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   2014| March-April  | Volume 18 | Issue 2  
    Online since March 19, 2014

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Gynecomastia: Clinical evaluation and management
Neslihan Cuhaci, Sefika Burcak Polat, Berna Evranos, Reyhan Ersoy, Bekir Cakir
March-April 2014, 18(2):150-158
DOI:10.4103/2230-8210.129104  PMID:24741509
Gynecomastia is the benign enlargement of male breast glandular tissue and is the most common breast condition in males. At least 30% of males will be affected during their life. Since it causes anxiety, psychosocial discomfort and fear of breast cancer, early diagnostic evaluation is important and patients usually seek medical attention. Gynecomastia was reported to cause an imbalance between estrogen and androgen action or an increased estrogen to androgen ratio, due to increased estrogen production, decreased androgen production or both. Evaluation of gynecomastia must include a detailed medical history, clinical examination, specific blood tests, imaging and tissue sampling. Individual treatment requirements can range from simple reassurance to medical treatment or even surgery. The main aim of any intervention is to relieve the symptoms and exclude other etiological factors.
  36 11,600 2,061
Diabetes and related remedies in medieval Persian medicine
Mohammad M Zarshenas, Sedigheh Khademian, Mahmoodreza Moein
March-April 2014, 18(2):142-149
DOI:10.4103/2230-8210.129103  PMID:24741508
Diabetes Mellitus is a common metabolic disorder presenting increased amounts of serum glucose and will cover 5.4% of population by year 2025. Accordingly, this review was performed to gather and discuss the stand points on diagnosis, pathophysiology, non-pharmacological therapy and drug management of diabetes this disorder as described in medieval Persian medicine. To this, reports on diabetes were collected and analyzed from selected medical and pharmaceutical textbooks of Traditional Persian Medicine. A search on databases as Pubmed, Sciencedirect, Scopus and Google scholar was also performed to reconfirm the Anti diabetic activities of reported herbs. The term, Ziabites, was used to describe what is now spoken as diabetes. It was reported that Ziabites, is highly associated with kidney function. Etiologically, Ziabites was characterized as kidney hot or cold dystemperament as well as diffusion of fluid from other organs such as liver and intestines into the kidneys. This disorder was categorized into main types as hot (Ziabites-e-har) and cold (Ziabites-e-barid) as well as sweet urine (Bole-e-shirin). Most medieval cite signs of Ziabites were remarked as unusual and excessive thirst, frequent urination and polydipsia. On the management, life style modification and observing the essential rules of prevention in Persian medicine as well as herbal therapy and special simple manipulations were recommended. Current investigation was done to clarify the knowledge of medieval scientists on diabetes and related interventions. Reported remedies which are based on centuries of experience might be of beneficial for- further studies to the management of diabetes.
  23 3,157 593
Type 1 diabetes and osteoporosis: A review of literature
Pooja Dhaon, Viral N Shah
March-April 2014, 18(2):159-165
DOI:10.4103/2230-8210.129105  PMID:24741510
With better care and intensive insulin therapy, microvascular complications have reduced and longevity has increased in patients with type 1 diabetes (T1DM). Therefore, there is a need to change the focus from microvascular complications to cardiovascular disease and osteoporosis. Though number of studies from other parts of the world show that patients with T1DM are at increased risk of osteoporosis and fractures, there is a paucity of data from India. A number of factors and mechanisms affecting bone health in patients with T1DM have been proposed. The main defect in genesis of osteoporosis is osteoblastic function, rather than osteoclastic overfunction. Assessment of bone mineral density by dual X-ray absorptiometry and other risk factors for osteoporosis, as a part of diagnostic procedure can help to design tailored treatment plans. A physically active healthy lifestyle, prevention of diabetic complications and adequate calcium and vitamin D supplementation are the mainstay for prevention of osteoporosis. Treatment of osteoporosis is not evidence based but it is proposed to be similar to osteoporosis associated with other conditions. Bisphosphonates are the mainstay for treatment of osteoporosis in patients with T1DM. However, more studies are needed to make definitive guidelines on prevention and treatment of osteoporosis in patients with T1DM.
  18 5,022 1,283
Evaluation of sexual dysfunction in women with type 2 diabetes
Jamshid Vafaeimanesh, Mehdi Raei, Fatemeh Hosseinzadeh, Mahmoud Parham
March-April 2014, 18(2):175-179
DOI:10.4103/2230-8210.129107  PMID:24741512
Background: Sexual dysfunction is a common complication of diabetes that adversely affects their quality of life. Its prevalence is known to be higher in diabetic men with and it is estimated to affect 20-85% of patients but the problem is probably less common in diabetic women. This study investigated the prevalence of sexual dysfunction and its risk factors among women with diabetes. Materials and Methods: This descriptive-analytic study was performed during May 2012 to Feb 2013 at Diabetes clinic of Shahid Beheshti Hospital of Qom and The Female Sexual Function Index (FSFI) was used for evaluation of sexual dysfunction. Conclusion: In this study, 59 (53.6%) women had sexual dysfunction. The mean age of patients with sexual dysfunction and healthy people was 48.22 ± 6.61 and 48.14 ± 5.37 years respectively and it was not statistically different in both groups (P = 0.94). Also, there was no significant difference between two groups in average duration of diabetes, fasting blood sugar (FBS), glycosylated hemoglobin (HbA1c) level, insulin resistance, abdominal circumference and body mass index BMI. Although the history of hypertension, coronary artery disease and exercise levels were not significantly associated with sexual dysfunction, but there was a significant association between albuminuria and sexual dysfunction (P = 0.001). Retinopathy and sexual dysfunction had statistically significant relationship (P = 0.007) while no association was found between diabetic neuropathy and sexual dysfunction (P = 0.79). Results: Sexual dysfunction is a common complication in diabetic patients which accompanies with some complications of diabetes and should be considered especially in patients with nephropathy or retinopathy.
  17 3,017 623
An observational study of cutaneous manifestations in diabetes mellitus in a tertiary care Hospital of Eastern India
Nandini Chatterjee, Chandan Chattopadhyay, Nilanjan Sengupta, Chanchal Das, Nilendu Sarma, Salil K Pal
March-April 2014, 18(2):217-220
DOI:10.4103/2230-8210.129115  PMID:24741520
Background: Diabetes mellitus and its impact on the human body have been extensively dissected over the years. However, skin which is the largest organ in the body, has received minimum attention. Therefore, this study was designed to analyze the prevalence and pattern of skin disorders among diabetic patients from Eastern region of India. Materials and Methods: This is an observational study, conducted in the General Medicine and Endocrinology departments of a Medical College and Hospital in Eastern India. The data were collected prospectively and systematically in a pre-established proforma designed by us, where clinical findings along with investigations were recorded. Results: Six hundred and eighty (680) diabetic patients were examined, there were (64.8%) male and (35.1%) were female, of them 95.3% were Type 2 diabetics while 4.7% were Type 1. Five hundred and three patients (503) out of six hundred and eighty. i.e. 73.9% were found to have skin lesions. Thirteen (13) (41%) Type1 diabetics demonstrated skin lesions commonest being diabetic xerosis, infections and diabetic hand. Among Type2 diabetics 490(75.61%) showed skin lesions. Here infections, xerosis, hair loss beneath the knees, diabetic dermopathy were the most frequent. Majority of patients (67%) had combination of more than one type of skin lesion. There was statistically significant correlation of skin lesions with duration of diabetes, however similar correlation could not be demonstrated regarding metabolic control. Conclusion: Involvement of skin is inevitable and multifarious in diabetes mellitus. Higher prevalence is seen in Type 2 diabetic population. The duration of diabetes is positively correlated with lesions and infective dermatologic manifestations were associated with higher HbA1C values.
  12 3,835 606
Untapped diamonds for untamed diabetes: The α-glucosidase inhibitors
Sanjay Kalra, Manoj Chadha, SK Sharma, AG Unnikrishnan
March-April 2014, 18(2):138-141
DOI:10.4103/2230-8210.129102  PMID:24741507
  7 1,761 409
Congenital hypothyroidism in neonates
Aneela Anjum, Muhammad Faheem Afzal, Syed Muhammad Javed Iqbal, Muhammad Ashraf Sultan, Asif Hanif
March-April 2014, 18(2):213-216
DOI:10.4103/2230-8210.129114  PMID:24741519
Context: Congenital hypothyroidism (CH) is one of the most common preventable causes of mental retardation in children and it occurs in approximately 1:2,000-1:4,000 newborns. Aims and Objectives: The aim of this study is to determine the frequency of CH in neonates. Settings and Design: This cross-sectional study was conducted in neonatal units of the Department of Pediatrics Unit-I, King Edward Medical University/Mayo Hospital, Lahore and Lady Willington Hospital Lahore in 6 months (January-June 2011). Materials and Methods: Sample was collected by non-probability purposive sampling. After consent, 550 newborn were registered for the study. Demographic data and relevant history was recorded. After aseptic measures, 2-3 ml venous blood analyzed for thyroid-stimulating hormone (TSH) level by immunoradiometric assay. Treatment was started according to the individual merit as per protocol. Statistical Analysis Used: Data was analyzed by SPSS 17 and Chi-square test was applied to find out the association of CH with different variables. Results: The study population consisted of 550 newborns. Among 550 newborns, 4 (0.8%) newborns had elevated TSH level. CH had statistically significant association with mother's hypothyroidism (P value 0.000) and mother's drug intake during the pregnancy period (P value 0.013). Conclusion: CH is 0.8% in neonates. It has statistically significant association with mother's hypothyroidism and mother's drug intake during pregnancy.
  7 2,055 624
The potential impact of family history of metabolic syndrome and risk of type 2 diabetes mellitus: In a highly endogamous population
Abdulbari Bener, Sarah Darwish, Abdulla O. A Al-Hamaq, Mohammad T Yousafzai, Eman A Nasralla
March-April 2014, 18(2):202-209
DOI:10.4103/2230-8210.129112  PMID:24741517
Aim: This study aims to determine the potential impact of positive family history of Metabolic Syndrome (MetS) among two generations, on developing Type 2 Diabetes Mellitus (T2DM) and the potential relation of consanguineous marriage among patients with MetS to the risk of developing T2DM among a sample of Qataris. Design: A cross-sectional study. Setting: Primary healthcare (PHC) centers. Materials and Methods: The survey and measurement were conducted from April 2011 to December 2012 among Qatari nationals above 20 years of age. Of the 2,182 subjects, who were approached to participate in the study, 1,552 (71%) gave their consent. Face-to-face interviews were conducted using a structured questionnaire followed by anthropometric measurements and laboratory tests. Metabolic syndrome was defined using the National Cholesterol Education Program-Third Adult Treatment Panel (ATP III) as well as International Diabetes Federation (IDF). Results: Overall, the prevalence of MetS was 26.2% according to ATP III and 36.9% according to IDF (P < 0.0001). The mean age of MetS patients with T2DM was significantly higher than those without T2DM (Mean 48 ± 9.9 vs. 42.5 ± 9.2; P < 0.001). The proportion of females was higher among MetS patients with T2DM as compared to those without T2DM (61% vs. 51%; P = 0.053). In addition, there were significant differences between MetS patients with and without DM in terms of co-morbidities of hypertension, coronary heart disease, and high cholesterol. The proportion of MetS patients with positive family history for MetS was significantly higher in MetS patients with T2DM as compared to those without T2DM (46.7% vs. 33.8%; P = 0.009). The proportion of positive family history of MetS among fathers (35% vs. 21.9%; P = 0.005), mothers (30.5% vs. 18.8%; P = 0.008), maternal aunt (18.3% vs. 11.2%; P = 0.055), and maternal grand father (19.5% vs. 10%; P = 0.010) were significantly higher in MetS patients with T2DM as compared to the counterpart. The proportion of consanguineous marriages was almost two times higher among MetS patients with T2DM as compared to those without T2DM (80.9% vs. 41.9%; P < 0.001). The proportion of MetS patients with T2DM was lower than MetS patients without DM below 45 years, but after 45 years, the proportion of MetS patients with T2DM remained higher than their counterparts. Conclusion: Family history of MetS among parents, maternal aunt, maternal grandfather, and consanguineous marriages among patients of MetS are significantly associated with the development of T2DM in Qatar. These results support the necessity of earlier screening for T2DM among MetS patients with positive family history of MetS.
  7 2,418 463
Treat-to-target trials in diabetes
Subhash K Wangnoo, Bipin Sethi, Rakesh K Sahay, Mathew John, Samit Ghosal, Surendra K Sharma
March-April 2014, 18(2):166-174
DOI:10.4103/2230-8210.129106  PMID:24741511
Treat-to-target is a therapeutic concept that considers well defined and specific physiologic targets as aims in controlling the pathophysiology of the disease. It has been widely used in diseases that pathophysiology includes, chronic metabolic and physiological disturbances, namely rheumatic conditions, vascular medicine and diabetes. In diabetes, the availability of "gold-standard" quantitative measures like fasting plasma glucose and glycated hemoglobin make the application of treat-to-target trials especially pertinent. Treatment modalities which have used single therapeutic agents or combinations or in combination with a variety of titration algorithms and implementation protocols have broadened our understanding of diabetes management with specific reference to insulin initiation and maintenance. Treat-to-target trials have been used to investigate a wide variety of questions including efficacy, safety, effect of treatment on comorbidities and patient satisfaction, ideal mechanisms to implement insulin initiation etc. A more generalized acceptance and implementation of treat-to-target trials may finally revolutionize diabetes management by combining aspects of individual care with standard treatment protocols.
  6 2,837 594
A rare case of triple thyroid ectopia
Mukund Rahalkar, Anand Rahalkar, Shrikant Solav
March-April 2014, 18(2):238-240
DOI:10.4103/2230-8210.129121  PMID:24741526
Various anomalies of thyro-glossal duct have been described, in which the duct may form a cyst or may present as a solid nodule to form an ectopic gland. The ectopic gland can develop along the tract of the duct to give rise to ectopic lingual, sublingual (pre-hyoid) or sub-hyoid (pyramidal) gland, with or without normal pre-tracheal thyroid gland.There are a few reports of double ectopia of thyroid but triple ectopia of thyroid is extremely rare. We have come across a case of triple thyroid ectopia, i.e., thyroid tissue at three locations along the tract of descent of thyro-glossal duct on CT, which hast been rarely reported in the world literature, and hence this report.
  5 1,193 234
Clinical features of bone metastasis for differentiated thyroid carcinoma: A study of 21 patients from a Tunisian center
Faouzi Kallel, Fatma Hamza, Salma Charfeddine, Wissem Amouri, Issam Jardak, Abdelmonem Ghorbel, Fadhel Guermazi
March-April 2014, 18(2):185-190
DOI:10.4103/2230-8210.129109  PMID:24741514
Introduction: The differentiated thyroid cancers have a good prognosis unless the presence of metastasis. These distant metastases, especially in bone, are a major cause of impaired quality of life and death requiring intensive management. The aim of our work was to study the patients' data, the disease characteristics and to analyze the therapeutic management of these patients. Results: This study concerned a cohort of 21 patients treated for differentiated thyroid cancer during the period from 1995 to 2011. Eighteen of our patients were aged over 45 years. A majority of them had follicular carcinoma. Bone metastases were often multiple and located at the axial skeleton. They were associated with other types of metastases, especially lung metastasis. A majority of patients received 131I treatment, following surgery or external beam radiotherapy for a palliative purpose. Overall survival was 65% at 5 years and 49% at 10 years. A long-term survival was achieved in 10% of the patients benefiting from a multidisciplinary care adapted to each case. Conclusion: Bone metastases often have a pejorative turning in the natural history of differentiated thyroid cancers. The right selection of individuals with better prognosis, for whom more aggressive curative treatment was indicated, requires a better understanding of the features of bone involvement.
  5 2,582 401
Hepatitis C virus infection in Egyptian children with type 1 diabetes mellitus: A single center study
Hekma Saad Farghaly, Kotb Abbass Metwalley, Heba Ahmed Abd El-Hafeez
March-April 2014, 18(2):197-201
DOI:10.4103/2230-8210.129111  PMID:24741516
Background: Only few studies have evaluated the epidemiology and risk factors of hepatitis C virus (HCV) infection in Egyptian children with type 1 diabetes mellitus (T1DM). The present study aimed at measurement of the rates of anti-HCV positivity by Enzyme-Linked Immuno-Sorbent Assay (ELISA) test and of HCV-Ribonucleic acid (RNA) positivity by polymerase chain reaction (PCR) among children with T1DM and to study the possible risk factors of infection. Settings and Design: Cross-sectional controlled study. Materials and Methods: The study included 150 children with T1DM (Group 1) (mean age 14. 76 ± 6.4 years). Fifty children age and sex-matched were included as control group (Group 2) (mean age 13.62 ± 2.11 years). They were screened for HCV antibodies using third generation ELISA and HCV-RNA positivity by PCR. Results: The frequency of anti-HCV positivity by ELISA was significantly higher in children with T1DM (n = 150) in comparison wiith control group (n = 50) (12% vs 6%; P<0.001), while the frequency of HCV-RNA positivity by PCR among the cases testing positive by ELISA was 75% for both diabetic group and control group. There were no significant differences in serum levels of liver biochemical profile in diabetic children with anti-HCV positivity (n = 18) in comparison to those with anti-HCV negativity (n = 132). Residence in rural area, low socioeconomic class and prior hospitalization were significant risk factors for anti-HCV positivity by ELISA. Conclusions: The frequency of HCV infection in children with T1DM in Upper Egypt appears to be high and is mainly related to residence in rural area, low socioeconomic class and prior hospitalization. HCV infection in these children is not associated with significant changes in hepatic biochemical parameters. Recommendations: Implementation of strict infection control measures are highly recommended to reduce the frequency of HCV infection. Furthermore, the silent evolution of HCV infection in children makes periodic screening of HCV in diabetic children mandatory.
  5 1,391 331
Health economics in India: The case of diabetes mellitus
Rakesh Sahay, Manash P Baruah, Sanjay Kalra
March-April 2014, 18(2):135-137
DOI:10.4103/2230-8210.129101  PMID:24741506
  4 2,434 545
Circulating adiponectin levels in Indian patients with psoriasis and its relation to metabolic syndrome
Shraddha Madanagobalane, Venkatswami Sandhya, Sankarasubramanian Anandan, Krishna G Seshadri
March-April 2014, 18(2):191-196
DOI:10.4103/2230-8210.129110  PMID:24741515
Background: Adiponectin is a cytokine mainly secreted from the adipose tissue, which has insulin-sensitizing effects, antiatherosclerotic actions, and antiinflammatory properties. There are a few studies that have demonstrated that adiponectin is reduced in patients with psoriasis suggesting that this adipocytokine may have a role in the pathogenesis of psoriasis. There have been no studies so far on adiponectin in relation to psoriasis and metabolic syndrome (MetS). Objectives: This study was performed to analyze serum adiponectin and insulin levels in psoriasis patients with and without MetS and in controls with and without MetS. Materials and Methods: We performed a case control study on 60 psoriasis patients, 29 with MetS and 31 without MetS and 40 controls, 20 with and 20 without MetS, matched for age, sex, and body mass index (BMI). Fasting serum insulin and adiponectin levels were measured in all groups. Results: The overall serum adiponectin levels were significantly reduced in psoriasis patients when compared with controls (P = 0.000). A significant reduction was also observed in psoriasis patients with MetS than those without MetS in the same group (P = 0.000). Similar decrease was observed between those with MetS in the psoriasis and control groups (P = 0.001). The lowest mean value of serum adiponectin (6387.9 ng/ml) was observed in psoriasis with MetS group and highest value (12146.3 ng/ml) in controls without MetS. Conclusion: Adiponectin levels are decreased in psoriasis patients irrespective of MetS thus indicating a role in its pathogenesis. This study prompts future trials on drugs increasing adiponectin levels in patients with psoriasis.
  4 1,802 384
Effect of octreotide on endometriosis in acromegaly: Case report with review of literature
Seerat Singh, Aditi Anupam Chakravarty, Smita Manchanda, Renuka Mallik, Shweta Chopra, Ajay Ajmani, Bindu Kulshreshtha
March-April 2014, 18(2):241-244
DOI:10.4103/2230-8210.129122  PMID:24741527
Objective: To study the effect of octreotide therapy on endometriotic lesions in a patient with coexisting endometriosis and acromegaly. Intervention: Patient: A 34-year-old female was diagnosed with acromegaly and coexisting endometriosis. Post-surgical resection of the tumor, patient was initiated on octreotide therapy. Results: There was improvement in menstrual bleeding as IGF1 levels decreased with Octreotide therapy. Resolution of the endometriotic lesions was observed during follow up. Conclusion: In this unusual case, the treatment of acromegaly concurred with regression in the endometriotic lesions. Causal or incidental association cannot be inferred from the present case.
  2 1,175 205
Brain death in ICU patients: Clinical significance of endocrine changes
Sukhminder Jit Singh Bajwa, Rudrashish Haldar
March-April 2014, 18(2):229-231
DOI:10.4103/2230-8210.129118  PMID:24741523
Numerous studies have been carried out among patients admitted in intensive care unit (ICU) having primary endocrine pathology, endocrine manifestations of systemic diseases or post-endocrine tissue surgery. However, minimal literary evidence is available highlighting the endocrine changes occurring during brain death in critically ill patients. A precise and timely diagnosis of brain death is required to convey the relatives about the prognosis and also to possibly plan for organ retrieval for transplantation purposes. The diagnosis of this condition as of today remains largely a clinical one. Brain death is associated with a multitude of endocrinological alterations which are yet to be completely unraveled and understood. Evaluating these endocrinological modifications lends us an added vista to add to the existing clinical parameters which might help us to confirm the diagnosis of brain death with a higher degree of precision. Moreover, since the efficacy of hormone replacement therapy to benefit in organ retrieval remains yet unproven, newer diagnostic modalities and research studies are definitely called for to strategize the optimal dosage and duration of such therapies.
  1 2,565 325
A case report of reactive hypoglycemia in a patient with pheochromocytoma and it's review of literature
Rajesh Patnaik Thonangi, Minaxi Bhardwaj, Bindu Kulshreshtha
March-April 2014, 18(2):234-237
DOI:10.4103/2230-8210.129120  PMID:24741525
Pheochromocytoma, a tumor characterized by catecholamine excess, is usually associated with impaired glucose tolerance. Hypoglycemia may occur after the abrupt withdrawal of catecholamines in the postoperative period. Rarely, insulin secretion by stimulation of β-2 adrenoreceptors may overwhelm the glucagon production, thereby causing hypoglycemia. Here, we describe a female with pheochromocytoma, who presented with postprandial hypoglycemia.
  1 4,462 453
Endocrinology and the arts at the feet of the dancing Lord: Parathyroid hormone resistance in an Indian icon
Krishna G Seshadri
March-April 2014, 18(2):226-228
DOI:10.4103/2230-8210.129117  PMID:24741522
The dance of Siva has a cosmic appeal. Nowhere has this dance been crystallised in its pristine form as in the Nataraja Bronzes from the Chola period. Mysticism surrounds the dancing form of the Nataraja. But does Nataraja dance upon an endocrine mystery. Does the demon under his feet Apasmara literally forgetfulness or epilepsy have an endocrine disorder. The short limbed stocky eye popping dwarf with possible mental retardation with a name that suggests epilepsy throws open a host of endocrine diagnoses. From cretinisim to the original descriptions of pseudohypoparathyroidism here is one view of the medical mystery under Shiva's dancing feet.
  1 2,896 279
Comment on trends in onomastics-the case of PCOS by Kalra et al.
Jyothi Idiculla
March-April 2014, 18(2):245-245
DOI:10.4103/2230-8210.129123  PMID:24741528
  1 1,338 220
Response to the editorial on "Defining vitamin D deficiency, using surrogate markers"
Subhosmito Chakraborty, Mohandas K Mallath
March-April 2014, 18(2):246-246
DOI:10.4103/2230-8210.129124  PMID:24741529
  1 857 173
Correlation between serum adiponectin and clinical characteristics, biochemical parameters in Indian women with polycystic ovary syndrome
Sunita J Ramanand, Jaiprakash B Ramanand, Balasaheb B Ghongane, Milind H Patwardhan, Varsha M Patwardhan, Ravi Ghanghas, Nimish R Halasawadekar, Praveenkumar Patil
March-April 2014, 18(2):221-225
DOI:10.4103/2230-8210.129116  PMID:24741521
Background: Polycystic ovary syndrome (PCOS) is a common disorder. PCOS women are at a high risk for insulin resistance and metabolic syndrome (MS). Adiponectin is positively related to insulin sensitivity. It has a preventive role in atherogenesis and MS. The present work was conducted to study the correlation between serum adiponectin levels and clinical characteristics and biochemical parameters in PCOS patients. Materials and Methods: A prospective study in 49 newly diagnosed (as per Rotterdam criteria) Indian PCOS women was conducted. PCOS women were clinically examined and investigated for biochemical parameters. Results : The mean serum adiponectin was 12 ± 9.4 μg/mL (range 0.47-45). Hypoadiponectinemia (serum adiponectin <4 μg/mL) was present in 22% patients. Age and adiponectin correlated significantly and inversely (r = −0.42, P = 0.027). Overweight/obese patients had lower mean adiponectin levels than normal weight (11.62 ± 9.5 vs 13.58 ± 9.5, P = 0.56). It was significantly lower in patients with acanthosis nigricans (AN) as compared with those without AN (8.4 ± 5.9 vs 15 ± 11, P = 0.038). Hirsute patients showed lower mean adiponectin levels than nonhirsute (10 ± 7.3 vs 13 ± 10, P = 0.57). A positive, insignificant correlation was observed between serum adiponectin and cholesterol, low-density lipoprotein, follicle stimulating hormone (FSH), thyroid stimulating hormone, levels. A negative insignificant correlation existed between serum adiponectin and luteinizing hormone (LH), LH: FSH ratio, prolactin, dehydroepiandrosterone, testosterone, triglyceride, high-density lipoprotein, fasting blood glucose, fasting insulin, and Homeostasis Model Assessment. Conclusion: Hypoadiponectinemia is present in one-fifth of women with PCOS. Adiponectin levels decrease as age advances. Low levels of adiponectin possibly contributes to the development of dermal manifestation (AN) of insulin resistance.
  1 2,659 416
Intraoperative parathyroid hormone assay-cutting the Gordian knot
Chandralekha Tampi, Nitin Chavan, Deepak Parikh
March-April 2014, 18(2):210-212
DOI:10.4103/2230-8210.129113  PMID:24741518
Background: Hyperparathyroidism is treated by surgical excision of the hyperfunctioning parathyroid gland. In case of adenoma the single abnormal gland is removed, while in hyperplasias, a subtotal excision, that is, three-and-a-half of the four glands are removed. This therapeutic decision is made intraoperatively through frozen section evaluation and is sometimes problematic, due to a histological overlap between hyperplasia and the adenoma. The intraoperative parathyroid hormone (IOPTH) assay, propogated in recent years, offers an elegant solution, with a high success rate, due to its ability to identify the removal of all hyperfunctioning parathyroid tissue. Aim: To study the feasibility of using IOPTH in our setting. Materials and Methods: Seven patients undergoing surgery for primary hyperparathyroidism had their IOPTH levels evaluated, along with the routine frozen and paraffin sections. Results: All seven patients showed more than a 50% intraoperative fall in serum PTH after excision of the abnormal gland. This was indicative of an adenoma and was confirmed by histopathological examination and normalization of serum calcium postoperatively. Conclusion: The intraoperative parathyroid hormone is a sensitive and specific guide to a complete removal of the abnormal parathyroid tissue. It can be incorporated without difficulty as an intraoperative guide and is superior to frozen section diagnosis in parathyroid surgery.
  1 3,110 200
Pituitary apoplexy presenting as myocardial infarction
Vishal Gupta, Sudarshan Patil, Dhiren Raval, Pratik Gopani
March-April 2014, 18(2):232-233
DOI:10.4103/2230-8210.129119  PMID:24741524
We describe a male patient who presented with sudden onset severe headache and right sided ptosis that was diagnosed to be secondary to pituitary apoplexy on the background of diabetes mellitus. This was complicated by left ventricular failure and acute coronary syndrome. The case highlights the importance of considering hypocortisolism/hypopituitarism as an important and rare precipitant of an acute coronary event as occurred in the case.
  - 1,099 231
Redefining vitamin D deficiency: Reply to comments
MK Garg, N Mahalle, Sanjay Kalra
March-April 2014, 18(2):247-247
DOI:10.4103/2230-8210.129125  PMID:24741530
  - 999 215
Comparative evaluation of sonographic ovarian morphology of Indian women with polycystic ovary syndrome versus those of normal women
Sanjeed Ahmed, Shivani Pahwa, Chandan Jyoti Das, Farooq A Mir, Sobia Nisar, Majid Jehangir, Shameem Parveen, Aafia Rashid, Mohd Ashraf Ganie
March-April 2014, 18(2):180-184
DOI:10.4103/2230-8210.129108  PMID:24741513
Objectives: To study ovarian morphology by ultrasound in women with or without polycystic ovary syndrome (PCOS) and to establish cut-off values of these parameters in Indian women with PCOS. Materials and Methods: A total of 119 consecutive women diagnosed PCOS and 77 apparently healthy women were enrolled. Transabdominal ultrasound examination was carried out to assess ovarian volume, stromal echogenecity, follicle number and size. Cut-off values of the above ovarian parameters with sensitivity, specificity, positive predictive value (PPV) and negative predictive values (NPV) were calculated. Results: Sensitivity of 79.49% and specificity of 90.67% was achieved with a cut-off of 8 mL as ovarian volume. A cut-off value of 9 follicles to distinguish between PCOS and control women yielded a sensitivity of 82.35% and specificity of 92.0% while as a follicular size of 5 mm yielded sensitivity and specificity of 74.67% and 78.15% respectively. With all the three parameters sensitivity was 87.39% and specificity 87.84% with 92.04% PPV and 81.25% NPV. Conclusion: Using two or three sonographic criteria in combination improves sensitivity and helps diagnose additional patients with PCOS. Our results are at variance with the established cut-off values highlighting the fact that American Society for Reproductive Medicine consensus cut-off values are not reproducible in Indian context.
  - 3,149 347