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   2017| July-August  | Volume 21 | Issue 4  
    Online since June 9, 2017

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Forum for injection technique and therapy expert recommendations, India: The Indian recommendations for best practice in insulin injection technique, 2017
Nikhil Tandon, Sanjay Kalra, Yatan Pal Singh Balhara, Manash P Baruah, Manoj Chadha, Hemraj B Chandalia, KM Prasanna Kumar, SV Madhu, Ambrish Mithal, Rakesh Sahay, Rishi Shukla, Annamalai Sundaram, Ambika G Unnikrishnan, Banshi Saboo, Vandita Gupta, Subhankar Chowdhury, Jothydev Kesavadev, Subhash K Wangnoo
July-August 2017, 21(4):600-617
DOI:10.4103/ijem.IJEM_97_17  PMID:28670547
Health-care professionals in India frequently manage injection or infusion therapies in persons with diabetes (PWD). Patients taking insulin should know the importance of proper needle size, correct injection process, complication avoidance, and all other aspects of injection technique from the first visit onward. To assist health-care practitioners in their clinical practice, Forum for Injection Technique and Therapy Expert Recommendations, India, has updated the practical advice and made it more comprehensive evidence-based best practice information. Adherence to these updated recommendations, learning, and translating them into clinical practice should lead to effective therapies, improved outcomes, and lower costs for PWD.
  15 5,955 895
Gestational weight gain and pregnancy outcomes in relation to body mass index in Asian Indian women
Balaji Bhavadharini, Ranjit Mohan Anjana, Mohan Deepa, Gopal Jayashree, Subramanyam Nrutya, Mahadevan Shobana, Belma Malanda, Arivudainambi Kayal, Anne Belton, Kurian Joseph, Kurian Rekha, Ram Uma, Viswanathan Mohan
July-August 2017, 21(4):588-593
DOI:10.4103/ijem.IJEM_557_16  PMID:28670545
Aim: The aim of the study was to compare the weight gain during pregnancy (using Institute of Medicine guidelines) among Asian Indians across different body mass index (BMI) categories (using World Health Organization Asia Pacific BMI cut points) and to compare the pregnancy outcomes in each of the different BMI categories. Methodology: Retrospective records of 2728 pregnant women attending antenatal clinics and private maternity centers in Chennai, South India, from January 2011 to January 2014 were studied. Pregnancy outcomes were analyzed in relation to BMI and weight gain across different BMI categories. Results: Overweight and obese women who gained more weight during pregnancy were at high risk of delivering macrosomic infants (overweight - odds ratio [OR]: 2.3, 95% confidence interval [CI]: 1.1–5.2, P = 0.02 and obese - OR: 1.6, 95% CI: 1.1–2.4, P = 0.01). In addition, obese women who gained more weight were also at high risk of preterm labor (OR: 2.1, 95% CI: 1.1–3.8; P = 0.01), cesarean section (OR: 1.9, 95% CI: 1.4–2.5; P< 0.001), and preeclampsia (OR: 2.8, 95% CI: 1.1–7.2, P = 0.03). Normal weight and overweight women who gained less weight had a protective effect from cesarean section and macrosomia. Conclusions: Overweight/obese women who gained more weight than recommended are at a high risk of developing adverse pregnancy outcomes. Normal and overweight women who gained weight less than recommended have low risk for cesarean section and macrosomia. However, they have a higher (statistically insignificant) risk for low birth weight and preterm birth. This highlights the need for gaining adequate weight during pregnancy.
  11 4,220 696
Effect of Vitamin D supplementation on vascular functions and oxidative stress in type 2 diabetic patients with Vitamin D deficiency
Nishanthi Anandabaskar, Sandhiya Selvarajan, Steven Aibor Dkhar, Sadish Kumar Kamalanathan, Kadhiravan Tamilarasu, Zachariah Bobby
July-August 2017, 21(4):555-563
DOI:10.4103/ijem.IJEM_140_17  PMID:28670540
Background: Vitamin D levels are reported to have an inverse liaison with the risk of cardiovascular diseases. Hence, we aimed to evaluate the effect of Vitamin D supplementation on changes in vascular functions and oxidative stress in type 2 diabetic patients with Vitamin D deficiency. Subjects and Methods: One hundred and three patients with type 2 diabetes attending endocrinology outpatients department in a tertiary care hospital were screened for Vitamin D deficiency. Patients with serum 25-hydroxy Vitamin D levels <20 ng/ml were considered as deficient and were administered 60,000 IU of oral Vitamin D3 weekly for 8 weeks. In these patients, parameters of vascular functions (carotid-femoral pulse wave velocity, brachial-ankle pulse wave velocity, and arterial stiffness index) and oxidative stress (serum malondialdehyde levels and total antioxidant status) were measured at baseline and after 8 weeks of oral Vitamin D supplementation. Results: Among 103 patients with type 2 diabetes, 75 (72.82%) were found to have Vitamin D deficiency. Amidst these patients, carotid-femoral pulse wave velocity (991.6 ± 161.82 vs. 899.29 ± 151.86, P< 0.001), right brachial-ankle pulse wave velocity (1446.16 ± 204.33 vs. 1350.8 ± 178.39, P< 0.001), and left brachial-ankle pulse wave velocity (1493.81 ± 219.65 vs. 1367.61 ± 220.64, P< 0.001) showed a significant reduction following Vitamin D supplementation. Further, these patients were found to have significant fall in serum malondialdehyde levels with rise in total antioxidant status ensuing Vitamin D supplementation. Conclusion: The present study shows that oral Vitamin D supplementation of 60,000 IU/week for 8 weeks significantly improves vascular functions and reduces oxidative stress in type 2 diabetic patients with Vitamin D deficiency.
  7 1,958 437
Randomized placebo control study of metformin in psoriasis patients with metabolic syndrome (systemic treatment cohort)
Surjit Singh, Anil Bhansali
July-August 2017, 21(4):581-587
DOI:10.4103/ijem.IJEM_46_17  PMID:28670544
Background: Psoriasis has been found to be associated with obesity, metabolic syndrome (MS), diabetes, and cardiovascular risk factors. Metformin treatment showed improvement in cardiovascular risk factors and hyperinsulinemia. Objective: To evaluate the efficacy and safety of metformin in psoriasis patients with MS. Materials and Methods: This was a single-center, parallel-group, randomized, open-label study with blinded end point assessment of metformin (1000 mg once daily for 12 weeks; n = 20) and placebo (n = 18) in psoriasis patients with MS. Total sample size was 38 participants. Results: Statistically significant improvement was observed in mean percentage change in erythema, scaling, and induration (ESI) (P = 0.048) in metformin as compared to placebo while mean percentage change in psoriasis area and severity index (PASI) and physician global assessment (PGA) scores was not significant (PASI - P = 0.215, PGA - P = 0.070). There was a statistically significant difference in percentage of parameters of MS improved following 12 weeks of treatment in metformin (19%) as compared to placebo (8.9%) group (P = 0.046). Statistically significant difference in percentage of patients achieving 75% reduction in ESI scores (P = 0.024). Significant improvement was observed in mean weight, body mass index (BMI), total cholesterol, and low-density lipoprotein (LDL) cholesterol in metformin group as compared to placebo. Improvement in BMI, fasting plasma glucose, serum triglycerides, high-density lipoprotein, LDL, systolic blood pressure, diastolic blood pressure, and total cholesterol was statistically significant in metformin group over the period of 12 weeks. There was no significant difference in adverse events in two groups except weight gain. Conclusion: Metformin has shown improvement in psoriasis and parameters of MS, hence can be used for the benefit of psoriasis patients having MS. Large, controlled studies are needed to confirm.
  6 1,531 289
Increased levels of serum interleukin-17 in patients with Hashimoto's thyroiditis
Fatemeh Esfahanian, Roghayeh Ghelich, Hoda Rashidian, Zohreh Jadali
July-August 2017, 21(4):551-554
DOI:10.4103/ijem.IJEM_412_16  PMID:28670539
Background: CD4+ T-cells play important roles in the pathogenesis of Hashimoto's thyroiditis (HT). However, there is limited data about characteristics and function of the newly interleukin (IL)-17–producing T-helper cells in this common autoimmune thyroid disorder. Aim: The purpose of this study was to assess the levels of T-helper 17-related cytokines in sera of patients with HT. Materials and Methods: Cytokine concentrations were measured in 48 patients with overt (n = 23) and subclinical hypothyroidism (25) and 35 healthy controls using enzyme-linked immunosorbent assay. Results: The serum levels of IL-17 were significantly higher in patients than controls (P = 0.001) while no differences were observed with regard to levels of IL-22 and IL-23 between patients and normal controls. Conclusion: These results suggest that IL-17 could play some role in the pathogenesis of HT.
  5 1,156 290
Occurrence and predictors of depression and poor quality of life among patients with Type-2 diabetes: A Northern India perspective
Prerna Bahety, Gunjan Agarwal, Deepak Khandelwal, Deep Dutta, Sanjay Kalra, Pankaj Taparia, Vikas Singhal
July-August 2017, 21(4):564-569
DOI:10.4103/ijem.IJEM_123_17  PMID:28670541
Background and Aims: Globally, depression has been linked to Type-2 diabetes mellitus (T2DM). However, similar data from India are scant. This study evaluated the occurrence and predictors of depression and health-related quality of life (QOL) in patients with T2DM as compared to healthy controls.Materials and Methods: One hundred adults with T2DM without prior diagnosis of depression and 100 matched controls were evaluated. Depression was assessed using Patient Health Questionnaire-9. World Health Organization QOL Brief (WHO-QOL-BREF) was used to assess QOL. Demography, anthropometry, biochemical parameters of diabetes control, and microvascular and macrovascular complications in patients were recorded. Results: Depression was significantly more common in T2DM (63%) as compared to controls (48%) (odds ratio [OR] - 1.84 [1.04, 3.24]; P = 0.03). In T2DM, depression was higher in patients with disease duration >5 years (OR = 2.66; P = 0.02), glycated hemoglobin >7% (OR = 3.45; P = 0.004), retinopathy (OR - 3.56; P = 0.03), and nephropathy (OR - 4.11; P = 0.07). Occurrence of depression was significantly higher among the patients with macrovascular complications, namely, coronary artery disease (17.4%; P = 0.000006), cerebrovascular disease (14.2%; P = 0.0006), and peripheral vascular disease (7.9%; P = 0.05). Insulin users had higher depression as compared to patients using only oral antihyperglycemic medications (P = 0.034). Patient with depression had significantly low QOL. The WHO-QOL for all the domains was significantly lower in T2DM with microvascular and macrovascular complications, as compared to those without. Conclusion: Indian T2DM had higher prevalence of depression and lower QOL as compared to controls, which was associated with poor glycemic control and higher end-organ damage. Public health measures are required to create more awareness for managing depression in diabetes.
  5 1,523 329
Myopathy in patients taking atorvastatin: A pilot study
K Manoj, N Jain, SV Madhu
July-August 2017, 21(4):504-509
DOI:10.4103/ijem.IJEM_79_17  PMID:28670530
Aim: This study aims to investigate the prevalence and risk factors of statin-induced myopathy. Subjects and Methods: A total of 200 patients aged ≥ 40 years and taking atorvastatin 10 mg/day or more for at least 2 weeks were recruited in the study. A detailed history of participants and anthropometry of study participants was recorded, and features of myopathy were explained. Biochemical investigations along with thyroid stimulating hormone (TSH) and Vitamin D were done in all patients. Results: Mean age of study population was 54.81 ± 9.10 years. Sixty-five percent (65.5%) of atorvastatin users had coronary heart disease, 62.5% were hypertensive, 38% had diabetes. Thirty-five percent (35.5%) patients were taking 10 mg/day atorvastatin, 45% were taking 20 mg/day, and 19.5% were taking 40 mg/day. The overall frequency of myopathy among statin users was 7.5% which was significantly higher with increasing dose of atorvastatin (1.4% in 10 mg/day group, 10% in 20 mg/day group, and 12.8% in 40 mg/day, P< 0.05). The frequency of atorvastatin-related myopathy was higher in females 8.65% compared to 6.25% in males. Serum TSH levels in patients with myopathy were 4.05 ± 7.76 μIU/ml while in those without myopathy were 3.13 ± 2.88 μIU/ml (P = 0.649). Serum 25-hydroxy Vitamin D levels were measured in 66 patients randomly. Mean levels in patients with myopathy were 15.98 ± 12.94 ng/ml and without myopathy were 10.20 ± 5.64 ng/ml (P = 0.285). Conclusion: The present study demonstrates that a significantly higher number of patients taking atorvastatin develop myopathy in real life clinical condition. The frequency of myopathy increases with increase in atorvastatin dose.
  5 1,837 455
Osteoporosis in otherwise healthy patients with type 2 diabetes: A prospective gender based comparative study
Balram Sharma, Hema Singh, Praveen Chodhary, Sanjay Saran, Sandeep Kumar Mathur
July-August 2017, 21(4):535-539
DOI:10.4103/ijem.IJEM_108_17  PMID:28670536
Background and Objective: Type 2 diabetes mellitus (T2DM) may affect bone loss differentially in adult males and postmenopausal females. We evaluated the prevalence of osteoporosis in otherwise healthy adults with T2DM. Materials and Methods: In a cross-sectional study, adults with T2DM, aged 50 years and above, were evaluated for bone mineral density (BMD) using dual-energy X-ray absorptiometry (DXA) scan at spine and hip. T-score of ≤−2.5 was defined as osteoporosis and score −2.49 to −1.0 as osteopenia at either site. Correlation of low BMD with demographic, clinical, and laboratory parameters including serum Vitamin D and serum testosterone (in males) was evaluated. Results: In 200 patients, mean age was 64.5 ± 7.0 years and age differed significantly in males and females (P < 0.0001). Osteoporosis was present in 35.5% adults with T2DM. Significantly greater proportion of females had osteoporosis (49.5% vs. 22.3%, P< 0.0001). Frequency of osteoporosis at spine (33.5%) was higher than the same at hip (13.5%). Compared to males, significantly greater proportion of females had osteoporosis and osteopenia at both spine (P < 0.0001) and hip (P < 0.0001). Among all parameters assessed, a significant positive correlation of T-score at spine and hip was seen with body mass index in both males (r = 0.287, P = 0.003 at spine and r = 0.421, P< 0.0001 at hip) and females (r = 0.291, P = 0.004 at spine and r = 0.280, P = 0.010 at hip). There was no association of Vitamin D deficiency (45.5% patients) with either T-score and presence of osteoporosis either at spine (P = 0.388 and P = 0.177) or hip (P = 0.431 and P = 0.593). Conclusion: Prevalence of osteoporosis in otherwise healthy T2DM was 35.5% with greater prevalence in females than males. Body mass but not Vitamin D or testosterone has an important role in the determination of bone loss in T2DM.
  5 1,564 416
Are predictive equations for estimating resting energy expenditure accurate in Asian Indian male weightlifters?
Mini Joseph, Riddhi Das Gupta, L Prema, Mercy Inbakumari, Nihal Thomas
July-August 2017, 21(4):515-519
DOI:10.4103/ijem.IJEM_563_16  PMID:28670532
Background: The accuracy of existing predictive equations to determine the resting energy expenditure (REE) of professional weightlifters remains scarcely studied. Our study aimed at assessing the REE of male Asian Indian weightlifters with indirect calorimetry and to compare the measured REE (mREE) with published equations. A new equation using potential anthropometric variables to predict REE was also evaluated. Materials and Methods: REE was measured on 30 male professional weightlifters aged between 17 and 28 years using indirect calorimetry and compared with the eight formulas predicted by Harris–Benedicts, Mifflin-St. Jeor, FAO/WHO/UNU, ICMR, Cunninghams, Owen, Katch-McArdle, and Nelson. Pearson correlation coefficient, intraclass correlation coefficient, and multiple linear regression analysis were carried out to study the agreement between the different methods, association with anthropometric variables, and to formulate a new prediction equation for this population. Results: Pearson correlation coefficients between mREE and the anthropometric variables showed positive significance with suprailiac skinfold thickness, lean body mass (LBM), waist circumference, hip circumference, bone mineral mass, and body mass. All eight predictive equations underestimated the REE of the weightlifters when compared with the mREE. The highest mean difference was 636 kcal/day (Owen, 1986) and the lowest difference was 375 kcal/day (Cunninghams, 1980). Multiple linear regression done stepwise showed that LBM was the only significant determinant of REE in this group of sportspersons. A new equation using LBM as the independent variable for calculating REE was computed. REE for weightlifters = −164.065 + 0.039 (LBM) (confidence interval −1122.984, 794.854]. This new equation reduced the mean difference with mREE by 2.36 + 369.15 kcal/day (standard error = 67.40). Conclusion: The significant finding of this study was that all the prediction equations underestimated the REE. The LBM was the sole determinant of REE in this population. In the absence of indirect calorimetry, the REE equation developed by us using LBM is a better predictor for calculating REE of professional male weightlifters of this region.
  5 1,528 257
Indirect calorimetry: From bench to bedside
Riddhi Das Gupta, Roshna Ramachandran, Padmanaban Venkatesan, Shajith Anoop, Mini Joseph, Nihal Thomas
July-August 2017, 21(4):594-599
DOI:10.4103/ijem.IJEM_484_16  PMID:28670546
Accurate determination of energy expenditure (EE) is vitally important yet often neglected in clinical practice. Indirect calorimetry (IC) provides one of the most sensitive, accurate, and noninvasive measurements of EE in an individual. Over the last couple of decades, this technique has been applied to clinical circumstances such as acute illness and parenteral nutrition. Beyond assessing the nutritional needs, it has also shed light on various aspects of nutrient assimilation, thermogenesis, the energetics of physical exercise, and the pathogenesis of obesity and diabetes. However, because of little or no experience with IC provided during medical education, the benefits of IC are poorly appreciated. Newer technology, cost-effectiveness, and a better understanding of how to interpret measurements should lead to more frequent use of IC. This review focuses on the physicochemical background of IC, the various indications for use, techniques and instruments, potential pitfalls in measurement, and the recent advances in technology that has adapted the technique to long-term studies in humans.
  5 3,596 849
Mutational analysis of androgen receptor gene in two families with androgen insensitivity
Radha Ramadevi Akella
July-August 2017, 21(4):520-523
DOI:10.4103/ijem.IJEM_345_16  PMID:28670533
Background: Androgen insensitivity syndrome (AIS) is a rare X-linked disorder due to mutations in the androgen receptor (AR) gene causing end-organ resistance to the androgenic hormone. Subjects and Methods: Genetic studies were carried out in two families by karyotype and targeted exome sequencing of the AR gene. Results: Two novel missense mutations were identified, p.L822P and p.P392S, in two families with complete androgen insensitivity (CAIS) and partial androgen insensitivity (PAIS), respectively. Both had 46, XY karyotype. The mother was a heterozygous carrier in PAIS and negative in CAIS. These two were novel mutations, reported for the first time, in the AR gene. In silico analysis predicted that both mutations were damaging. We reviewed the various reported Indian mutations in the AR gene. Conclusion: AR gene mutations cause a wide spectrum of disorders from CAIS to male infertility or primary amenorrhea. Early diagnosis is essential for gender assignment and further management, family counseling, and prenatal diagnosis.
  4 1,351 266
High prevalence of serine protease inhibitor Kazal type 1 gene variations detected by whole gene sequencing in patients with fibrocalculous pancreatic diabetes
Anish Kolly, C Shivaprasad, Annie A Pulikkal, Sridevi Atluri, Vijaya Sarathi, CS Dwarakanath
July-August 2017, 21(4):510-514
DOI:10.4103/ijem.IJEM_116_17  PMID:28670531
Aim of Study: The aim is to study the prevalence and pattern of serine protease inhibitor Kazal type 1 (SPINK1) gene variations in patients with fibrocalculous pancreatic diabetes (FCPD) using whole gene sequencing. Materials and Methods: A total of 56 consecutive patients of FCPD were recruited for the study. Diagnosis of FCPD was based on the presence of diabetes mellitus in patients having chronic pancreatitis with radiological evidence of ductal calcifications, in the absence of other known causes for pancreatitis. Ethylenediaminetetraacetic acid samples were collected from all patients, and complete gene sequencing was performed for SPINK1 gene using Sanger technique. Results: Overall 35 patients (62.5%) were detected to have genetic alterations in SPINK1 gene. N34S polymorphism was seen in 23 participants (41.07%) out of which 3 were homozygous. N34S was seen to be in linkage disequilibrium with IVS1 − 37T>C (18/23) and IVS3-69insAAAA (19/23) polymorphisms. Seven patients (12.5%) had a 272 C>T 3'UTR polymorphism while one patient (1.8%) had a P55S polymorphism. Two patients (3.5%) had an IVS3 + 2T>C mutation which has been shown to be associated with loss of function of SPINK protein. Overall 48.2% of FCPD patients had genetic variations that were significant compared to the control population. There was no difference in anthropometric and biochemical parameters between those with or without SPINK1 gene variations. Conclusions: Variations in SPINK1 gene are frequently observed in FCPD. N34S polymorphism was the most common variation followed by intronic variations. Two patients had the pathogenic intronic IVS3 + 2T>C mutation. Whole gene sequencing of the SPINK1 gene enabled detection of an additional 7.1% of patients with significant SPINK1 gene variations as compared to targeted screening for the N34S variation.
  3 1,129 264
A study of the patients suffering from tuberculosis and tuberculosis-diabetes comorbidity in Revised National Tuberculosis Control Program Centers of Northern Madhya Pradesh, India
Anil Kumar Agarwal, Ginisha Gupta, Priyesh Marskole, Anju Agarwal
July-August 2017, 21(4):570-576
DOI:10.4103/ijem.IJEM_89_17  PMID:28670542
Background: Diabetes mellitus (DM) is recognized as an important risk factor to tuberculosis (TB). India has high TB burden, along with rising DM prevalence. Aim: This study was conducted to document the coexistence of DM and TB in persons with established TB under the Revised National Tuberculosis Control Program. Type of Study: This was a cross-sectional, descriptive observational study conducted at selected Directly Observed Therapy center in Gwalior North Central India. Materials and Methods: A total of 550 patients with confirmed diagnosis of TB and on treatment were recruited. The study participants were screened for DM and diagnoses were made on the basis of the World Health Organization criteria. Clinical parameters were compared between persons with DM and those without DM. Results: DM/TB co-morbidity was noted in 85 individuals and these made up 15.4% of the study population. The mean age was higher in DM patients with TB (43.4 ± 15.4 vs. 33.1 ± 16.2 years, P = 0.000); the mean duration of symptoms of TB with DM was more (124 ± 16.4 vs. 107.49 ± 10.3 days). Multinomial logistic regression analysis showed that increasing age, positive family history of diabetes, sedentary occupation, and presence of pulmonary TB were significantly associated with diabetes among TB patients. Conclusions: Diabetes is an important co-morbid feature to be sought in patients with TB. This study re-echo the need to raise awareness on screening for DM in persons with TB.
  3 2,241 450
Medication counseling for thyroxine
Sanjay Kalra, AG Unnikrishnan, Mangesh Tiwaskar, Rakesh Sahay, Banshi Saboo, Vijay Negalur, Deepak Khandelwal, Pritam Gupta, Sujoy Ghosh, AK Das, Ganapathi Bantwal, Sarita Bajaj, Sameer Agarwal, Rashmi Aggarwal, Navneet Agarwal
July-August 2017, 21(4):630-631
DOI:10.4103/ijem.IJEM_91_17  PMID:28670549
This communication from the National Indian Patient-centered Thyroid Management group provides a useful tool to help in medication counseling during hypothyroidism management. The authors classify and list aspects of thyroxine use which must be discussed with patients on thyroxine supplementation or replacement. Issues related to concomitant food and medications intake, preconception and pregnancy management, as well as sick day care, are also discussed.
  2 1,508 312
Sanjay Kalra, Komal Verma, Yatan Pal Singh Balhara
July-August 2017, 21(4):632-633
DOI:10.4103/ijem.IJEM_136_17  PMID:28670550
Our understanding of the biopsychosocial model of health, and its influence on chronic endocrine conditions, has improved over the past few decades. We can distinguish, for example, between diabetes distress and major depressive disorders in diabetes. Similar to diabetes distress, we suggest the existence of “thyrostress” in chronic thyroid disorders. Thyro-stress is defined as an emotional state, characterized by extreme apprehension, discomfort or dejection, caused by the challenges and demand of living with thyroid disorders such as hypothyroidism. This communication describes the etiology, clinical features, differential diagnosis, and management of thyro-stress.
  2 3,089 227
Parathyromatosis following endoscopic parathyroid surgery: A rare occurrence
Ajay Aggarwal, Roopak Wadhwa, Vivek Aggarwal
July-August 2017, 21(4):641-642
DOI:10.4103/ijem.IJEM_61_17  PMID:28670557
  2 790 156
Prevalence of thyroid peroxidase antibody and pregnancy outcome in euthyroid autoimmune positive pregnant women from a tertiary care center in Haryana
Rajesh Rajput, Tekchand Yadav, Shashi Seth, Smiti Nanda
July-August 2017, 21(4):577-580
DOI:10.4103/ijem.IJEM_397_16  PMID:28670543
Objective: To study the prevalence of thyroid peroxidase autoantibody in euthyroid pregnant women and to evaluate the association between thyroid peroxidase autoantibody and pregnancy outcomes. Materials and Methods: One thousand thirty consecutive pregnant women attending the antenatal clinic over a period of 1 year and were carrying a healthy singleton uncomplicated intrauterine pregnancy and consuming iodized salt were recruited for the study. Outcomes of the pregnancy was compared between TPO antibody positive euthyroid women (group 1) and TPO antibody negative euthyroid women (group 2). Results: Out of 1030 women, 164 (18.9%) were detected TPO antibody positive with euthyroid status. The mean FT4 and TSH level were significantly different in those who were TPO Ab positive as compared TPO Ab negative euthyroid pregnant women. No correlation was observed between the maternal age, gestational age and gravidity with anti TPO antibody levels. Eighteen (12%) women in Group 1and 5 (3.3%) women in Group 2 had miscarriages and the difference was found to be statistically significant (P value of 0.004). Twenty-one (14%) women in Group 1 and 5 (3.3%) women in Group 2 had preterm deliveries, which was also found to be statistically significantly (p value of 0.001). Other pregnancy related complications like Intrauterine death, IUGR, preeclampsia and PIH though are present in comparatively higher number in TPO Ab positive euthyroid pregnant women as compared to TPO Ab negative euthyroid pregnant women but this difference was not found to be statistically significant. Conclusions: To conclude with the present study shows that a good number of pregnant women with euthyroid status have TPO Ab positivity and this is associated with some adverse pregnancy outcomes like miscarriage and preterm birth of the baby.
  2 3,329 338
The serological and biochemical markers of adrenal cortex and endocrine pancreas dysfunction in patients with Hashimoto's thyroiditis: A hospital-based pilot study
Jaya Prakash Sahoo, Jayakumar Selviambigapathy, Sadishkumar Kamalanathan, VS Negi, MG Sridhar, Sitanshu Sekhar Kar, Muthupillai Vivekanandan
July-August 2017, 21(4):540-544
DOI:10.4103/ijem.IJEM_72_17  PMID:28670537
Background: The prevalence of both islet cell and adrenal autoimmunity among Asian Indian hypothyroidism patients with Hashimoto's thyroiditis (HT) is lacking in literature. Objectives: The objective of this study was to assess the proportion of Addison's disease (AD) and type 1 diabetes mellitus (T1DM) in patients with HT. Materials and Methods: The patients with hypothyroidism due to HT were included in this study over 2 years. Primary hypothyroidism was defined as high serum thyroid-stimulating hormone (>5.5 mIU/L) with or without low thyroxine level. HT was defined by the presence of high thyroid peroxidase antibody (Ab) titer (>35 IU/ml). Autoimmune markers of AD and T1DM, i.e., adrenal (21-hydroxylase) Ab, glutamic acid decarboxylase (GAD) Ab, and insulinoma-associated antigen-2 (IA-2) Ab were measured among them. In addition, 250 μg adrenocorticotropic hormone (ACTH) stimulation test was done in patients with adrenal Ab. Similarly, beta cell function was assessed in patients with GAD and/or IA-2 Ab. Results: Out of 150 patients screened, 136 patients were included in this study. Seven patients had adrenal Ab while 15 had IA-2 Ab. The GAD Ab was not present in any of the patients in the study. ACTH stimulation test was done in four of seven patients with adrenal Ab and beta cell function was assessed in 8 of 15 patients with islet cell Ab. All patients with adrenal Ab had normal adrenal function and 1 out of 15 with IA-2 Ab developed diabetes mellitus during follow-up. Conclusions: Either adrenal or islet cell Ab was found in 16% Asian Indian hypothyroidism patients with HT.
  2 965 206
The effect of yoga and peer support interventions on the quality of life of women with diabetes: Results of a randomized controlled trial
Aswathy Sreedevi, Ambika Gopalakrishnan Unnikrishnan, Sundaram Ramaiyer Karimassery, Kuttikattu Soman Deepak
July-August 2017, 21(4):524-530
DOI:10.4103/ijem.IJEM_28_17  PMID:28670534
Objective: This was an interventional study to understand the effect of two low-cost interventions; yoga and peer support on the quality of life (QOL) of women with type 2 diabetes. Methodology: An open label parallel three-armed randomized control trial was conducted among 124 recruited women with diabetes for 3 months. Block randomization with a block length of six was carried out. In the yoga arm, sessions by an instructor, consisting of a group of postures coordinated with breathing were conducted for an hour, 2 days a week. In the peer support arm, each peer mentor after training visited 13–14 women with diabetes every week followed by a phone call. The meeting was about applying disease management plans in daily life. At the beginning and end of the study, QOL was assessed by the translated, validated World Health Organization QOL-BREF in four domains physical, psychological, social, and environmental domains. Results: The majority (96%) of the study participants perceived the peer support and yoga intervention to be beneficial. Paired t-test revealed significant increases in the social and environmental domain in the peer group and in the environmental domain in the yoga group, though this disappeared in the between-group comparison perhaps due to poor glycemic control (hemoglobin A1c varied from 9.4 to 9.6) and the short duration of 3 months of the study. Conclusion: Peer support and yoga improved perceptions of QOL though its impact on scores was not significant due to a short period of study among women with poor glycemic control.
  2 2,139 327
A prospective study on role of supplemental oral calcium and Vitamin D in prevention of postthyroidectomy hypocalcemia
Krishnan Ravikumar, Dhalapathy Sadacharan, Sankaran Muthukumar, Thalavai Sundarram, Selladurai Periyasamy, RV Suresh
July-August 2017, 21(4):498-503
DOI:10.4103/ijem.IJEM_402_16  PMID:28670529
Background: Postoperative transient hypocalcemia is sequelae of total thyroidectomy (TT), which is observed in up to 50% of patients. Routine oral calcium and Vitamin D supplementation have been proposed to prevent symptomatic hypocalcemia preventing morbidity and facilitating early discharge. Patients and Methods: A total of 208 patients with nontoxic benign thyroid disorders, undergoing TT, were serially randomized into four groups: Group A (no supplements were given), Group B (oral calcium - 2 g/day given), Group C (calcium and calcitriol - 1 mcg/day are given), and Group D (calcium, calcitriol, and cholecalciferol - 60,000 IU/day are given). Patients were monitored for clinical and biochemical hypocalcemia (serum calcium, [Sr. Ca] <8 mg/dl), along with serum intact parathormone (Sr. PTH) and magnesium 6 h after surgery and Sr. Ca every 24 h. Intravenous (IV) calcium infusion was started, if any of the above four groups exhibit frank hypocalcemia. Patients are followed up with Sr. Ca and Sr. PTH at 3 and 6 months. Results: All groups were age and sex matched. Hypocalcemia was observed in 72/208 (34.61%) cases. Incidence of hypocalcemia was higher in Group A (57.69%) and Group B (50%) compared to Group C (15.38%) and Group D (15.38%). Hypocalcemia necessitating IV calcium occurred in 31/208 (14.90%) patients. IV calcium requirement exceeded in Group A (26.92%) and Group B (23.07%) compared to Group C (5.76%) and Group D (3.84%). There was no statistical difference in basal levels of serum Vitamin D, calcium, magnesium, intact PTH, and 6 h after surgery. Permanent hypoparathyroidism developed in five patients on follow-up. Conclusion: Routine postoperative supplementation of oral calcium and Vitamin D will help in the prevention of postthyroidectomy transient hypocalcemia significantly. Preoperative Vitamin D levels do not predict postoperative hypocalcemia.
  2 1,624 506
Diabetes care: Evolution of philosophy
Sanjay Kalra, Manash P Baruah, Bharti Kalra
July-August 2017, 21(4):495-497
DOI:10.4103/ijem.IJEM_109_17  PMID:28670528
  1 1,740 287
Technosocial competence in diabetology
Sanjay Kalra, Karthik Balachandran
July-August 2017, 21(4):489-491
DOI:10.4103/ijem.IJEM_155_17  PMID:28670526
  1 1,494 286
Iodine deficiency: An under recognized problem
Sudha Rathna Prabhu, Subramanian Kannan, Shriraam Mahadevan
July-August 2017, 21(4):640-641
DOI:10.4103/ijem.IJEM_39_17  PMID:28670556
  1 1,138 222
Menstrual cycle abnormalities in patients with prolactinoma and drug-induced hyperprolactinemia
Bindu Kulshreshtha, Isha Pahuja, Deepak Kothari, Indu Chawla, Neera Sharma, Shikha Gupta, Anuja Mittal
July-August 2017, 21(4):545-550
DOI:10.4103/ijem.IJEM_515_16  PMID:28670538
Background and Objective: Hyperprolactinemia affects the reproductive endocrine axis; however, the degree of dysfunction may vary depending on etiology. The aim of the present study was to analyze menstrual cyclicity in patients with prolactinoma and drug-induced hyperprolactinemia (DIH). Methodology: Patients with prolactinoma and DIH were retrospectively analyzed for menstrual cyclicity at presentation and response to therapy. Results: Of 128 females with hyperprolactinemia, 58 had prolactinoma (41 microadenoma and 17 macroadenoma) and 39 had DIH. Patients with prolactinoma had higher prolactin levels and increased frequency of oligomenorrhea (77.5% vs. 46%) as compared to DIH. Patients with macroprolactinoma had more severe menstrual disturbances compared to microprolactinoma. A higher percentage of patients with microprolactinoma and DIH achieved regular menstrual cycles compared to macroprolactinoma postcabergoline treatment (85% and 90% vs. 65%). There was no correlation between time to regularization of menstrual cycles with age, menstrual cycle length, duration of menstrual irregularity, or initial prolactin level in patients with prolactinoma. Linear regression analysis showed a significant association between time to regularization of menstrual cycles with time to normalization of prolactin levels (P = 0.001). Conclusion: There is a prompt restoration of menstrual cycles in patients with microprolactinoma and DIH. Patients with macroprolactinoma have more severe menstrual disturbances and lesser frequency of cycle restoration postcabergoline treatment compared to microprolactinoma and DIH.
  1 2,126 292
Dose modification of antidiabetic agents in patients with type 2 diabetes mellitus and heart failure
DC Sharma, Arthur Asirvatham, Parminder Singh
July-August 2017, 21(4):618-629
DOI:10.4103/ijem.IJEM_442_16  PMID:28670548
Heart failure is the most common comorbidity of diabetes. The incidence of heart failure in patients with diabetes is about 9%–22%, which is four times higher Than that in patients without diabetes. Heart failure and diabetes are collectively associated with increased morbidity and mortality compared to either condition alone. Several epidemiological studies have demonstrated an increased risk of heart failure in patients with diabetes; moreover, poor glycemic control accounts for the increased risk of heart failure. At present, several oral (metformin, sulfonylureas, thiazolidinediones, dipeptidyl peptidase-4 inhibitors, etc.) as well as injectable (insulins, glucagon-like peptide 1 receptor agonists) antidiabetic agents are available. However, optimal treatment strategy to achieve adequate glycemic control in patients with type 2 diabetes mellitus (T2DM) and heart failure has not been well studied. In the view of rising prevalence of heart failure in patients with diabetes mellitus, clinicians need to understand the potential implications of antidiabetic agents in patients with heart failure. A group of experts from across India were involved in a consensus meeting in Pondicherry during the National Insulin Summit in November 2015. They evaluated agents currently available for the treatment of diabetes looking at existing scientific evidence relevant to each class of therapy. In addition, the existing guidelines and prescribing literature available with all these agents were also reviewed. Findings from the expert evaluations were then factored into the national context incorporating personal experience and common clinical practices in India. The purpose of this consensus document is to assist the clinicians while treating patients with T2DM and heart failure.
  1 1,952 513
Thyroid vigilance
Sanjay Kalra, Deepak Khandelwal, Sameer Aggarwal
July-August 2017, 21(4):492-494
DOI:10.4103/ijem.IJEM_104_17  PMID:28670527
  - 1,262 295
Challenges facing optimum care of diabetic children in Iraq
Mahmood Dhahir Al-Mendalawi
July-August 2017, 21(4):642-643
DOI:10.4103/ijem.IJEM_122_17  PMID:28670558
  - 463 119
Metabolic karma in diabetes care: Medico-philosophical reflections
Sanjay Kalra, Pallavi Kawatra
July-August 2017, 21(4):643-644
DOI:10.4103/ijem.IJEM_120_17  PMID:28670559
  - 702 186
“Syndrome of inappropriate antidiuretic hormone secretion” as a diagnostic and a prognostic indicator in olfactory neuroblastoma
K Devaraja, Kapil Sikka, Rajeev Kumar, Prem Sagar
July-August 2017, 21(4):644-645
DOI:10.4103/ijem.IJEM_94_17  PMID:28670560
  - 651 148
Cardiovascular safety of oral antidiabetic medications: Need of the hour
Prashant Ulhas Kaduskar
July-August 2017, 21(4):634-635
DOI:10.4103/ijem.IJEM_47_17  PMID:28670551
  - 713 194
Vitamin D deficiency among healthy children: An undisputed and booming problem
Suresh Kumar Angurana, Vikas Mahajan
July-August 2017, 21(4):635-636
DOI:10.4103/ijem.IJEM_76_17  PMID:28670552
  - 710 153
Does testosterone replacement therapy promote an augmented risk of thrombotic events in thalassemia major male patients with hypogonadism?
Vincenzo De Sanctis, Shahina Daar, Ashraf T Soliman, Heba Elsedfy, Doaa Khater, Salvatore Di Maio
July-August 2017, 21(4):636-637
DOI:10.4103/ijem.IJEM_73_17  PMID:28670553
  - 870 197
Pandora's box: Neurological manifestations of hypoparathyroidism
Ambarish Bhattacharya, Kaushik Ghosh, Nilanjan Sengupta
July-August 2017, 21(4):638-639
DOI:10.4103/ijem.IJEM_44_17  PMID:28670554
  - 577 177
On the therapy for polycystic ovary syndrome
Vittorio Unfer, Giovanni Monastra
July-August 2017, 21(4):639-640
DOI:10.4103/ijem.IJEM_409_17  PMID:28670555
  - 816 206
Effect of antithyroid therapies on bone and body composition: A prospective, randomized, clinical study comparing antithyroid drugs with radioiodine therapy
Shekhar Kansara, Narendra Kotwal, K. V. S. Hari Kumar, Yashpal Singh, Vimal Upreti, Amit Nachankar
July-August 2017, 21(4):531-534
DOI:10.4103/ijem.IJEM_103_17  PMID:28670535
Background: Thyrotoxicosis is associated with loss of body weight and bone mineral content (BMC). Antithyroid drugs (ATD) and radioiodine therapy (RIT) are the common options for the management of thyrotoxicosis. We evaluated the effect of ATD and RIT on BMC and body composition. Materials and Methods: In this prospective study, we randomized 60 patients of thyrotoxicosis (20–50 years, treatment naïve, males) to receive either ATD (Group 1) using carbimazole or RIT (Group 2). We excluded patients with significant ophthalmopathy and thyroid malignancy. The patients were followed serially for 1 year. Body composition was analyzed using the bioimpedance method and BMC by dual-energy X-ray absorptiometry technique. The data were analyzed using appropriate statistical measures. Results: The patients had a mean age of 33 ± 4.2 years and mean symptoms duration of 8.2 ± 2.7 months before the diagnosis. A total of 51 patients had Graves' disease, and the remaining 9 had toxic multinodular goiter. BMC at lumbar spine and femoral neck improved with both the therapies similarly at the end of 1 year. The body weight, protein, and fat content also increased after 1 year of observation similar between the two groups. None of the observed parameters showed a difference with regard to the mode of ATD. Conclusion: ATD and RIT have comparable effects on the bone and body composition in the management of thyrotoxicosis. Further long-term studies are needed to confirm the observed findings.
  - 1,026 253