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   2011| April-June  | Volume 15 | Issue 2  
    Online since June 7, 2011

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Evaluation of efficacy and safety of orlistat in obese patients
Suyog S Jain, Sunita J Ramanand, Jaiprakash B Ramanand, Pramod B Akat, Milind H Patwardhan, Sachin R Joshi
April-June 2011, 15(2):99-104
DOI:10.4103/2230-8210.81938  PMID:21731866
Context: Rapidly rising prevalence of obesity is alarming. Obesity predisposes to co-morbidities like hypertension, type 2 diabetes mellitus, dyslipidemias, thus substantially rising healthcare expenditure. Lifestyle modifications alone have very limited success, necessitating the addition of pharmacotherapy to it. Objective: Present study was carried out to evaluate the efficacy and safety of orlistat in obese patients. Materials and Methods: Eighty obese (BMI>30) patients according to inclusion and exclusion criteria were randomized into either of the two groups. Group 1 received orlistat 120 mg three times a day and group 2 received placebo three times a day. Weight, waist circumference, BMI, total cholesterol, triglycerides, HDL, LDL were measured at baseline and then at 8 th , 16 th and 24 th week. ADR reported by patients were recorded. For safety evaluation various hematological and biochemical parameters were assessed. Z test was used for analysis of data. Results: Compared to placebo, orlistat caused significant reduction (P<0.05) in weight (4.65 kg vs 2.5 kg; orlistat vs placebo, respectively), BMI (1.91 kg/m 2 vs 0.64 kg/m 2 ) and waist circumference (4.84 cm vs 2 cm), cholesterol (10.68 mg vs 6.18 mg) and LDL level (5.87 mg vs 2.33 mg). In the orlistat group, the GI side effects like loose stools, oily stools/spotting, abdominal pain and fecal urgency were observed. Conclusion: Orlistat is an effective and well-tolerated antiobesity drug, which can be employed as an adjunct to therapeutic lifestyle changes to achieve and maintain optimal weight.
  16 5,360 1,112
Management of hyperglycemia in geriatric patients with diabetes mellitus: South Asian consensus guidelines
Manash P Baruah, Sanjay Kalra, Ambika Gopalakrishnan Unnikrishnan, Syed Abbas Raza, Noel Somasundaram, Mathew John, Prasad Katulanda, Dina Shrestha, Ganpathy Bantwal, Rakesh Sahay, Tint Swe Latt, Faruque Pathan
April-June 2011, 15(2):75-90
DOI:10.4103/2230-8210.81935  PMID:21731863
Asia is home to four of the world's five largest diabetic populations, two of them being South Asian nations, namely, India and Pakistan. This problem is compounded by a substantial rise in the elderly population in Asian countries. On the other hand, the heterogeneous health condition and multiple co-morbidities make the care of chronic disease in the elderly a challenging task. The aim of the South Asian Consensus Guidelines is to provide evidence-based recommendations to assist healthcare providers in the rational management of type 2 diabetes mellitus in the elderly population. Current Guidelines used systematic reviews of available evidence to form its key recommendations. No evidence grading was done for the purpose of this manuscript. The clinical questions of the guidelines, the methodology of literature search, and medical writing strategy were finalized by consultations in person and through mail. The South Asian Consensus guideline emphasizes tailoring of glycemic goals for patients based on age, co-morbid conditions especially that of cardiovascular system, risk of hypoglycemia, and life expectancy. It also recommends cautious use of available pharmacotherapy in geriatric patients with diabetes. The primary principle of diabetes therapy should be to achieve euglycemia, without causing hypoglycemia. Appropriate use of modern insulins and oral drugs, including incretin mimetics will help physicians achieve this aim.
  9 18,847 1,501
Endocrine effects of Fukushima: Radiation-induced endocrinopathy
Asfandyar Khan Niazi, Shaharyar Khan Niazi
April-June 2011, 15(2):91-95
DOI:10.4103/2230-8210.81936  PMID:21731864
The unfortunate accidents of Chernobyl and Fukushima have led to an enormous amount of radioactive material being released into the atmosphere. Radiation exposure to the human body may be as a result of accidents, such as those in Chernobyl and Fukushima, or due to occupational hazards, such as in the employees of nuclear plants, or due to therapeutic or diagnostic procedures. These different sources of radiations may affect the human body as a whole or may cause localized damage to a certain area of the body, depending upon the extent and dosage of the irradiation. More or less every organ is affected by radiation exposure. Some require a higher dose to be affected while others may be affected at a lower dose. All the endocrine glands are susceptible to damage by radiation exposure; however, pituitary, thyroid and gonads are most likely to be affected. In addition to the endocrine effects, the rates of birth defects and carcinomas may also be increased in the population exposed to excessive radiation.
  8 3,337 796
Relationship of associated secondary hyperparathyroidism to serum fibroblast growth factor-23 in end stage renal disease: A case-control study
Hamdy Sliem, Gamal Tawfik, Fadia Moustafa, Heba Zaki
April-June 2011, 15(2):105-109
DOI:10.4103/2230-8210.81939  PMID:21731867
Introduction: Secondary hyperparathyroidism (SHPT) is an insidious disease that develops early in the course of chronic kidney disease (CKD) and increases in severity as the glomerular filtration rate deteriorates. Recent studies have identified fibroblast growth factor-23 (FGF23) as a new protein with phosphaturic activity. It is mainly secreted by osteoblasts and is now considered the most important factor for regulation of phosphorus homeostasis. It is not yet proven if there is any direct relation between parathyroid hormone (PTH) and FGF23. The present study aims to evaluate the relation between serum FGF23, phosphorus, and PTH in end-stage renal disease in patients with SHPT on regular hemodialysis. Materials and Methods: Forty-six consecutive CKD adult patients (case group) and 20 healthy adults (control group) were included in the study. All patients had SHPT and were on regular hemodialysis. Both groups were subjected to full medical history, clinical examination and biochemical studies. Serum phosphorus, calcium, ferritin, hemoglobin level, blood urea, creatinine, PTH, and FGF23 were analyzed. Results: Levels of FGF23 were significantly higher in the case group in comparison with those in the control group, viz., 4-fold, and positively correlated with PTH. Phosphorus levels in the case group were significantly high in spite of the increasing levels of FGF23. Both PTH and FGF23 were positively correlated with phosphorus and negatively with hemoglobin levels. Conclusion: SHPT and FGF23 may have a partial role in the development of anemia in patients with CKD. FGF23 could be a central factor in the pathogenesis of SHPT. Its role in controlling hyperphosphatemia in CKD is vague.
  6 2,577 458
Dyslipidemia as a contributory factor in etiopathogenesis of diabetic neuropathy
Fakhir S Al-Ani, Marwan S Al-Nimer, Fatima S Ali
April-June 2011, 15(2):110-114
DOI:10.4103/2230-8210.81940  PMID:21731868
Objectives: The pathogenesis of neuropathy in type 2 diabetes mellitus is multifactorial.Dyslipidemia may contribute to the development of diabetic neuropathy. This study aimed to assess the atherogenic lipid indices in type 2 diabetic patients with neuropathy.Material and Methods: Fifty-one patients with type 2 diabetes mellitus and 31 healthy subjects were studied in the Unit of Neurophysiology at the University Hospital of Medical College, Al-Nahrin University in Baghdad, Iraq, from January 2002 to January 2003. Neuropathy total symptom score (NTSS), neuropathy impairment score in the lower leg (NIS-LL), and electrophysiological study of sensory (ulnar and sural) and motor (ulnar and common peroneal) nerves were used to assess nerve function. Fasting venous blood was obtained from each participant for determination of lipid profile and atherogenic lipid ratios. Results: The frequency of high blood pressure was significantly higher in neuropathic patients. The electrophysiology study revealed significant decrease in conduction velocity of ulnar (sensory and motor components), sural, and common peroneal nerves. The minimum F-wave latency of motor nerve was significantly prolonged. Among the lipid fractions, only high-density lipoprotein-cholesterol was significantly reduced by 14% of healthy participant's value. Atherogenic lipid ratios were significantly higher in diabetic patients than corresponding healthy ratios. Conclusion: Metabolic lipid disturbances in terms of atherogenicity co-existwith neuropathy in type 2 diabetes mellitus, irrespective of duration of disease.
  6 3,520 687
Prevalence of neonatal hypothyroidism and phenylketonuria in Southern Thailand: A 10-year report
Yavamal Sutivijit, Arirat Banpavichit, Viroj Wiwanitkit
April-June 2011, 15(2):115-117
DOI:10.4103/2230-8210.81941  PMID:21731869
Background: Congenital hypothyroidism and phenylketonuria, the two major problems of several metabolic errors are presently the focus of attention, in Thailand. These two conditions are assigned as diseases to be controlled under the National Public Health Policies of Thailand. Materials and Methods: Here, the authors summarize and report the 10-year study on the prevalence of neonatal hypothyroidism and phenylketonuria in Southern Thailand. Results: This report is good representative data from Thailand, a country in Southeast Asia. Another interesting point in this study is the concern of the recalling process. Conclusion: It can be seen that there are a considerable number of infants who did not receive the confirmation test due to loss of follow-up after calling for a recheck.
  6 2,444 384
Loss of follow-up of diabetic patients: What are the reasons?
Viroj Wiwanitkit
April-June 2011, 15(2):144-144
DOI:10.4103/2230-8210.81952  PMID:21731880
  5 1,620 301
Cabergoline-induced tricuspid regurgitation: Case report and review of literature
Mohammad Hayat Bhat, Syed Mushtaq, Sameena Saba, Riyaz Saif, Gazanfar Ali
April-June 2011, 15(2):137-139
DOI:10.4103/2230-8210.81949  PMID:21731877
The increased risk of cardiac valve disease in patients treated for Parkinson's disease with cabergoline has raised concerns about the safety of treatment with ergot-derived dopamine agonists in patients with endocrine diseases, especially prolactinoma. Concern is raised because the use of cabergoline was associated in one study with an increased prevalence of moderate tricuspid regurgitation, and in two other studies with mild tricuspid regurgitation. Furthermore, the use of cabergoline was associated with increased frequencies of valvular thickening, calcifications, and increased mitral tenting area.
  4 2,144 325
17-α-Hydroxylase deficiency: An unusual case with primary amenorrhea and hypertension
Sunil Kumar Kota, Kirtikumar Modi, Ratan Jha, Surya Narayan Mandal
April-June 2011, 15(2):127-129
DOI:10.4103/2230-8210.81945  PMID:21731873
A 14-year-old girl presented with acute onset quadriparesis and newly detected hypertension. Parental consanguinity, delayed puberty with normal stature form the additional information. Hypokalemia with metabolic alkalosis, low cortisol, high ACTH and FSH pointed to the possibility of CAH with 17α hydroxylase deficiency. 46XX karyotype and high progesterone supported this. Normalization of hypokalemia and hypertension with glucocorticoid treatment confirmed the diagnosis. In summary, the possibility of 17 OHD should be suspected in patients with hypokalemic myopathy, Hypertension and hypogonadism so that appropriate therapy can be implemented.
  3 2,800 528
Geriatric endocrinology
David Owens, Sanjay Kalra, Rakesh Sahay
April-June 2011, 15(2):71-72
DOI:10.4103/2230-8210.81933  PMID:21731861
  3 1,902 552
Acromegaly associated with a symptomatic Rathke's cyst
Vishal Gupta, Ashley Grossman, Aneesa Kapadia, Kiran Thorat
April-June 2011, 15(2):140-142
DOI:10.4103/2230-8210.81950  PMID:21731878
Our aim is to describe a case of acromegaly that was associated with symptomatic Rathke's cyst. We describe a young male student without any significant family history who presented with clinical and biochemical features consistent with growth hormone excess, which was confirmed with dynamic testing. He also described a persistent headache predating symptoms of growth hormone excess by 4 years. Magnetic resonance imaging (MRI) of the pituitary showed a large sellar mass which was thought to be a somatotroph adenoma. Trans-sphenoidal surgery was performed; however, a colloid lesion was identified by the neurosurgeon that proved to be a Rathke's cyst. The association of acromegaly with Rathke's cyst is very rare, with less than 10 cases found to be reported on review of literature. This is the first report from India.
  1 2,472 316
The anesthetic, critical care and surgical challenges in the management of craniopharyngioma
Sukhminder Jit Singh Bajwa, Sukhwinder Kaur Bajwa, Gavinder Singh Bindra
April-June 2011, 15(2):123-126
DOI:10.4103/2230-8210.81944  PMID:21731872
Among the childhood brain neoplasms, craniopharyngioma constitutes about 2-6% of all primary intracranial tumors. Craniopharyngioma poses a multitude of challenges to the neurosurgeon, endocrinologist, oncologist, intensivist and the anesthesiologist. The morbidity and mortality due to radical surgical treatment is quite high, to the extent of 40-50%. The conservative approach with limited surgical intervention and radiotherapy assistance is taken by some neurosurgeons, but its usefulness is very doubtful. We are reporting a case of craniopharyngioma in an 18-year-old female who had progressive loss of vision and was successfully managed with combined radical surgery and medical therapy.
  1 4,021 632
A young lady with swelling and stiffness of calf muscles
HS Kiran, KA Sudharshana Murthy, AN Aparna
April-June 2011, 15(2):130-131
DOI:10.4103/2230-8210.81946  PMID:21731874
Hypothyroidism causes a variety of changes in the body. Though uncommon, hypothyroidism can present as myopathy. Hoffman's syndrome is a specific, rare form of hypothyroid myopathy, which causes proximal weakness and pseudohypertrophy of muscles.
  1 8,295 456
Metformin high dosage and bleeding episode: A clinical case study
Viroj Wiwanitkit
April-June 2011, 15(2):132-133
DOI:10.4103/2230-8210.81947  PMID:21731875
Although metformin is a widely used anti-diabetic drug, it has certain side effects. This case reports a bleeding episode which occurred after up- titration of metformin while trying to achieve adequate glycemic control.
  1 2,965 423
Cor pulmonale in a case of infantile Gaucher's disease
Soumya Patra, Sayan Chatterjee, Shilpi Singhla, Bijoy Patra, Anu Maheswari, Anju Seth
April-June 2011, 15(2):134-136
DOI:10.4103/2230-8210.81948  PMID:21731876
Infantile Gaucher's disease presenting as cor pulmonale is rarely reported in pediatric literature. We report a 3.3 year old boy with infantile Gaucher's disease who presented to us as interstitial lung disease, pulmonary hypertension along with features of cor pulmonale. The high resolution CT findings were typical of interstitial and airspace disease. Cor pulmonale in this patient was a result of severe pulmonary hypertension.
  1 2,211 312
State of endocrinology and diabetology in Brazil
Daniel Giannella-Neto
April-June 2011, 15(2):118-119
DOI:10.4103/2230-8210.81942  PMID:21731870
Brazil is a large, populous country in South America, which has one of the biggest concentrations of people with diabetes. This article reviews the current status of diabetes care, medical education and training, and diabetes/endocrine research in Brazil. It highlights achievements in public health and research, which can be emulated by other countries. In Endocrine/Diabetes fields, a more realistic and responsible policies in terms of medical traineeship, patient education, and mainly scientific production would be mandatory to raise Brazil to a global competitive level.
  1 1,606 245
Nuclear detonation, thyroid cancer and potassium iodide prophylaxis
Viroj Wiwanitkit
April-June 2011, 15(2):96-98
DOI:10.4103/2230-8210.81937  PMID:21731865
The recent nuclear disaster at Japan has raised global concerns about effects of radioactive leakage in the environment, associated hazards, and how they can be prevented. In this article, we have tried to explain about the guidelines laid down by World Health Organization for a potassium iodide prophylaxis following a nuclear disaster, and its mechanism of action in preventing thyroid cancer. Data was collected mainly from the studies carried out during the Chernobyl disaster of Russia in 1986 and the hazardous effects especially on the thyroid gland were studied. It was seen that radioactive iodine leakage from the nuclear plants mainly affected the thyroid gland, and especially children were at a higher risk at developing the cancers. Potassium Iodide prophylaxis can be administered in order to prevent an increase in the incidence of thyroid cancers in the population of an area affected by a nuclear disaster. However, one has to be cautious while giving it, as using it without indication has its own risks.
  1 2,117 342
Radiation exposure and cytotoxic endocrinopathy: It is time for action
Sanjay Kalra, Ambika Gopalakrishnan Unnikrishnan, Warren Lee
April-June 2011, 15(2):73-74
DOI:10.4103/2230-8210.81934  PMID:21731862
  - 1,656 323
Endocrinology in Thailand: Unique challenges, unique solutions
Viroj Wiwanitkit
April-June 2011, 15(2):120-122
DOI:10.4103/2230-8210.81943  PMID:21731871
Thailand is a developing country in Southeast Asia with a nationally acknowledged requirement for improvement of the medical system. At present, endocrinology is a specific branch of medicine that is taught in few medical schools. There are very few endocrinologists in Thailand, who are unable to cope with the large number of patients with endocrinology problems. Primary care for common endocrine disorders, such as diabetes mellitus and thyroid disease, is still the domain of general practitioners. In this article, the author will present unique challenges and unique solutions of endocrinology practice in Thailand.
  - 1,586 233
Endocrine disruptors: Ubiquitous, yet less known
Dilip Gude
April-June 2011, 15(2):143-144
DOI:10.4103/2230-8210.81951  PMID:21731879
  - 1,585 279