate prevalence and co-relate that of hypothyroidism in patients with DM in relation to the age and sex, the lipid profile, body mass index visiting diabetes clinic and inpatients in B. P. Koirala Institute of Health Sciences.
Settings and Design:
The hospital-based descriptive study.
Materials and
Methods:
Two hundred and seventy-one known or newly detected cases of DM aged more than 15 years were selected randomly from September 2012 to September 2013 and subjected to evaluation for thyroid function - clinically and biochemically and other relevant investigations were done.
Statistical Analysis Used:
For descriptive statistics mean, standard deviation, percentage, proportion were calculated. For inferential statistics following test were carried out at the level of significant 0.05 where confidence interval is 95%. The statistical operations were done through Statistical Package for the Social Sciences version 10.
Results:
Of 271 subjects, the prevalence of hypothyroidism (clinical and subclinical) in diabetics was, 4.05% (11/271) with females preponderance, of which 7 (30.4%) were clinically hypothyroid and 4 (17.4%) were subclinical hypothyroid. One (4.3%) patient had subclinical hyperthyroidism. The mean age at diagnosis of type 2 DM was 51-60 years. 8.69% of diabetics with primary hypothyroids were having morbid obesity. High-density lipoprotein among different thyroid status were statistically significant (
P
= 0.042).
Conclusions:
Hypothyroidism is not uncommon in diabetes, and we found body mass index, mean triglyceride and cholesterol levels were more in those diabetic patients having coexisting hypothyroidism.
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419
EDITORIALS
Sulfonylureas: Assets in the past, present and future
Sanjay Kalra, SV Madhu, Sarita Bajaj
May-June 2015, 19(3):314-316
DOI
:10.4103/2230-8210.149925
PMID
:25932384
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3
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597
LETTERS TO THE EDITOR
Congenital Hypothyroidism: Recent Indian data
Sudha Rathna Prabhu, Shriraam Mahadevan, Sujatha Jagadeesh, Seshadri Suresh
May-June 2015, 19(3):436-437
DOI
:10.4103/2230-8210.152800
PMID
:25932408
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3
1,368
390
ORIGINAL ARTICLES
Endocrine dysfunction in patients of leprosy
Rohit Kumar Singh, Rohit Bhasin, YS Bisht, K. V. S. Kumar
May-June 2015, 19(3):369-372
DOI
:10.4103/2230-8210.152775
PMID
:25932392
Background:
Leprosy is a chronic granulomatous disease and affects many internal organs in addition to the skin and peripheral nerves. Endocrine dysfunction is often silent and is often missed in patients of leprosy leading to significant morbidity. We studied the presence of occult endocrine disorders in leprosy patients and compared the same with disease parameters.
Materials and Methods:
We evaluated 40 patients of leprosy (aged 18-70 years, any duration) in this cross-sectional, observational study. All subjects were assessed for pituitary, thyroid, adrenal, gonadal function, and dynamic testing was done when deemed necessary. The participants were divided into two groups: Group 1 (Leprosy,
n
= 40) and Group 2 (Controls,
n
= 20) and the data were analyzed with appropriate statistical tests.
Results:
The study participants (35 males, 5 females) had a mean age of 36.4 ± 11.3 years, and duration of the disease was 2.5 ± 5.5 years. Eleven out of 40 patients showed results consistent with an endocrine disorder, including subclinical hypothyroidism (
n
= 4), sick euthyroid syndrome (
n
= 3), growth hormone (GH) deficiency (
n
= 2), primary hypogonadism (
n
= 2) and secondary hypogonadism in one patient. One patient had partial hypopituitarism (GH deficiency and secondary hypogonadism) and none of the controls showed any hormonal dysfunction. Testosterone levels showed inverse correlation with the number of skin patches (
P
= 0.0006).
Conclusion:
Occult endocrine dysfunction is seen in a quarter of patients with leprosy. Thyroid and gonadal axes abnormalities are common, and the severity is more in lepromatous forms of the disease. Further large studies are required to confirm the findings observed in our study.
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Effect of diabetic education on the knowledge, attitude and practices of diabetic patients towards prevention of hypoglycemia
Garima Bhutani, Sanjay Kalra, Sonika Lamba, Prem Kumar Verma, Rahul Saini, Meenakshi Grewal
May-June 2015, 19(3):383-386
DOI
:10.4103/2230-8210.152781
PMID
:25932395
Aims:
To assess the role of diabetic education in increasing awareness about hypoglycemia and decreasing hypoglycemic symptoms in diabetics.
Materials and Methods:
This is a longitudinal study involving the use of a structured questionnaire for obtaining baseline information related to knowledge, attitude and practices (KAP) of diabetic patients regarding hypoglycemia. Then the patients were given diabetic education by the treating doctor regarding hypoglycemia, its symptoms and prevention; the effect of which was assessed by repeating the same questionnaire after a month. The occurrence of hypoglycemic symptoms was also compared before and after diabetic education.
Results:
There is a significant improvement in all parameters like KAP with diabetic education. The hypoglycemic episodes also decrease significantly.
Conclusions:
Proper diabetic education is seen to improve the knowledge and attitude of the diabetic patients toward hypoglycemia. This leads to improved practices of such patients and decrease hypoglycemic episodes in them.
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548
BRIEF COMMUNICATIONS
Prolonged adrenal insufficiency after unilateral adrenalectomy for Cushing's Syndrome
Bindu Kulshreshtha, Arpita Arora, Anshita Aggarwal, Minakshi Bhardwaj
May-June 2015, 19(3):430-432
DOI
:10.4103/2230-8210.152794
PMID
:25932404
The contralateral healthy adrenal in patients undergoing unilateral adrenalectomy for Cushing's is known to be suppressed temporarily and forms the basis of peri and postoperative steroids. We present four cases of Cushing's who had prolonged adrenal insufficiency with continued requirement for steroids for periods ranging 1-4 years after unilateral adrenalectomy for Cushing's. We further review literature regarding the recovery of the hypothalamo pituitary adrenal axis postsurgery in patients with Cushing's syndrome.
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ORIGINAL ARTICLES
Neurological, psychiatric, ophthalmological, and endocrine complications in giant male prolactinomas: An observational study in Algerian population
Farida Chentli, Said Azzoug, Katia Daffeur, Lina Akkache, Hadjer Zellagui, Meriem Haddad, Nadia Kalafate
May-June 2015, 19(3):359-363
DOI
:10.4103/2230-8210.152771
PMID
:25932390
Introduction:
Prolactinomas are less frequent, but more invasive in males. Giant ones (≥4 cm) are extremely rare in literature. Their neurological, psychiatric and endocrine complications are life threatening. Our aim was to report the largest mono center series in order to analyze their frequency, their characteristics, and their complications.
Subjects and Methods:
All patients had clinical examination, hormonal, ophthalmological, and radiological assessment based on computed tomography scan and cerebral magnetic resonance imaging. Positive diagnosis was based on clinical symptoms, high prolactin ± immunohistochemy study. Mixed adenomas were excluded by hormonal exploration and immunohistochemy. For those who received medical treatment only, a reduction in tumor size was considered a supplementary positive point for the diagnosis.
Results:
Among 154 male prolactinomas seen between 1987 and 2013, we observed 44 giant tumors (28.5%). Median age = 36 years, and 38.3% were under 30. Median tumor height = 53.95 mm (40-130) and median prolactin = 15,715 ng/ml (
n
< 20). Solid and cystic aspect ± calcifications was observed in 25%. 42 had cavernous sinuses invasion. Other invasions were: Posterior= 65.9%, anterior= 63.6%, temporal= 15.9% and frontal = 9%. For endocrine complications: Hypogonadism = 98.4%, thyrotroph and corticotroph deficits were seen in respectively 34%, and 32%. Posterior pituitary insufficiency was observed in one case. For ophthalmological complications: Optic atrophy = 46%, Ptosis = 6.8%, diplopia/strabismus = 4.5%. Neurological complications were: Memory loss and/or unconsciousness = 18.2%, epilepsy = 15.9%, frontal syndrome = 9% and obstructive hydrocephalus = 6.8%.
Conclusion:
Giant prolactinomas account for 28% in our population. Severe neurological complications are frequent. But, obstructive hydrocephalus is rare, which argues for a slow progression.
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262
Turmeric use is associated with reduced goitrogenesis: Thyroid disorder prevalence in Pakistan (THYPAK) study
Ali Jawa, Ali Jawad, Syed Hunain Riaz, Muhammad Zaman Khan Assir, Abdul Wahid Chaudhary, Muhammad Zakria, Javed Akram
May-June 2015, 19(3):347-350
DOI
:10.4103/2230-8210.152768
PMID
:25932388
Introduction:
South Asian population has a particularly high prevalence of thyroid disorders mainly due to iodine deficiency and goitrogen use. There is no data available for prevalence of thyroid disorders in the general population living in nonmountainous regions of Pakistan.
Materials and Methods:
A total of 2335 residents of Pak Pattan, Punjab, Pakistan were interviewed about demographic, dietary, medical and environmental history as well as screened for goiter. Individuals of all ages and either gender were included.
Results:
Median age was 34 (10-88) years and 1164 (49.9%) were males. Median monthly income was 49 (3.9-137) USD. Six hundred and sixty-nine (28.7%) subjects had palpable goiter. 77.5% (
n
= 462) and 22.5% (
n
= 133) had World Health Organization Grade I and Grade II goiters respectively, further screened by measuring thyroid-stimulating hormone (TSH). In subjects with TSH <0.4 mg/dL, free T3 and free T4 levels were measured. In 185 goiter subjects when TSH was measured, 50% (
n
= 93) were euthyroid, 48% (
n
= 89) were hyperthyroid, and one subject each was hypothyroid and subclinically hyperthyroid. 29/89 hyperthyroid subjects underwent radionuclide scanning. Twelve subjects had heterogeneous uptake consistent with multinodular goiter, 12 subjects had diffuse uptake, two had cold nodules and two had hyperfunctioning single nodules. Goiter was significantly more common among females, unmarried individuals and individuals drinking tube well (subterranean) water. Goiter was less common among those who consumed daily milk, daily ghee (hydrogenated oil), spices, chilies, and turmeric.
Discussion:
In our study population, goiter was endemic with very high prevalence of hyperthyroidism. Turmeric use was association with reduced goitrogenesis. Further studies to assess iodine sufficiency, thiocyanate exposure and autoimmunity need to be conducted. Masses consuming high goitrogen diets should be educated to incorporate turmeric, spices and green chilies in their cooking recipes, to reduce the risk of goiter development. In addition, use of iodized salt in their daily diet cannot be overemphasized.
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LETTERS TO THE EDITOR
Postpartum screening after gestational diabetes mellitus: Aiming for universal coverage
V Seshiah
May-June 2015, 19(3):435-435
DOI
:10.4103/2230-8210.149926
PMID
:25932406
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237
Comparison of direct versus Friedewald estimation of low density lipoprotein cholesterol in Indian patients: Cost-effectiveness concerns?
Harshad Malve
May-June 2015, 19(3):436-436
DOI
:10.4103/2230-8210.152799
PMID
:25932407
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221
Yoga: An endocrine therapy
Prashant Kaduskar, KM Suryanarayana
May-June 2015, 19(3):437-438
DOI
:10.4103/2230-8210.152801
PMID
:25932409
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1,315
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ORIGINAL ARTICLES
Community health orientation of Indian Journal of Endocrinology and Metabolism: A bibliometric analysis of Indian Journal of Endocrinology and Metabolism
Kanica Kaushal, Sanjay Kalra
May-June 2015, 19(3):399-404
DOI
:10.4103/2230-8210.152787
PMID
:25932398
Background:
Endocrine and metabolic diseases especially diabetes have become focus areas for public health professionals. Indian Journal of Endocrinology and Metabolism (IJEM), a publication of Endocrine Society of India, is a peer-reviewed online journal, which covers technical and clinical studies related to health, ethical and social issues in field of diabetes, endocrinology and metabolism. This bibliometric analysis assesses the journal from a community health perspective.
Materials and Methods:
Every article published in IJEM over a period of 4 years (2011-2014) was accessed to review coverage of community health in the field of endocrinology.
Results:
Seven editorials, 30 review articles, 41 original articles, 12 brief communications, 20 letter to editors, 4 articles on guidelines and 2 in the section "endocrinology and gender" directly or indirectly dealt with community health aspects of endocrinology. Together these amounted to 17% of all articles published through these 4 years. There were 14 articles on general, 60 pertaining to pancreas and diabetes, 10 on thyroid, 7 on pituitary/adrenal/gonads, 21 on obesity and metabolism and 4 on parathyroid and bone; all community medicine related.
Conclusion:
Community health is an integral part of the modern endocrinology diabetology and metabolism practice and it received adequate journal space during the last 4 years. The coverage is broad based involving all the major endocrine disorders.
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