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   2011| October-December  | Volume 15 | Issue 4  
    Online since September 30, 2011

 
 
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REVIEW ARTICLES
Diabetes and psychiatric disorders
Yatan Pal Singh Balhara
October-December 2011, 15(4):274-283
DOI:10.4103/2230-8210.85579  PMID:22028998
Interface of diabetes and psychiatry has fascinated both endocrinologists and mental health professionals for years. Diabetes and psychiatric disorders share a bidirectional association -- both influencing each other in multiple ways. The current article addresses different aspects of this interface. The interaction of diabetes and psychiatric disorders has been discussed with regard to aetio-pathogenesis, clinical presentation, and management. In spite of a multifaceted interaction between the two the issue remains largely unstudied in India.
  33 10,816 1,154
Gonadotropin releasing hormone agonists: Expanding vistas
Navneet Magon
October-December 2011, 15(4):261-267
DOI:10.4103/2230-8210.85575  PMID:22028996
Gonadotropin-releasing hormone (GnRH) agonists are derived from native GnRH by amino acid substitution which yields the agonist resistant to degradation and increases its half-life. The hypogonadotropic hypogonadal state produced by GnRH agonists has been often dubbed as "pseudomenopause" or "medical oophorectomy," which are both misnomers. GnRH analogues (GnRH-a) work by temporarily "switching off" the ovaries. Ovaries can be "switched off" for the therapy and therapeutic trial of many conditions which include but are not limited to subfertility, endometriosis, adenomyosis, uterine leiomyomas, precocious puberty, premenstrual dysphoric disorder, chronic pelvic pain, or the prevention of menstrual bleeding in special clinical situations. Rapidly expanding vistas of usage of GnRH agonists encompass use in sex reassignment of male to female transsexuals, management of final height in cases of congenital adrenal hyperplasia, and preserving ovarian function in women undergoing cytotoxic chemotherapy. Hypogonadic side effects caused by the use of GnRH agonists can be tackled with use of "add-back" therapy. Goserelin, leuprolide, and nafarelin are commonly used in clinical practice. GnRH-a have provided us a powerful therapeutic approach to the treatment of numerous conditions in reproductive medicine. Recent synthesis of GnRH antagonists with a better tolerability profile may open new avenues for both research and clinical applications. All stakeholders who are partners in women's healthcare need to join hands to spread awareness so that these drugs can be used to realize their full potential.
  31 7,561 1,975
Choosing a Gliptin
Vishal Gupta, Sanjay Kalra
October-December 2011, 15(4):298-308
DOI:10.4103/2230-8210.85583  PMID:22029001
The treatment of type 2 diabetes mellitus (T2DM) has included the use of metformin and sulfonylurea (SU) as first-line anti-diabetic therapies world over since years. This remains, despite the knowledge that the combination results in a progressive decline in [beta]-cell function and by 3 years up to 50% of diabetic patients can require an additional pharmacological agent to maintain the glycosylated hemoglobin (HbA1c) <7.0% (UKPDS). Gliptins represent a novel class of agents that improve beta cell health and suppress glucagon, resulting in improved post-prandial and fasting hyperglycemia. They function by augmenting the incretin system (GLP-1 and GIP) preventing their metabolism by dipeptidyl peptidase-4 (DPP-4). Not only are they efficacious but also safe (weight neutral) and do not cause significant hypoglycemia, making it a unique class of drugs. This review focuses on gliptins (sitagliptin, vildagliptin, saxagliptin, linagliptin, and alogliptin) discussing pharmacokinetics, pharmacodynamics, efficacy, and safety.
  26 21,636 4,164
Gestational diabetes mellitus: Non-insulin management
Navneet Magon, V Seshiah
October-December 2011, 15(4):284-293
DOI:10.4103/2230-8210.85580  PMID:22028999
Gestational diabetes mellitus (GDM) complicates a substantial number of pregnancies. There is consensus that in patients of GDM, excellent blood glucose control, with diet and, when necessary, oral hypoglycemics and insulin results in improved perinatal outcomes, and appreciably reduces the probability of serious neonatal morbidity compared with routine prenatal care. Goals of metabolic management of a pregnancy complicated with GDM have to balance the needs of a healthy pregnancy with the requirements to control glucose level. Medical nutrition therapy is the cornerstone of therapy for women with GDM. Surveillance with daily self-monitoring of blood glucose has been found to help guide management in a much better way than blood glucose checking in labs and clinics, which tends to be less frequent. Historically, insulin has been the therapeutic agent of choice for controlling hyperglycemia in pregnant women. However, difficulty in medication administration with multiple daily injections, potential for hypoglycemia, and increase in appetite and weight make this therapeutic option cumbersome for many pregnant patients. Use of oral hypogycemic agents (OHAs) in pregnancy has opened new vistas for GDM management. At present, there is a growing acceptance of glyburide (glibenclamide) use as the primary therapy for GDM. Glyburide and metformin have been found to be safe, effective and economical for the treatment of gestational diabetes. Insulin, however, still has an important role to play in GDM. GDM is a window of opportunity, which needs to be seized, for prevention of diabetes in future life. Goal of our educational programs should be not only to improve pregnancy outcomes but also to promote healthy lifestyle changes for the mother that will last long after delivery. Team effort on part of obstetricians and endocrinologists is required to make " the diabetes capital of the world" into " the diabetes care capital of the world".
  25 7,826 2,513
Ramadan and diabetes: As-Saum (The fasting)
Mohammed Abdul Jaleel, Syed Abbas Raza, Farah Naaz Fathima, Bushra Naaz Fathima Jaleel
October-December 2011, 15(4):268-273
DOI:10.4103/2230-8210.85578  PMID:22028997
Ramadan, the ninth month of Islamic lunar calendar, is marked by religious ritual of fasting from early dawn till sunset by Muslims. Islam has allowed many categories of people to be exempt totally or temporarily from fasting. Patients with uncontrolled diabetes face possible major metabolic risks including hypoglycemia, hyperglycemia with or without the risk of impending ketosis, dehydration, and thrombosis. Diabetics can be stratified into four categories based on their level of risk associated with fasting. The recommended ruling for persons in categories 1 and 2 is that they are prohibited from fasting to prevent harming themselves based on the certainty or the preponderance of probability that harm will occur, whereas the recommended ruling for those in categories 3 and 4 is that they should fast. The strategies to ensure safety of diabetics who are planning to fast include Ramadan-focused patient education, pre-Ramadan medical assessment, following a healthy diet and physical activity pattern, physician-recommended modifications in medication protocol and therapeutic recommendations and checking blood glucose as and when required.
  19 7,324 838
EDITORIALS
Polycystic ovary syndrome - A metabolic malady, the mother of all lifestyle disorders in women - Can Indian health budget tackle it in future?
M Ashraf Ganie, Sanjay Kalra
October-December 2011, 15(4):239-241
DOI:10.4103/2230-8210.85571  PMID:22028993
  7 4,497 883
CASE REPORTS
Metabolic bone disease as a presenting manifestation of primary Sjögren's syndrome: Three cases and review of literature
Deepak Khandelwal, Saptarshi Bhattacharya, Ankur Gadodia, Rajesh Khadgawat, Nikhil Tandon, AC Ammini
October-December 2011, 15(4):341-345
DOI:10.4103/2230-8210.85599  PMID:22029009
Primary Sjögren's syndrome (pSS) is a chronic autoimmune disease characterized by a progressive lymphocytic infiltration of the exocrine glands with varying degrees of systemic involvement. Chronic inflammation compromises the glands' function that leads to dry symptoms in the mouth/eyes. Renal involvement is a well recognized extraglandular manifestation of pSS. Metabolic bone disease (MBD), however, rarely occurs as the primary manifestation of a renal tubule disorder due to pSS. To the best of our knowledge there are only 6 reported cases of metabolic bone disease as the primary manifestation of pSS to date. Four of these had distal renal tubular acidosis (RTA), and 2 had a combined picture of distal and proximal tubular dysfunction. We herein present our experience of 3 cases who presented to us with a clinical picture suggestive of MBD. While investigating these patients, we found evidence of RTA, which was found to be secondary to pSS.
  6 3,628 560
ORIGINAL ARTICLES
Comparison of the performance of two measures of central adiposity among apparently healthy Nigerians using the receiver operating characteristic analysis
Christian Ifedili Okafor, Olufemi Fasanmade, Esther Ofoegbu, Augustine Efedaye Ohwovoriole
October-December 2011, 15(4):320-326
DOI:10.4103/2230-8210.85588  PMID:22029004
Objective: To compare the performance of waist circumference (WC) and waist-to-hip ratio (WHR) in predicting the presence of cardiovascular risk factors (hypertension and generalized obesity) in an apparently healthy population. Materials and Methods: We recruited 898 apparently healthy subjects (318 males and 580 females) of the Igbo ethnic group resident in Enugu (urban), Southeast Nigeria. Data collection was done using the World Health Organization Stepwise approach to Surveillance of risk factors (STEPS) instrument. Subjects had their weight, height, waist and hip circumferences, systolic and diastolic blood pressures measured according to the guidelines in the step 2 of STEPS instrument. Generalized obesity and hypertension were defined using body mass index (BMI) and JNC 7 classifications, respectively. Quantitative and qualitative variables were analyzed using t-test and Chi-square analysis, respectively, while the performance of WC and WHR was compared using the Receiver Operating Characteristic (ROC) analysis. P value was set at <0.05. Results: The mean age of the subjects was 48.7 (12.9) years. Central obesity was found in 76.9% and 66.5% of subjects using WHR and WC, respectively. WC had a significantly higher area under the curve (AUC) than WHR in all the cardiovascular risk groups, namely, generalized obesity (AUC = 0.88 vs. 0.62), hypertension alone (AUC = 0.60 vs. 0.53), and both generalized obesity and hypertension (AUC = 0.86 vs. 0.57). Conclusion: WC performed better than WHR in predicting the presence of cardiovascular risk factors. Being a simple index, it can easily be measured in routine clinic settings without the need for calculations or use of cumbersome techniques.
  6 1,985 363
REVIEW ARTICLES
Human immunodeficiency virus endocrinopathy
Uma Sinha, Nilanjan Sengupta, Prasanta Mukhopadhyay, Keshab Sinha Roy
October-December 2011, 15(4):251-260
DOI:10.4103/2230-8210.85574  PMID:22028995
Human immunodeficiency virus (HIV) endocrinopathy encompasses a broad spectrum of disorders. Almost all the endocrine organs are virtually affected by HIV infection. HIV can directly alter glandular function. More commonly secondary endocrine dysfunction occurs due to opportunistic infections and neoplasms in immunocompromised state. The complex interaction between HIV infection and endocrine system may be manifested as subtle biochemical and hormonal perturbation to overt glandular failure. Antiretroviral therapy as well as other essential medications often result in adverse endocrinal consequences. Apart from adrenal insufficiency, hypogonadism, diabetes and bone loss, AIDS wasting syndrome and HIV lipodystrophy need special reference. Endocrinal evaluation should proceed as in other patients with suspected endocrine dysfunction. Available treatment options have been shown to improve quality of life and long-term mortality in AIDS patients.
  6 3,512 986
ORIGINAL ARTICLES
Correlation between microalbuminuria and urinary copper in type two diabetic patients
Afsaneh Talaei, Saber Jabari, Mohamad Hasan Bigdeli, Heidar Farahani, Mansour Siavash
October-December 2011, 15(4):316-319
DOI:10.4103/2230-8210.85586  PMID:22029003
Introduction: Diabetes mellitus and its chronic complications may be associated with alterations in the plasma, tissue, and urinary levels of some trace elements like copper. Materials and Methods: This cross-sectional study evaluates the 24 hour urinary copper levels in type 2 diabetic patients with microalbuminuria in comparison with patients without albuminuria. Results: Forty-two patients with microalbuminuria (case) and 40 patients without microalbuminuria (control) participated in the study. Mean (CI 95%) urinary copper levels were 36.14 (14.54-57.74) and 14.77μcg /L (10.17-19.37) in the case and control groups respectively (P = 0.003). There was no significant effect of diabetes duration or HbA1c on urinary copper. Conclusion: The present study shows diabetic patients with microalbuminuria have increased urinary copper excretion, however does not exclude the potential toxic effects of this high copper excretion on the progression of diabetic nephropathy.
  5 2,197 484
Anthropometry and physical fitness in individuals with family history of type-2 diabetes mellitus: A comparative study
Samata Padaki, K Vijayakrishna, Amrut Dambal, Roopa Ankad, R Manjula, Chinagudi Surekharani, Anita Herur, Shailaja Patil
October-December 2011, 15(4):327-330
DOI:10.4103/2230-8210.85595  PMID:22029005
Context: The risk of becoming a diabetic for an individual with a positive family history of diabetes increases by two- to fourfold. Aim: To record the anthropometric indices and the physical fitness in individuals with family history of type-2 diabetes mellitus and compare these results with those of controls. Settings and Design: This is a comparative study done in the department of physiology. Materials and Methods: Thirty-two apparently healthy medical students with family history of type-2 Diabetes Mellitus were chosen for the study and matched with equal number of controls. Anthropometric measurements (height, weight, waist circumference, hip circumference, thigh circumference, upper segment and lower segment) were recorded. Body mass index (BMI), waist-hip ratio (WHR), waist-thigh ratio (WTR), and upper to lower segment ratio (US/LS ratio) were calculated. Blood pressure and heart rate were measured. Physical fitness was evaluated using Queen's College step test protocol. Rate Pressure Product (RPP) and Physical Fitness Index (PFI) were calculated before and after exercise. Statistical Analysis: Statistical analysis was done using SPSS software. Results: BMI, WHR, US/LS ratio, and RPP at rest were significantly higher (P < 0.05), whereas WTR, PFI, and RPP after exercise lower (P > 0.05) in cases as compared to controls. Conclusions: It can be concluded that apparently healthy individuals with family history of type-2 diabetes mellitus have higher anthropometric values and lower physical fitness than the controls.
  5 2,216 458
REVIEW ARTICLES
South Asian Consensus Guidelines for the rational management of diabetes in human immunodeficiency virus/acquired immunodeficiency syndrome
Sanjay Kalra, Ambika Gopalakrishnan Unnikrishnan, Syed Abbas Raza, Ganpathy Bantwal, Manash P Baruah, Tint Swe Latt, Dina Shrestha, Mathew John, Prasad Katulanda, Noel Somasundaram, Rakesh Sahay, Faruque Pathan
October-December 2011, 15(4):242-250
DOI:10.4103/2230-8210.85573  PMID:22028994
As newer methods of management are made available, and accessible, survival rates with human immunodeficiency virus (HIV) are increasing. This means that chronic, metabolic complications of HIV are becoming more frequent in clinical practice, as acute morbidity is controlled. Management of HIV/acquired immunodeficiency syndrome (AIDS) is gradually expanding to include these chronic and metabolic complications of the disease, and the adverse effects associated with its treatments, including diabetes. Unfortunately, no guidelines are available to help the medical practitioners choose appropriate therapy for patients with these conditions. 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 patients with HIV. The development of these guidelines used systematic reviews of available evidence to form its key recommendations. These guidelines and associated review of literature represent a compilation of available knowledge regarding rational management of diabetes in HIV. Patients of diabetes with concomitant HIV infection are managed optimally with insulin therapy and judicious use of highly active antiretroviral therapy with suitable alternatives is also recommended. These guidelines should prove helpful to physicians, not only in South Asia, but also across the globe, while managing patients with coexistent HIV and diabetes.
  5 2,880 555
LETTERS TO THE EDITOR
Origin of primary adrenal lymphoma and predisposing factors for primary adrenal insufficiency in primary adrenal lymphoma
Sagili Vijaya Bhaskar Reddy, Shashank Prabhudesai, Babu Gnanasekaran
October-December 2011, 15(4):350-351
DOI:10.4103/2230-8210.85604  PMID:22029014
  4 1,557 387
ORIGINAL ARTICLES
Iodine status and its correlations with age, blood pressure, and thyroid volume in South Indian women above 35 years of age (Amrita Thyroid Survey)
Vadayath Usha Menon, Gopi Chellan, Karimassery Ramaiyar Sundaram, Srikanth Murthy, Harish Kumar, Ambika Gopalakrishnan Unnikrishnan, Rohinivilasam Vasukutty Jayakumar
October-December 2011, 15(4):309-315
DOI:10.4103/2230-8210.85584  PMID:22029002
Background: Thyroid disorders are more commonly seen among females and the prevalence increases with age. There is no population data from India focusing on iodine levels and their correlations with thyroid volume and other factors in adult women. Aim: This study was designed to establish the iodine status and its relation with various factors including thyroid volume measured by ultrasound among the females of Kerala. Materials and Methods: This was a cross sectional house to house survey among the females above 35 years of age in a randomly selected urban area in Cochin Corporation, Kerala State, India. Selected subjects were interviewed, examined and blood and urine tests were done. Thyroid volume was calculated using ultrasound. Results: Among the 508 subjects who participated in the checkup, 471 subjects were included for analysis. Mean age was 50.3 + 10.7 years and 53.2% were postmenopausal. A total of 98% of the subjects were using iodized salt and median urinary iodine excretion (UIE) was 162.6 mcg/l. UIE had negative correlation with age and systolic blood pressure (BP), but had no correlation with thyroid volume (TV), thyroid nodularity, free thyroxine 4 (FT4), thyroid stimulating hormone (TSH) or anti thyroid peroxidase (TPO) levels. Iodine deficiency was more commonly seen in subjects with hypertension and also among postmenopausal females. Conclusions: This study showed that females > 35 years were iodine sufficient, though one third of the subjects had UIE levels less than the recommended level. Iodine levels had significant negative correlation with age and systolic BP and no correlation with thyroid volume or biochemical parameters. Iodine deficiency was significantly higher in subjects with new and known hypertension and this relation merits further evaluation.
  4 3,173 592
CASE REPORTS
Cushing's syndrome in a case of thymic carcinoma
HS Asha, K Sudeep, Manika Alexander, Anila Korula, Birla Roy Gnanamuthu, Nihal Thomas
October-December 2011, 15(4):346-348
DOI:10.4103/2230-8210.85601  PMID:22029011
A 29-year-old gentleman presented with episodic features suggestive of Cushing's syndrome. He was evaluated and diagnosed with ectopic Adrenocorticotropic hormone (ACTH)-dependent Cushing's syndrome due to a thymic tumor. The thymic lesion was excised and histopathology confirmed thymic carcinoma with neuroendocrine differentiation, with local, perineural, and vascular invasion. The postoperative problems and further treatment options have been discussed in this case report.
  3 2,799 328
Adult onset pseudohypoparathyroidism type-1b with normal phosphaturic response to exogenous parathyroid hormone
Sandeep Kharb, Abhay Gundgurthi, MK Dutta, MK Garg
October-December 2011, 15(4):337-340
DOI:10.4103/2230-8210.85598  PMID:22029008
Pseudohypoparathyroidism type-1b is a hereditary disorder of clinical hypoparathyroidism without AHO phenotype, characterized by blunted nephrogenous cyclic-AMP (cAMP) response to exogenous parathyroid hormone (PTH). Here we report a young adult presenting with hypocalcemic tetany with raised PTH levels. His urinary cAMP response to exogenous PTH (recombinant 1-34) was blunted; however, phosphaturic response was normal.
  2 3,609 416
LETTERS TO THE EDITOR
Hypoparathyroidism and reversible dilated cardiomyopathy
M Suresh Babu, Sasidharan Sameer
October-December 2011, 15(4):351-352
DOI:10.4103/2230-8210.85605  PMID:22029015
  2 1,683 254
CASE REPORTS
Nephrogenic diabetes insipidus with idiopathic Fanconi's syndrome in a child who presented as vitamin D resistant rickets
Soumya Patra, Gulnaz Nadri, Harish Chowdhary, Harish K Pemde, Varinder Singh, Jagdish Chandra
October-December 2011, 15(4):331-333
DOI:10.4103/2230-8210.85596  PMID:22029006
Fanconi's syndrome is a complex of multiple tubular dysfunctions of proximal tubular cells occurring alone or in association with a variety of inherited (primary) or acquired (secondary) disorders. It is characterized by aminoaciduria, normoglycaemic glycosuria, tubular proteinuria without hematuria, metabolic acidosis without anion gap and excessive urinary excretion of phosphorous, calcium, uric acid, bicarbonate, sodium, potassium, and magnesium. Whereas diabetes insipidus is a disease of collecting tubules and child mainly presents with dehydration and hypernatremia. Though all the cases published till date were secondary to drugs, myeloma, hematological disorders, etc., we are reporting the first case of idiopathic Fanconi's syndrome along with nephrogenic diabetes insipidus in a child who presented to us as resistant rickets. Medline search did not reveal any case of nephrogenic diabetes insipidus associated with idiopathic Fanconi syndrome. We hypothesized that the NDI may be due to of severe hypokalemia induced tubular dysfunction.
  1 2,142 382
EDITORIALS
Human immunodeficiency virus and the endocrine system
Sanjay Kalra, Hamdy Sleim, Narendra Kotwal
October-December 2011, 15(4):231-233
DOI:10.4103/2230-8210.85566  PMID:22028990
  1 2,028 527
LETTERS TO THE EDITOR
Intensive care management of critically sick diabetic patients
Sukhminder Jit Singh Bajwa
October-December 2011, 15(4):349-350
DOI:10.4103/2230-8210.85603  PMID:22029013
  1 1,683 290
CASE REPORTS
Single photon emission computed tomography-CT in ectopic parathyroid adenoma
K. V. S Hari Kumar, Sangeeta Jha, Altamash Shaikh, KD Modi
October-December 2011, 15(4):334-336
DOI:10.4103/2230-8210.85597  PMID:22029007
Primary hyperparathyroidism often presents with protean manifestations, resulting in delayed diagnosis. At times, aberrant development and migration of the gland leads to ectopic location leading to problems in localization. Judicious use of combination methods of localization is recommended in treatment failure or recurrent disease. We report the use of single photon emission computed tomography-CT in precise localization of parathyroid adenoma in a patient with failed initial surgery.
  - 1,867 293
EDITORIALS
The first years of Indian Journal of Endocrinology and Metabolism
GR Sridhar
October-December 2011, 15(4):234-236
DOI:10.4103/2230-8210.85568  PMID:22028991
  - 1,575 289
Academic endocrinology in India: Forty, fifteen or both?
Sanjay Kalra, Ambika Gopalakrishnan Unnikrishnan, Shashank Joshi
October-December 2011, 15(4):237-238
DOI:10.4103/2230-8210.85570  PMID:22028992
  - 1,535 320
ERRATUM
Erratum

October-December 2011, 15(4):345-345
PMID:22029010
  - 1,124 180
Erratum

October-December 2011, 15(4):348-348
PMID:22029012
  - 1,018 202
REVIEW ARTICLES
Pioglitazone: Indian perspective
Rishi Shukla, Sanjay Kalra
October-December 2011, 15(4):294-297
PMID:22029000
Pioglitazone was approved in 1999 as an adjunct to exercise and diet to improve glycemic control in adults with type 2 diabetes mellitus, primarily by reducing insulin resistance. Beyond these effects on glucose metabolism, pioglitazone has positive effects on lipid metabolism, blood pressure, endothelial function, adiponectin, and C-reactive protein levels. These make pioglitazone treatment effective beyond glucose control. Pioglitazone generally has been viewed as a safer option for patients who warrant treatment with a thiazolidinedione-class drug. There has been some recent data on cancer incidence in patients on pioglitazone, which is currently being reviewed by drug regulatory authorities in the United States and in Europe. Given the benefits of pioglitazone, alone and in combination, it would be appropriate to continue judicious use of the drug in patients who may benefit from its use.
  - 2,398 591
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