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   2014| May-June  | Volume 18 | Issue 3  
    Online since May 3, 2014

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Imaging of vertebral fractures
Ananya Panda, Chandan J Das, Udismita Baruah
May-June 2014, 18(3):295-303
DOI:10.4103/2230-8210.131140  PMID:24944921
Vertebral fracture is a common clinical problem. Osteoporosis is the leading cause of non-traumatic vertebral fracture. Often, vertebral fractures are not clinically suspected due to nonspecific presentation and are overlooked during routine interpretation of radiologic investigations. Moreover, once detected, many a times the radiologist fails to convey to the clinician in a meaningful way. Hence, vertebral fractures are a constant cause of morbidity and mortality. Presence of vertebral fracture increases the chance of fracture in another vertebra and also increases the risk of subsequent hip fracture. Early detection can lead to immediate therapeutic intervention improving further the quality of life. So, in this review, we wish to present a comprehensive overview of vertebral fracture imaging along with an algorithm of evaluation of vertebral fractures.
  11,179 986 11
A cross-sectional study of polycystic ovarian syndrome among adolescent and young girls in Mumbai, India
Beena Joshi, Srabani Mukherjee, Anushree Patil, Ameya Purandare, Sanjay Chauhan, Rama Vaidya
May-June 2014, 18(3):317-324
DOI:10.4103/2230-8210.131162  PMID:24944925
Introduction: Polycystic ovary disease is a common endocrine condition which is rapidly gaining epidemic proportions. No community based prevalence data is available for this syndrome in India. Materials and Methods: A cross-sectional community-based study was undertaken in a sampled census block of Mumbai to assess the prevalence of polycystic ovarian syndrome (PCOS) among 778 adolescents and young girls aged 15-24 years. Among them, 600 completed all clinical, ultrasonography (USG), and biochemical investigations. Results: The prevalence of PCOS among them was 22.5% by Rotterdam and 10.7% by Androgen Excess Society criteria. Nonobese comprised 71.8% of PCOS diagnosed by Rotterdam criteria. Mild PCOS (oligomenorrhea and polycystic ovaries on USG) was the most common phenotype (52.6%). History of oligomenorrhea had a positive predictive value of 93.3% and negative predictive value of 86.7% to detect a possible case of PCOS. Hyperinsulinemia (serum insulin >15 μlU/mL) was present among 19.2% of diagnosed PCOS cases. Obese girls with PCOS were more hirsute, hypertensive, and had significantly higher mean insulin and 2 h post 75 g glucose levels compared with nonobese PCOS. Conclusion: To our knowledge, this is the first urban community-based study diagnosing PCOS and phenotypes among adolescent and young girls in India. This study demonstrates that PCOS is an emerging disorder during adolescence and screening could provide opportunity to target the group for promoting healthy lifestyles and early interventions to prevent future morbidities.
  9,566 1,196 36
Knowledge and awareness of diabetes in urban and rural India: The Indian Council of Medical Research India Diabetes Study (Phase I): Indian Council of Medical Research India Diabetes 4
M Deepa, A Bhansali, RM Anjana, R Pradeepa, SR Joshi, PP Joshi, VK Dhandhania, PV Rao, R Subashini, R Unnikrishnan, DK Shukla, SV Madhu, AK Das, V Mohan, T Kaur
May-June 2014, 18(3):379-385
DOI:10.4103/2230-8210.131191  PMID:24944935
Background: Representative data on knowledge and awareness about diabetes is scarce in India and is extremely important to plan public health policies aimed at preventing and controlling diabetes. Aim: The aim of the following study is to assess awareness and knowledge about diabetes in the general population, as well as in individuals with diabetes in four selected regions of India. Materials and Methods: The study subjects were drawn from a representative sample of four geographical regions of India, Chandigarh, Tamil Nadu, Jharkhand and Maharashtra representing North, South, East and West and covering a population of 213 million. A total of 16,607 individuals (5112 urban and 11,495 rural) aged ≥20 years were selected from 188 urban and 175 rural areas. Awareness of diabetes and knowledge of causative factors and complications of diabetes were assessed using an interviewer administered structured questionnaire in 14,274 individuals (response rate, 86.0%), which included 480 self-reported diabetic subjects. Results: Only 43.2% (6160/14,274) of the overall study population had heard about a condition called diabetes. Overall urban residents had higher awareness rates (58.4%) compared to rural residents (36.8%) (P < 0.001). About 46.7% of males and 39.6% of females reported that they knew about a condition called diabetes (P < 0.001). Of the general population, 41.5% (5726/13,794) knew about a condition called diabetes. Among them, 80.7% (4620/5726) knew that the prevalence of diabetes was increasing, whereas among diabetic subjects, it was 93.0% (448/480). Among the general and diabetic population, 56.3% and 63.4% respectively, were aware that diabetes could be prevented. Regarding complications, 51.5% of the general population and 72.7% diabetic population knew that diabetes could affect other organs. Based on a composite knowledge score to assess knowledge among the general population, Tamil Nadu had the highest (31.7) and Jharkhand the lowest score (16.3). However among self-reported diabetic subjects, Maharashtra had the highest (70.1) and Tamil Nadu, the lowest score (56.5). Conclusion: Knowledge and awareness about diabetes in India, particularly in rural areas, is poor. This underscores the need for conducting large scale diabetes awareness and education programs.
  7,631 1,288 41
Link between hypothyroidism and small intestinal bacterial overgrowth
Anant D Patil
May-June 2014, 18(3):307-309
DOI:10.4103/2230-8210.131155  PMID:24944923
Altered gastrointestinal (GI) motility is seen in many pathological conditions. Reduced motility is one of the risk factors for development of a small intestinal bacterial overgrowth (SIBO). Hypothyroidism is associated with altered GI motility. The aim of this article was to study the link between hypothyroidism, altered GI motility and development of SIBO. Published literature was reviewed to study the association of altered GI motility, SIBO and hypothyroidism. Altered GI motility leads to SIBO. SIBO is common in patients with hypothyroidism. Patients with chronic GI symptoms in hypothyroidism should be evaluated for the possibility of SIBO. Both antibiotics and probiotics have been studied and found to be effective in management of SIBO.
  7,580 689 3
Current status of management, control, complications and psychosocial aspects of patients with diabetes in India: Results from the DiabCare India 2011 Study
Viswanathan Mohan, Siddharth N Shah, Shashank R Joshi, V Seshiah, Binode Kumar Sahay, Samar Banerjee, Subhash Kumar Wangnoo, Ajay Kumar, Sanjay Kalra, AG Unnikrishnan, Surendra Kumar Sharma, PV Rao, Shahid Akhtar, Raman V Shetty, Ashok Kumar Das, On Behalf of the DiabCare India 2011 Study Group
May-June 2014, 18(3):370-378
DOI:10.4103/2230-8210.129715  PMID:24944934
Objectives: DiabCare India 2011 was a cross-sectional study in patients with diabetes mellitus, undertaken to investigate the relationship between diabetes control, management and complications in a subset of urban Indian diabetes patients treated at referral diabetes care centres in India. Materials and Methods: This was a cross-sectional, multicentre (330 centres) survey in 6168 diabetes patients treated at general hospitals, diabetes clinics and referral clinics across India. Patient data, including medical and clinical examination reports during the past year were collected during their routine visit. The patients' and physicians' perceptions about diabetes management were recorded using a questionnaire. Results: A total of 6168 subjects with diabetes (95.8% type 2), mean age 51.9 ± 12.4 years and mean duration of diabetes, 6.9 ± 6.4 years were included. Mean HbA1c was 8.9 ± 2.1% and the mean fasting (FPG), post prandial (PPG) and random (RBG) plasma glucose levels were 148 ± 50 mg/dl 205 ± 66 mg/dl and 193 ± 68mg/dl respectively. Neuropathy was the most common complication (41.4%); other complications were: Foot (32.7%), eye (19.7%), cardiovascular (6.8%) and nephropathy (6.2%). The number of diabetic complications increased with mean duration of diabetes. Most (93.2%) of the patients were on oral anti-diabetic drugs (OADs) and 35.2% were on insulin (±OADs). More than 15% physicians felt that the greatest barrier to insulin therapy from patient's perspective were pain and fear of using injectable modality; 5.2% felt that the greatest barrier to insulin therapy from physician's perspective was the treatment cost; 4.8% felt that the major barriers to achieve optimum diabetic care in practice was loss to follow-up followed by lack of counselling (3.9%) and treatment compliance (3.6%). Conclusion: DiabCare India 2011 has shown that type 2 diabetes sets in early in Indians and glycaemic control is often sub-optimal in these patients. These results indicate a need for more structured intervention at an early stage of the disease and need for increased awareness on benefits of good glycaemic control. It cannot be overemphasized that the status of diabetes care in India needs to be further improved. (ClinTrials.gov identifier: NCT01351922)
  6,542 1,029 25
Chronic complications in newly diagnosed patients with Type 2 diabetes mellitus in India
Aravind Sosale, KM Prasanna Kumar, SM Sadikot, Anant Nigam, Sarita Bajaj, AH Zargar, SK Singh
May-June 2014, 18(3):355-360
DOI:10.4103/2230-8210.131184  PMID:24944931
Background: Prevalence of diabetes is on an increase in India, currently there is limited nation-wide data regarding the prevalence of chronic complications in diabetic patients at diagnosis. This information will help health-care professionals approach management more aggressively to prevent complications. Objective: To determine the prevalence of chronic complications in newly-diagnosed Type 2 diabetic (T2D) patients in India. Design and Methods: This was a cross-sectional survey of T2D patients, diagnosed within 3 months of their first visit to the centers doing the survey. Each patient was screened for diabetic complications, hypertension, dyslipidemia, and body mass index. Family history was recorded. Standard protocols were used to make the diagnosis of retinopathy, neuropathy and nephropathy. Data analysis was carried out using the standard statistical techniques. Results: Of the total 4,600 (males 67%, females 33%) newly diagnosed patients with T2D, majority were from the age group 41-50 years (40%). 13.15% of newly detected India T2D had neuropathy 6.1% had retinopathy and 1.06% had nephropathy. Risk factors of macro vascular complication such as hypertension, obesity, and dyslipidemia were observed in 23.3%, 26%, and 27% of patients respectively. Ischemic heart disease was noticed in 6%. Conclusion: High prevalence of micro vascular complications was present at diagnosis along with association of CV cardiovascular risk factors among Indian T2D. In view of this, screening must be instituted for all diabetics for complications at the time of diagnosis itself.
  5,303 1,020 17
Continuous glucose monitoring system and new era of early diagnosis of diabetes in high risk groups
Ashraf Soliman, Vincenzo DeSanctis, Mohamed Yassin, Rania Elalaily, Nagwa E Eldarsy
May-June 2014, 18(3):274-282
DOI:10.4103/2230-8210.131130  PMID:24944918
Continuous glucose monitoring (CGM) systems are an emerging technology that allows frequent glucose measurements to monitor glucose trends in real time. Their use as a diagnostic tool is still developing and appears to be promising. Combining intermittent glucose self-monitoring (SGM) and CGM combines the benefits of both. Significant improvement in the treatment modalities that may prevent the progress of prediabetes to diabetes have been achieved recently and dictates screening of high risk patients for early diagnosis and management of glycemic abnormalities. The use of CGMS in the diagnosis of early dysglycemia (prediabetes) especially in high risk patients appears to be an attractive approach. In this review we searched the literature to investigate the value of using CGMS as a diagnostic tool compared to other known tools, namely oral glucose tolerance test (OGTT) and measurement of glycated hemoglobin (HbA1C) in high risk groups. Those categories of patients include adolescents and adults with obesity especially those with family history of type 2 diabetes mellitus, polycystic ovary syndrome (PCO), gestational diabetes, cystic fibrosis, thalassemia major, acute coronary syndrome (ACS), and after renal transplantation. It appears that the ability of the CGMS for frequently monitoring (every 5 min) glucose changes during real-life settings for 3 to 5 days stretches the chance to detect more glycemic abnormalities during basal and postprandial conditions compared to other short-timed methods.
  5,150 1,053 19
A revisit to prevailing care and challenges of managing diabetes in India: Focus on regional disparities
Manash P Baruah, Ankit Pathak, Sanjay Kalra, Ashok K Das, Abdul H Zargar, Sarita Bajaj, Ambika G Unnikrishnan, Rakesh K Sahay
May-June 2014, 18(3):254-263
DOI:10.4103/2230-8210.131113  PMID:24944916
An unprecedented rise in diabetes prevalence in India is the outcome of lifestyle changes in the background of genetic predisposition. Moreover, there is a substantial regional variation in diabetes prevalence and management. The highest prevalence of DM was observed in southern region (Ernakulum, Kerala) and lowest prevalence was observed in North Eastern region (Manipur). Similarly large variations have been evident in overall awareness and diabetes care across the geographies within India. The regional challenges are largely affected by poor disease awareness, socioeconomic disparity and underutilization of the public health-care services. Though government has taken initiatives to address this issue, overall situation demands a collaborative effort from patients, health care professionals and the state. This article reviews the regional disparity of diabetes epidemiology, current management practices and government policies for T2DM in India, identifies policy and research gaps, and suggests corrective measures to address the lacunae in diabetes care.
  5,129 877 5
Consensus statement on diabetes in children
KM Prasanna Kumar, N Prabhu Dev, KV Raman, Rajnanda Desai, T Geetha Prasadini, AK Das, Soraya Ramoul
May-June 2014, 18(3):264-273
DOI:10.4103/2230-8210.129714  PMID:24944917
While T1DM has been traditionally seen as a minor concern in the larger picture of pediatric ailments, new data reveals that the incidence of T1DM has assumed alarming proportions. It has long been clear that while the disease may be diagnosed at an early age, its impact is not isolated to afflicted children. The direct impact of the disease on the patient is debilitating due to the nature of the disease and lack of proper access to treatment in India. But this impact is further compounded by the utter apathy and often times antipathy, which patients withT1DM have to face. Lack of awareness of the issue in all stakeholders, low access to quality healthcare, patient, physician, and system level barriers to the delivery of optimal diabetes care are some of the factors which hinder successful management of T1DM. The first international consensus meet on diabetes in children was convened with the aim of providing a common platform to all the stakeholders in the management of T1DM, to discuss the academic, administrative and healthcare system related issues. The ultimate aim was to articulate the problems faced by children with diabetes in a way that centralized their position and focused on creating modalities of management sensitive to their needs and aspirations. It was conceptualized to raise a strong voice of advocacy for improving the management of T1DM and ensuring that "No child should die of diabetes". The unique clinical presentations of T1DM coupled with ignorance on the part of the medical community and society in general results in outcomes that are far worse than that seen with T2DM. So there is a need to substantially improve training of HCPs at all levels on this neglected aspect of healthcare.
  4,234 646 2
Role of Glitazars in atherogenic dyslipidemia and diabetes: Two birds with one stone?
Srinivasa P Munigoti, CV Harinarayan
May-June 2014, 18(3):283-287
DOI:10.4103/2230-8210.131134  PMID:24944919
A triad of high triglycerides, low high-density lipoprotein (HDL) cholesterol, and elevated small dense low-density lipoprotein particles occurring in a patient with type 2 diabetes is referred to atherogenic diabetic dyslipidemia (ADD). Despite statin therapy, a significant residual risk remains potentially attributable to increased triglyceride concentration and low HDL cholesterol, a characteristic hallmark of ADD. Current therapeutic options in reducing this residual risk include nicotinic acid, omega 3 fatty acids, and selective peroxisome proliferator-activated receptor-alpha (PPAR) agonists (fibrates). These drugs are limited in their potential either by lack of evidence to support their role in reducing cardiovascular events or due to their side effects. This review details their current status and also the role of new glitazar, saroglitazar adual PPARα/γ agonist with predominant PPARα activity in the management of ADD.
  3,788 739 9
Waist height ratio: A universal screening tool for prediction of metabolic syndrome in urban and rural population of Haryana
Rajesh Rajput, Meena Rajput, Mohan Bairwa, Jasminder Singh, Ompal Saini, Vijay Shankar
May-June 2014, 18(3):394-399
DOI:10.4103/2230-8210.131201  PMID:24944937
Aims: To compare waist circumference (WC), body mass index (BMI), waist hip ratio (WHR), and waist-to-height ratio (WHtR) and define an appropriate cut-off, which is most closely predictive of the non-adipose components of the IDF metabolic syndrome (MetS) definition. Methods and Results: A total of 3,042 adults (1,693 in rural area and 1,349 in urban area) were screened for the presence of MetS according to the IDF definition. Among 3,042 adults selected as subjects, 1,518 were male and 1,524 were female. The receiver operating curve (ROC) analysis was done to determine the optimal cut-off value and the best discriminatory value of each of these anthropometric parameters to predict two or more non-obese components of metabolic syndrome. The area under ROC (AURC) for WC was superior to that for other anthropometric variables. The optimal cut-off value of WC in urban and rural males was >89 cm, which is higher than that in urban and rural females at 83 cm and 79 cm, respectively; the optimal cut-off for WHtR was >0.51 in rural females, 0.52 in rural males, and 0.53 in both urban males and females. Both parameters were found to be better than BMI and WHR. ROC and AURC values for WC were better than those for WHtR in men and women in both urban and rural areas (P = 0.0054); however, when the entire study cohort was analyzed together, irrespective of gender and place of residence, then at a value of 0.52, WHtR scored over WC as a predictor of metabolic syndrome (P = 0.001). Conclusion: Although the predictive value of different gender-specific WC values is clearly superior to other anthropometric measures for predicting two or more non-adipose components of MetS, a single value of WHtR irrespective of gender and the area of residence can be used as a universal screening tool for the identification of individuals at high risk of development of metabolic complications.
  3,800 622 19
Assessment of anthropometric indices among residents of Calabar, South-East Nigeria
Enang Ofem Egbe, Otu Akaninyene Asuquo, Essien Okon Ekwere, Fasanmade Olufemi, AE Ohwovoriole
May-June 2014, 18(3):386-393
DOI:10.4103/2230-8210.131196  PMID:24944936
Background: Obesity is a risk factor for type 2 diabetes mellitus which may be addressed by application of intensive lifestyle interventions. Thus, establishing normative values of anthropometric indices in our environment is crucial. This study aimed to determine normative values of anthropometric indices of nutrition among residents of Calabar. Materials and Methods: This cross sectional observational study recruited residents of Calabar aged between 15-79 years using a multistage sampling method. Trained research assistants collected socio-demographic data and did anthropometric measurements. Results: There were 645 (56.5%) males and 489 (43.1%) females. Males had significantly lower general adiposity and hip circumference (HC) than females while females had significantly lower waist circumference (WC) and waist hip ratio (WHR) than males. The WHR increased with age particularly among males. Body mass index (BMI) also increased with age in both males and females with a peak in the middle age bracket, followed by a decline among the elderly. The mean (SD) BMI was 27.7 (5.0) kg/m 2 . Males had a mean (SD) BMI of 27.0 (4.4) kg/m 2 , while females had a mean (SD) BMI of 28.5 (5.5) kg/m 2 respectively. WC correlated positively and significantly with BMI and WHR in males and females. WHR correlated positively and significantly with BMI in males and females. Conclusion: There are positive linear inter relationships between the indices of nutrition which is strongest between WC and BMI. In view of the strong independent association of DM with indices of nutrition, it is appropriate to derive normal cut-off values for WC, WHR and BMI nationally.
  3,897 305 2
Prevention of diabetes: How far have we gone?
Ambady Ramachandran, Chamukuttan Snehalatha
May-June 2014, 18(3):252-253
DOI:10.4103/2230-8210.131112  PMID:24944915
  3,138 635 3
Clinical profile, outcomes, and progression to type 2 diabetes among Indian women with gestational diabetes mellitus seen at a diabetes center in south India
Manni Mohanraj Mahalakshmi, Balaji Bhavadharini, Maheswari Kumar, Ranjit Mohan Anjana, Sapna S Shah, Akila Bridgette, Mridusmita Choudhury, Margaret Henderson, Lane Desborough, Mohan Viswanathan, Harish Ranjani
May-June 2014, 18(3):400-406
DOI:10.4103/2230-8210.131205  PMID:24944938
Aim: To describe the clinical profile, maternal and fetal outcomes, and the conversion rates to diabetes in women with gestational diabetes mellitus (GDM) seen at a tertiary care diabetes center in urban south India. Materials and Methods: Clinical case records of 898 women with GDM seen between 1991 and 2011 were extracted from the Diabetes Electronic Medical Records (DEMR) of a tertiary care diabetes center in Chennai, south India and their clinical profile was analyzed. Follow-up data of 174 GDM women was available. To determine the conversion rates to diabetes, oral glucose tolerance test (OGTT) was done in these women. Glucose tolerance status postpartum was classified based on World Health Organization (WHO) 2006 criteria. Results: The mean maternal age of the women was 29 ± 4 years and mean age of gestation at first visit were 24 ± 8.4 weeks. Seventy percent of the women had a family history of diabetes. Seventy-eight percent of the women delivered full-term babies and 65% underwent a cesarean section. The average weight gain during pregnancy was 10.0 ± 4.2 kg. Macrosomia was present in 17.9% of the babies, hypoglycemia in 10.4%, congenital anomalies in 4.3%, and the neonatal mortality rate was 1.9%. Mean follow-up duration of the 174 women of whom outcome data was available was 4.5 years. Out of the 174, 101 women who were followed-up developed diabetes, of whom half developed diabetes within 5 years and over 90%, within 10 years of the delivery. Conclusions: Progression to type 2 diabetes mellitus (T2DM) in Indian women with GDM is rapid. There is an urgent need to develop standardized protocols for GDM care in India that can improve the maternal and fetal outcomes and help prevent future diabetes in women with GDM.
  2,857 545 17
Intravenous iron replacement therapy in eugonadal males with iron-deficiency anemia: Effects on pituitary gonadal axis and sperm parameters; A pilot study
Ashraf Soliman, Mohamed Yassin, Vincenzo De Sanctis
May-June 2014, 18(3):310-316
DOI:10.4103/2230-8210.131158  PMID:24944924
Aim of the study: To evaluate semen parameters and to assess serum FSH, LH, Testosterone (T) concentrations before and 12 weeks after intravenous iron therapy (800-1200 mg elemental iron therapy - IVI) in adults with iron-deficiency anemia (IDA). Materials and Methods: We studied 11 eugonadal adults with IDA, aged 40 ± 5 years, due to defective intake of iron. Anemia was diagnosed when hemoglobin (Hb) was equal or below 10 g/dl. Serum iron, total iron-binding capacity (TIBC) and ferritin concentrations confirmed the diagnosis of IDA. Basal serum concentrations of FSH, LH, and T were measured. Semen parameters were evaluated before and 6-7 weeks after IVI therapy. Results: After IVI therapy and correction of anemia, a significant increase of Hb from 8.1 ± 1.17 g/dL to 13.1 ± 0.7 g/dL was observed and was associated with an increase of T (from 12.22 ± 1.4 nmol/L to 15.9 ± 0.96 nmol/L; P < 0.001), FSH (from 2.82 ± 0.87 to 3.82 ± 1.08 IU/L; P = 0.007), and LH (from 2.27 ± 0.9 to 3.82 ± 1.5 IU/L; P = 0.0002). Total sperm count (TSC) increased significantly from 72 ± 17.5 million/ml to 158 ± 49 million/mL (P < 0.001), rapid progressive sperm motility (RPM) increased from 22 ± 9.4 to 69 ± 30 million/ml (P < 0.001), and sperms with normal morphology (NM) increased from 33 ± 5 to 56 ± 7 million/ml (P < 0.001). Increment in Hb concentration was correlated significantly with LH, FSH, and T concentrations after IVI (r = 0.69 and r = 0.44, r = 0.75, respectively; P < 0.01). The increment in serum T was correlated significantly with increments in the TSC and total sperm motility and RPM (r = 0.66, 0.43, and 0.55, respectively; P < 0.001) but not with gonadotrophin levels. Conclusion: Our study proved for the first time, to our knowledge, that correction of IDA with IVI is associated with significant enhancement of sperm parameters and increased concentrations of serum LH, FSH, and T. These effects on spermatogenesis are reached by an unknown mechanism and suggest a number of pathways that need further human and/or experimental studies.
  3,031 294 7
Prevalence of gestational diabetes mellitus in rural Haryana: A community-based study
Meena Rajput, Mohan Bairwa, Rajesh Rajput
May-June 2014, 18(3):350-354
DOI:10.4103/2230-8210.131176  PMID:24944930
Background and Objectives: Gestational diabetes mellitus (GDM) is a global health concern as it affects health status of both mother and fetus. In India, prevalence of GDM varies in different populations and no data is available from rural Haryana. This study was undertaken to determine the prevalence of GDM and risk factors associated with it in rural women of Haryana. Materials and Methods: Nine hundred and thirteen women, with estimated gestational age above 24 weeks from a rural block of Haryana who consented to participate were given a standardized 2-h 75-g oral glucose tolerance test (OGTT). Pro forma containing general information on demographic characteristics, educational level, gravida, family history of diabetes, and past history of GDM was filled-up. A World Health Organization (WHO) criterion for 2-h 75-g OGTT was used for diagnosing GDM. Results: GDM was diagnosed in 127/913 (13.9%) women with higher mean age as compared to non-GDM women. Majority (78.4%) of the women were housewives, rest engaged in agriculture (9.2%) and labor (5.5%). Women with gravida ≥3 and positive family history of diabetes had significantly higher prevalence of GDM. History of macrosomia (birth weight ≥4 kg) was significantly associated with prevalence of GDM (P = 0.002). On multiple logistic regression analysis, risk factors found to be significantly associated with GDM were maternal age >25 years, gravida >3, history of macrosomic baby, and family history of diabetes. Conclusion: The prevalence of GDM has been found quite high in rural Haryana. Appropriate interventions are required for control and risk factor modifications.
  2,443 512 7
The endocrine quiz
Sanjay Kalra, Manash P Baruah, V Sri Nagesh
May-June 2014, 18(3):304-306
DOI:10.4103/2230-8210.131151  PMID:24944922
With the recent explosion in endocrine conferences, audience fatigue has set in and conference planners are now looking at newer pedagogic methods to revive the interest of audiences in these conferences. The endocrine quiz has finally come of vogue and is increasingly becoming one of the most popular attractions of any ranking endocrine conference. The endocrine quiz has a large and varied palette and draws questions from religious scriptures, history, literature, current affairs, sports, movies and basic and paramedical sciences. The more we delve into the quizzable aspects of endocrinology, the more we realize that endocrinology is ubiquitous and there is no sphere in human life untouched by endocrine disorders. Be it epic characters like Kumbhakarna and Bheema, fiction characters like Tintin or Orphan Annie, sportspersons like Gail Devers or heads of state like George Bush Sr and Boris Yeltsin, all have contributed to the melting pot of endocrine quizzing. Adding further grist to the endocrine mill are the Nobel prizes, with their attendant anecdotes and controversies. Step into this world of endocrine quizzing to have an up close and personal look at the diverse facets of this subject.
  2,431 496 -
Diabetes in Africa - Puzzles and challenges
Geoff Gill
May-June 2014, 18(3):249-251
DOI:10.4103/2230-8210.131111  PMID:24944914
  2,336 392 7
Our experience with papillary thyroid microcancer
Anulekha Mary John, Paul M Jacob, Regi Oommen, Sheila Nair, Aravindan Nair, Simon Rajaratnam
May-June 2014, 18(3):410-413
DOI:10.4103/2230-8210.131211  PMID:24944940
Background: Papillary thyroid microcarcinoma (PTMC) describes a focus of papillary thyroid cancer that is less than 1 cm in size. These tumors are frequently found on histopathological examination of thyroid specimens, operated upon for an indication other than suspected malignancy. Materials and Methods: From 2005 to 2012, 94 of 1300 thyroidectomy specimens in our institution were found to have PTMC. Of these, 77 were isolated PTMC while the others were associated with other differentiated cancers. We studied their clinicopathologic features, treatment and long-term outcome. Results: There were 18 men and 59 women (the male: female ratio was 1:3), their mean age was 44 ± 10.5 years (range: 18-72 years). Multinodular goiter was the most common indication for surgery. Malignancy was suspected in only 31.4% cases. The mean tumor size was 4.1 ± 2.3 mm. Nearly 17% cases had slightly larger tumors measuring >6 but <10 mm. Multifocal tumor was found in 44.1% of cases and among these, multifocal disease restricted to a single lobe was found in 19.5%. Eleven patients (14.2%) had cervical lymph node metastasis, 3 (3.9%) had extra thyroid tumor extension and 2 (2.6%) had evidence of vascular invasion. One patient (1.3%) presented with bone metastasis.Majority of the patients (79.2%) underwent total thyroidectomy with or without lymph node dissection. Sixteen patients (20.7%) who had initially undergone hemithyroidectomy went on to have completion thyroidectomy. Twenty nine patients (36.8%) also received radioactive iodine.The mean duration of follow-up was 20.2 ± 13.5 months. On follow-up one patient developed cervical lymph node recurrence and one died due to a second malignancy. Conclusions: PTMC is often found as an incidental finding on the thyroidectomy specimen. Sometimes they present with regional lymph node metastasis and very rarely with distant metastasis. They have a good prognosis similar to papillary thyroid carcinoma.
  2,034 391 8
A retrospective study on finding correlation of pioglitazone and incidences of bladder cancer in the Indian population
V Balaji, V Seshiah, G Ashtalakshmi, SG Ramanan, M Janarthinakani
May-June 2014, 18(3):425-427
DOI:10.4103/2230-8210.131223  PMID:24944944
Objectives: This retrospective cohort study analyzed the clinical data of cancer patients conducted in a cancer hospital, Chennai to assess the correlation (if any) between use of antidiabetic agents including pioglitazone and the incidence of bladder cancer. Materials and Methods: Totally, 5079 cancer patients' with and without diabetes were included and analyzed in this retrospective study. Results: A total of 1077 patient data were screened out of a total of 5079. A total of 20 patients were found to have bladder cancer. Out of 1077 patients, 31 were pioglitazone users on the drug for not less than 2 years. The remaining 1046 were on other drugs other than pioglitazone. It is observed that 1 out of 31 developed bladder cancer in the pioglitazone group 19 out of 1046 developed bladder cancer in the nonpioglitazone group. The result of the analysis indicates that there is no significant (P = 0.918) association between pioglitazone and bladder cancer. Conclusion: In this retrospective study, the number of diabetic patients on pioglitazone with bladder cancer was fewer than the diabetic patients on other medications with the disease. Further, no link could be established between any specific drug use and bladder cancer. Least number of patients with bladder cancer was on pioglitazone, suggesting that pioglitazone alone cannot be considered a cause for increased incidence of bladder cancer in diabetic patients.
  1,903 500 17
Prevalence of metabolic syndrome in the family members of women with polycystic ovary syndrome from North India
Iram Shabir, Mohd Ashraf Ganie, Mohd Afzal Zargar, Dilafroz Bhat, Mohd Muzzafar Mir, Aleem Jan, Zaffar Amin Shah, Vicar Jan, Riyaz Rasool, Andleeb Naqati
May-June 2014, 18(3):364-369
DOI:10.4103/2230-8210.131186  PMID:24944933
Background: Polycystic ovary syndrome (PCOS) is the most complex and common endocrine disorder of women in reproductive years. In addition to irregular menstrual cycles, chronic anovulation and hyperandrogenism, it has many metabolic manifestations such as obesity, hyperlipidemia, hyperinsulinemia, insulin resistance, dysglycemia, increased risk of cardiovascular disease or possibly endometrial cancer. Familial clustering of PCOS in consistence with the genetic susceptibility has been described. Materials and Methods: The present study assessed the clinical, biochemical and hormonal parameters including prevalence of metabolic syndrome by two different criteria in the first- degree relatives of patients with PCOS. Results: The average age of 37 index patients was 23 ± 3.6 years, with the mean age of menarche as 13.3 ± 1.2 years. The mean age and age of menarche in mothers (n = 22) was 48.8 ± 5.1 and 13 ± 1.3 years, respectively, whereas as it was 23.5 ± 4.7 and 13.3 ± 1.2 years in sisters (n = 22), respectively. Metabolic syndrome (MS) defined by International Diabetes Federation (IDF) criteria was present in 10 index patients, 1 brother, 4 sisters, 17 mothers and 15 fathers while as by Adult Treatment Panel III (ATP III) it was in 8 index patients, 5 sisters, 16 mothers and 11 fathers. Conclusion: The presence of MS or related metabolic derangements is high in the family members of women with PCOS.
  1,979 413 9
Relationship of lipid parameters with bone mineral density in Indian population
MK Garg, Raman K Marwaha, Nikhil Tandon, Kuntal Bhadra, N Mahalle
May-June 2014, 18(3):325-332
DOI:10.4103/2230-8210.131165  PMID:24944926
Introduction: Cardiovascular disease and osteoporosis share common risk factors including dyslipidemia. There are conflicting reports of differential relation of various lipid parameters on bone mineral density (BMD). Hence, we studied the correlation between lipid parameters and BMD in healthy adult. Materials and Methods: A total of 2347 participants (male 39.4%; female 60.6%) included in this cross-sectional study were divided according to sex and age. Fasting blood samples were drawn for biochemical parameters. BMD at lumbar spine, femur, and forearm were measured by dual energy X-ray absorptiometry (DXA). Results: In males, BMD at femur and lumbar spine decreased significantly with increasing quartiles of total cholesterol (TC) (P < 0.0001, and 0.004) and low-density lipoprotein cholesterol (LDL-c) (P = 0.001, and 0.01). In premenopausal women, BMD at femoral neck (P = 0.001) and lumbar spine (P = 0.029) showed declining trend with LDL-c (P = 0.007). In postmenopausal women, only BMD at total femur decreased significantly with TC (P = 0.024) and LDL-c (P = 0.036). All above findings were confirmed in correlation studies. In multiple regression analysis after adjusting for age, body mass index, ionized calcium, alkaline phosphatase, 25 hydroxy vitamin D, and parathyroid hormone levels correlation of BMD with TC and LDL-c persisted. TC, LDL-c was higher in subjects with low bone density compared those with normal bone density in both sexes. Conclusions: TC and LDL-c had weak but significant negative correlation with BMD at femur and lumbar spine.
  1,941 441 12
Zinc transporter-8 autoantibodies can replace IA-2 autoantibodies as a serological marker for juvenile onset type 1 diabetes in India
C Shivaprasad, Rajneesh Mittal, Mala Dharmalingam, Prasanna K Kumar
May-June 2014, 18(3):345-349
DOI:10.4103/2230-8210.131174  PMID:24944929
Introduction: Zinc transporter-8 (ZnT8) is an islet cell secretory granule membrane protein recently identified as an autoantigen in type 1 diabetes (T1D). The aim of this study was to estimate the prevalence of antibodies to ZnT8 (ZnT8A) in juvenile onset T1D and to determine the utility of ZnT8A as an independent marker of autoimmunity either alone in antibody-negative subjects or in conjunction with glutamic acid decarboxylase (GAD) and insulinoma-2 antigen antibodies (GADA and IA2A). Research Design: ZnT8A, GADA, and IA2A were measured in sera of consecutive T1D patients (n = 88, age range 2-18 years) within 4 years of diagnosis and 88 sex-matched controls. Results: The prevalences of GADA, ZnT8a, and IA2A were 64.7%, 31.8% and 19.3%, respectively. In newly diagnosed patients, the frequency of ZnT8A was 45%. ZnT8A were positive in 26% of patients negative for both GADA and IA2A. IA2A were positive only in two patients who were negative for other two antibodies. Combined use of ZnT8A and GADA could detect 97% of antibody positive patients. In receiver operating characteristic (ROC) analysis, the performances of GADA and ZnT8As were better than that of IA2A; and AUCs of GADA, ZnT8A, and IA2A for the prediction of T1D were 0.8, 0.65, and 0.59, respectively. Conclusions: ZnT8A complements GADA and increases the diagnostic sensitivity for detection of autoimmunity in juvenile-onset T1D. Inclusion of ZnT8A increases the proportion of patients with antibody positivity to nearly 80%. ZnT8A can replace IA2A as a serological marker for autoimmunity in Indian T1D patients without loss of sensitivity and specificity.
  1,936 418 14
Endocrine dysfunction among adult patients with tuberculosis: An African experience
Davis Kibirige
May-June 2014, 18(3):288-294
DOI:10.4103/2230-8210.131136  PMID:24944920
A broad spectrum of endocrine conditions has been reported among adult patients with tuberculosis in Africa. This review aims to describe the magnitude and pathogenesis of the following endocrinopathies among patients with tuberculosis in Africa: adrenal insufficiency, diabetes mellitus, disorders of calcium and vitamin D metabolism, thyroid dysfunction and hypogonadism. PubMed database and Google scholar were used to search for the relevant published English language studies and case reports relating to endocrine abnormalities and tuberculosis in Africa up to July 2013. The search terms used were endocrine dysfunction, endocrine abnormalities, adrenal insufficiency, diabetes mellitus, thyroid dysfunction, hypogonadism, disorders of calcium and vitamin D metabolism, tuberculosis, Africa. Reference lists of the identified articles were further used to identify other studies. Adrenal insufficiency, diabetes mellitus and calcium-vitamin D abnormalities were the most prevalent and frequently reported endocrine disorders among adult patients with tuberculosis in Africa. A meticulous endocrine evaluation among tuberculosis patients with suspected endocrine abnormalities should be encouraged in Africa and other high TB endemic regions. Treatment of these endocrine disorders has generally been shown to improve quality of life and reduce mortality.
  1,852 494 5
Diabetic retinopathy in acromegaly
Said Azzoug, Farida Chentli
May-June 2014, 18(3):407-409
DOI:10.4103/2230-8210.131207  PMID:24944939
Introduction: Although growth hormone (GH) has been implicated in the pathogenesis of diabetic retinopathy (DR), DR is deemed to be rare in patients with GH excess. Our aim was to study its prevalence in subjects with acromegaly suffering from diabetes mellitus (DM), to analyze its characteristics, and to look for predictive factors such as age at diagnosis, GH concentration and duration, DM duration, DM control, and family background. Materials and Methods: Forty patients with acromegaly and DM (21 males, 19 females), median age = 50 years, underwent a systematic ophthalmological examination with dilated funduscopy to seek diabetic retinopathy. Results: Among this population, 05 (12.5%) had DR. It was at an early stage or background retinopathy in 3 cases and at a more advanced stage or proliferative retinopathy in 2 cases. We did not find any correlation with age at diagnosis, GH levels and duration, DM duration and family history of DM, but poor glycemic control seems to play a role although statistical analysis showed borderline significance. Conclusion: From this study, we conclude that prevalence of DR in patients with acromegaly is 12.5%, and it is slight or moderate. Among studied factors, only poor glycemic control seems to be implicated in its development.
  1,988 267 4
Association of serum paraoxonase enzyme activity and oxidative stress markers with dyslipidemia in obese adolescents
Moushira Erfan Zaki, Hala El-Bassyouni, Sanaa Kamal, Mona El-Gammal, Eman Youness
May-June 2014, 18(3):340-344
DOI:10.4103/2230-8210.131173  PMID:24944928
Objectives : The aim of the present study was to investigate the serum paraoxonase 1 (PON1) concentration and oxidative stress markers and assess its relations with the biochemical parameters in obese adolescents. Materials and Methods : One hundred and fifty obese adolescents (range 16-18 years) and 150 healthy age- and sex-matched controls were enrolled in the study. The data were extracted from a project entitled "Obesity among Youth: Lifestyle and Genetic Factors" funded by the Science and Technology Development Fund, Egypt. Serum paraoxonase 1 (PON1), nitric oxide (NO), and malonaldehyde were measured. Anthropometry, fasting glucose, insulin concentrations, total cholesterol, high density lipoprotein-cholesterol, low density lipoprotein-cholesterol, triglycerides, systolic and diastolic blood pressure (BP) were measured. Insulin resistance was determined by Homeostasis Model Assessment of Insulin Resistance (HOMA-IR). Diagnostic accuracy of oxidative markers to identify dyslipidemia was calculated with ROC analysis. Results: The study showed that PON1 activity was significantly lower in obese adolescents than controls. Obese adolescents had significant lower NO level and significant increased MA values as compared to controls. PON1 was negatively correlated with MAD and body mass index in obese subjects. Obese adolescents showed dyslipidemia and increased blood pressure and HOMA-IR values. PON1 had high area under the curve in ROC analysis for identifying dyslipidemia in obese subjects. Conclusions: Our results indicate that obese subjects have increased oxidative stress and decreased PON1 activity. The lower paraoxonase level might contribute to the greater risk of dyslipidemia, insulin resistance, high blood pressure that are considered as important components in the pathogenesis of the metabolic syndrome in obese adolescents.
  1,806 440 13
Interventional endocrinology: A futuristic perspective
Rajiv Singla, Sweta Singla
May-June 2014, 18(3):422-424
DOI:10.4103/2230-8210.131221  PMID:24944943
Interventions in endocrinology make a huge impact on life of patients with endocrine diseases. This brief communication discusses the role played by both medical and surgical interventions in practice of endocrinology. Endocrinology is branch of medicine where treatment is as close to ideal as possible. For people with hormone deficiencies, medical intervention in form of replacement with hormones generated by recombinant technologies is a perfectly natural treatment. Hormone excess is also being evaluated and treated with exceedingly precise surgical interventions with minimal morbidity.
  1,932 298 -
Is it necessary to rename gestational diabetes mellitus?
Dhastagir S Sheriff
May-June 2014, 18(3):428-428
DOI:10.4103/2230-8210.131224  PMID:24944945
  1,649 221 -
Glucose homeostasis in Egyptian children and adolescents with β-Thalassemia major: Relationship to oxidative stress
Kotb Abbass Metwalley, Abdel -Rahman Abdel-Hamed El-Saied
May-June 2014, 18(3):333-339
DOI:10.4103/2230-8210.131169  PMID:24944927
Background: Oxidative stress in children with β-thalassemia may contribute to shortened life span of erythrocytes and endocrinal abnormalities. Aim: This study was aimed to evaluate glucose homeostasis in Egyptian children and adolescents with β-thalassemia major and its relation to oxidative stress. Materials and Methods: Sixty children and adolescents with β-thalassemia major were studied in comparison to 30 healthy age and sex-matched subjects. Detailed medical history, thorough clinical examination, and laboratory assessment of oral glucose tolerance test (OGTT), serum ferritin, alanine transferase (ALT), fasting insulin levels, plasma malondialdehyde (MDA) as oxidant marker and serum total antioxidants capacity (TAC) were performed. Patients were divided into two groups according to the presence of abnormal OGTT. Results: The prevalence of diabetes was 5% (3 of 60) and impaired glucose tolerance test (IGT) was 8% (5 of 60). Fasting blood glucose, 2-hour post-load plasma glucose, serum ferritin, ALT, fasting insulin level, homeostatic model assessment for insulin resistance index (HOMA-IR) and MDA levels were significantly elevated while TAC level was significantly decreased in thalassemic patients compared with healthy controls (P < 0.001 for each). The difference was more evident in patients with abnormal OGTT than those with normal oral glucose tolerance (P < 0.001 for each). We also observed that thalassemic patients not receiving or on irregular chelation therapy had significantly higher fasting, 2-h post-load plasma glucose, serum ferritin, ALT, fasting insulin, HOMA-IR, oxidative stress markers OSI and MDA levels and significantly lower TAC compared with either those on regular chelation or controls. HOMA-IR was positively correlated with age, serum ferritin, ALT, MDA, and negatively correlated with TAC. Conclusions: The development of abnormal glucose tolerance in Egyptian children and adolescents with β--thalassemia is associated with alteration in oxidant-antioxidant status and increase in insulin resistance. Recommendation: 1- Glucose tolerance tests, HOMA-IR, and MDA should be an integral part of the long-term follow-up of children and adolescents with β-thalassemia major. 2- Regular iron chelation and antioxidant therapy should be advised for thalassemic patients to improve glucose hemostasis.
  1,396 376 9
Risk of developing adulthood obesity among females born with low birth weight: Results from a non-concurrent study from rural Southern India
Arup Chakraborty, PS Rakesh, V Kumaran, Jasmin Prasad, Anu M Alexander, Kuryan George
May-June 2014, 18(3):414-418
DOI:10.4103/2230-8210.131214  PMID:24944941
Objective: To determine the relationship between birth weight and the evolution of obesity in adult life in women from a rural developmental block in southern India. Design: Non-concurrent cohort Setting: General community- a rural developmental block in southern India. Participants: Two hundred and seventy one young healthy females were recruited from a birth cohort. The study subjects were 98 women in the age group of 19-23 years who had been born with low birth weight (LBW) and 173 women in the same age group who had been born with normal birth weight (NBW). Materials and Methods: Data collection involved interview using a structured questionnaire and anthropometric measurements. Analysis: Chi-square test to assess significance of association, independent sample t test to assess the difference between means, odds ratios for measuring magnitude of association, stratified analysis to identify various interactions and confounders, and multiple logistic regression models to identify the relationship between birth weight and young adult obesity (BMI > 25). Results: A crude odds ratio of 0.564 (95% CI 0.262 - 1.214) was obtained for the association between LBW and development of obesity later in life. In the final logistic regression model, it was found that a young adult female with low birth weight who belonged to a higher socio-economic group had a higher risk of developing obesity (Adjusted odds for the interaction term between LBW and high SES 6.251; 95% CI 1.236 - 31.611). Conclusion: The study could not find any significant association between LBW and development of obesity later in life, but it found a higher probability of developing obesity later in life among low birth weight female children born in high socio-economic status families.
  1,247 388 1
General seizures revealing macro-adenomas secreting prolactin or prolactin and growth hormone in men
Farida Chentli, Lina Akkache, Katia Daffeur, Said Azzoug
May-June 2014, 18(3):361-363
DOI:10.4103/2230-8210.131185  PMID:24944932
Background: Epilepsy is a heterogeneous condition with numerous etiologies. Pituitary tumors are rarely responsible for generalized convulsions except when they are very large. Apart from anecdotic cases, only one study concerning epilepsy frequency in male macroprolactinomas is available in Medline. Our aim was to analyze epilepsy frequency and conditions under which seizures appear and disappear in men harboring macroprolactinomas or somatolactotroph adenomas. Materials and Methods: We retrospectively analyzed 90 men with macro-adenomas (>1 cm) secreting prolactin (PRL) (n = 82) or both PRL and growth hormone (n = 8) to look for generalized seizures. We took into account familial and personal medical history, clinical examination, routine and hormonal analyzes, and radiological assessment based on cerebral magnetic resonance imaging. Results: Between 1992 and 2012, we collected eight cases (8.9%): Seven were hospitalized for recent generalized seizures; one had epilepsy after conventional radiotherapy given in 1992 because of neurosurgery failure and resistance to bromocriptine. Their median age was 33.75 years (22-58), median PRL was 9,198 ng/ml and median tumor height was 74 mm (41-110). The temporal lobe was invaded in six cases. After tumor reduction, epilepsy disappeared and never relapsed after a follow-up varying between 1 and 20 years. Conclusion: Epilepsy, which is a life-threatening condition, can be the first presentation in men with prolactinomas or somatolactotroph adenomas, especially those involving the supra sellar area, and the brain. Convulsions can also appear after radiotherapy. That one should be avoided, if possible, before tumor reduction by surgery or medical treatment.
  1,302 275 3
Status of iodine deficiency disorder in district Udham Singh Nagar, Uttarakhand state India
Umesh Kapil, RM Pandey, Vandana Jain, Madhulika Kabra, Neha Sareen, Ajeet Singh Bhadoria
May-June 2014, 18(3):419-421
DOI:10.4103/2230-8210.131219  PMID:24944942
Background: Iodine deficiency disorder (IDD) is a public health problem in Uttarakhand state. Objective: The present study was conducted in district Udham Singh Nagar, Uttarakhand state with an objective to assess the status of iodine deficiency amongst school age children (6-12 years). Materials and Methods: Thirty clusters were selected by utilizing the population proportionate to size (PPS) cluster sampling methodology. A total of 1807 children in the age group of 6-12 years were included. The clinical examination of the thyroid of each child was conducted. Urine and Salt samples were collected from children. Results: The Total Goiter Rate (TGR) was found to be 13.2%. The proportion of children with Urinary Iodine Excretion (UIE) level <20, 20-49, 50-99, 100-199 and ≥200 μg/l was found to be nil, 6.0, 21.2, 34.2 and 38.5 percent, respectively. The median UIE level was 150 μg/l. Only 46.7% of the salt samples had stipulated level of iodine of 15 ppm and more. Conclusion: The study population had mild degree of public health problem of iodine deficiency.
  1,343 228 2
Farida Chentli, Leyla Rabhi, Nassima Belhadj-Aissa, Said Azzoug
May-June 2014, 18(3):437-438
DOI:10.4103/2230-8210.131233  PMID:24944954
  1,216 187 1
Author Reply
V Kumaravel, S Vanishree, M Anitharani, BWC Sathiyasekaran
May-June 2014, 18(3):440-440
  1,204 163 -
Comparison of the world health organization and the international association of diabetes and pregnancy study groups criteria in diagnosing gestational diabetes mellitus in South Indians
Prasanta Kumar Nayak, Subarna Mitra, JayaPrakash Sahoo, Sadishkumar Kamalnathan
May-June 2014, 18(3):433-434
DOI:10.4103/2230-8210.131229  PMID:24944950
  840 339 2
A very rare cohort of elderly patients with autoimmune polyglandular syndrome type 3b
Zulfiqar Abrar-Ahmad
May-June 2014, 18(3):430-431
DOI:10.4103/2230-8210.131226  PMID:24944947
  923 236 1
Proteus syndrome: More vigilance needed to diagnose it
Suresh Kumar Angurana, Renu Suthar Angurana
May-June 2014, 18(3):429-430
DOI:10.4103/2230-8210.131225  PMID:24944946
  894 227 -
Catecholamine induced cardiomyopathy in phaeochromocytoma
Prashant K Panda, Jatinder Mokta, Kiran Mokta, Bhaskar Bhardwaj
May-June 2014, 18(3):432-433
DOI:10.4103/2230-8210.131228  PMID:24944949
  882 225 5
Primary hyperparathyroidism and malignancy: Forgotten friends or new aquaintances
Krishnarpan Chatterjee, Chetana Sen, Gopal C Ghosh
May-June 2014, 18(3):436-436
DOI:10.4103/2230-8210.131232  PMID:24944953
  816 182 -
Primary hypothyroid induced by drug interaction
Martin Diarra, Youssef Khabbal, Sad Boujraf, Farida Ajdi
May-June 2014, 18(3):431-432
DOI:10.4103/2230-8210.131227  PMID:24944948
  769 218 1
Prevalence of thyroid function test abnormalities and thyroid autoantibodies in children with vitiligo
Mahmood Dhahir Al-Mendalawi
May-June 2014, 18(3):435-435
DOI:10.4103/2230-8210.131231  PMID:24944952
  761 217 -
Response to the study by V. Kumaravel et al., titled "Are the current Indian growth charts really representative?"
Vaman V Khadilkar, Anuradha V Khadilkar
May-June 2014, 18(3):439-439
DOI:10.4103/2230-8210.131234  PMID:24944955
  738 206 -
Is metabolic syndrome prevailing in Iraqi children?
Mahmood D Al-Mendalawi
May-June 2014, 18(3):434-435
DOI:10.4103/2230-8210.131230  PMID:24944951
  569 161 -