Publications by authors named "Jyotsna"

137 Publications

Etiology and Clinical Profile of Patients with Tall Stature: A Single-Center Experience.

Indian J Endocrinol Metab 2020 Sep-Oct;24(5):428-433. Epub 2020 Nov 9.

Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India.

Background: There is no published literature on the profile of patients with tall stature (TS) from India. This study aimed to evaluate the etiological and clinical profile of patients with TS referred to our hospital.

Materials And Methods: We performed a retrospective review of records of patients referred to us for evaluation of TS (January 2007 to March 2020). Relevant clinical, anthropometric, biochemical, and radiological data at presentation were recorded, and the final diagnosis reviewed.

Results: The study included 16 subjects (6 boys, 10 girls) with a mean age at presentation of 13.2 ± 3.6 years. Most subjects were pubertal ( = 10) and belonged to the overweight or obese category ( = 10). The mean height and height standard deviation score (SDS) were 172.3 ± 20.3 cm and 3.6 ± 1.5, respectively, while mean mid-parental height (MPH) and MPH SDS were 168.8 ± 8.8 cm and 1.2 ± 0.9, respectively. The etiological diagnoses were familial TS ( = 9), acrogigantism ( = 3), obesity-related TS ( = 2), constitutional advancement of growth ( = 1), and Marfan syndrome ( = 1). The mean height SDS in subjects with acrogigantism was 6.4 ± 1.2 compared to 3.0 ± 0.6 in those with other etiologies of TS. Only one girl with familial TS and significantly increased predicted adult height (+4.56 SDS) opted for sex steroid therapy.

Conclusion: Familial TS is the most common diagnosis among patients referred for evaluation to our hospital. One should consider the possibility of acrogigantism in patients with growth acceleration, extreme TS, and markedly increased gap between height SDS and MPH SDS. Most patients with familial TS require reassurance and sex steroid therapy should be reserved for highly selected cases.
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http://dx.doi.org/10.4103/ijem.IJEM_360_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7810048PMC
November 2020

Diabetes mellitus in pheochromocytoma and paraganglioma: Prevalence, dynamics of insulin secretion / sensitivity and predictors of remission.

Diabetes Metab Syndr 2020 Nov-Dec;14(6):2169-2175. Epub 2020 Nov 5.

Department of Endocrinology and Metabolism, All India Institute of Medical Sciences(AIIMS), New Delhi, India.

Background And Aims: Pheochromocytoma and paraganglioma (PPGL) are associated with dysglycemia and diabetes mellitus (DM) much of which improves post operatively. In this study, we set out to ascertain pre and post-operative prevalence of DM in patients with PPGL based on oral glucose tolerance test (OGTT) and HbA1c and to evaluate effect of insulin secretion and sensitivity indices on DM pre-operatively.

Methods: Clinical and anthropometric data collection, HbA1c, 75 g OGTT with serum insulin estimation were done pre-operatively (n = 34) and at follow-up after successful surgery (n = 24) in patients with PPGL.

Results: Pre and post-operative prevalence of DM were 48%(18/37) and 17% (4/24) respectively. Comparison of patients with highest (Q4) and lowest (Q1) quartiles of insulinogenic index (IGI),a parameter of insulin secretion, revealed trends towards higher prevalence of DM in patients with lower IGI (Q4 to Q1: 29% versus 71%,n = 28, p = 0.24)but no association was observed with HOMA-IR (Q4 to Q1:50% versus 57%, n = 28, p = 1.00), an insulin sensitivity index. DM remitted in 77% patients post-operatively, predicted by duration of DM of<3 years.

Conclusion: There is high prevalence of DM in PPGL, with marked remission post-operatively, especially predicted by shorter duration of DM. Impaired insulin secretion is more strongly associated with pre-operative DM than increased insulin resistance.
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http://dx.doi.org/10.1016/j.dsx.2020.10.030DOI Listing
November 2020

Effectiveness of Yoga-based Exercise Program Compared to Usual Care, in Improving HbA1c in Individuals with Type 2 Diabetes: A Randomized Control Trial.

Int J Yoga 2020 Sep-Dec;13(3):233-238. Epub 2020 Sep 13.

Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India.

Background: This study was designed to evaluate the effectiveness of a yoga-based exercise program (YBEP) in improving glycemic control in people with type 2 diabetes mellitus.

Materials And Methods: Patients on stable oral glucose-lowering agents for at least 3 months and HbA1c 7.5%-10% were randomized in 1:1 ratio. The primary outcome measure was the difference of change in mean HbA1c between groups.

Results: The participants ( = 81) had mean (±standard deviation) age of 50.6 (±8.5) years and HbA1c of 8.5 ± 0.7% (68.97 ± 7.42 mmol/mol). The follow-up data were available in 96% (78/81) of participants. Of 40 participants, 25 (62.5%) attended ≥75% (≥10 out of 13) of the sessions in YBEP. On the intention to treat analysis, a favorable reduction (0.21% 95% confidence interval [-0.34, 0.75], = 0.454) in HbA1c was seen in YBEP group as compared to usual care. The reduction in HbA1c by ≥0.5% was observed in 44.7% of participants in YBEP as compared to 37.5% in usual care arm, respectively. Those who attended ≥75% of the sessions had better HbA1c reduction of 0.3% in comparison to 0.1% reduction seen in those who attended <75% of the sessions.

Conclusions: YBEP demonstrated a clinically relevant HbA1c reduction compared to usual care in participants who had attended at least 75% of the yoga sessions. The reduction in HbA1c by >0.5% in 44.7% in the yoga group, suggests, that it can be prescribed as an exercise to individuals who are unable to walk either due to limited joint mobility, adverse weather conditions, lack of space for walking, cultural or religious prohibitions for women for outdoor physical activity, and so on.CTRI registration no: CTRI/2017/05/008564.
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http://dx.doi.org/10.4103/ijoy.IJOY_33_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7735507PMC
September 2020

Teaching NeuroImages: An Imaging Clue in a Boy With Developmental Delay.

Neurology 2021 04 4;96(14):e1925-e1926. Epub 2020 Dec 4.

From the Department of Pediatric Neurology, Amrita Institute of Medical Sciences, Cochin, Kerala, India.

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http://dx.doi.org/10.1212/WNL.0000000000011286DOI Listing
April 2021

Evaluation of eating disorders and their association with glycemic control and metabolic parameters in adult patients with type 2 diabetes mellitus.

Diabetes Metab Syndr 2020 Nov-Dec;14(6):1555-1561. Epub 2020 Aug 10.

Department of Endocrinology and Metabolism, AIIMS, New Delhi, India. Electronic address:

Background: There is little data on the prevalence and effects of eating disorders in patients with T2DM.

Aims: To evaluate the presence of eating disorders (ED) and their association with glycemic control and metabolic parameters in adult patients with type 2 diabetes mellitus (T2DM).

Methods: A cross-sectional study was conducted in the endocrinology outpatient unit of our tertiary care centre between January 2017 to December 2018. Eating Attitudes Test (EAT-26) and Binge Eating Scale (BES) questionnaires were used to screen for ED in adults with T2DM (group 1) and controls without T2DM (group 2). Cut off scores ≥18 on BES was considered as a positive screen for Binge eating disorder in participants with and without T2DM. A score of ≥30 on EAT-26 was defined as abnormal for participants with T2DM and ≥20 for those without T2DM. Formal psychiatric assessment was done to diagnose ED in those who screened positive on the basis of scores on BES or EAT-26 or both. Demographic, anthropometric and relevant medical details like duration of treatment, glycemic control, complications were recorded.

Results: A total of 512 individuals (256 in each group) participated in this study. Out of these, 10.9% of individuals with T2DM and 14.1% of those without T2DM screened positive for ED, with no significant difference in the two groups. After a detailed psychiatric assessment, two patients (0.8%) in each group were confirmed to have ED. Participants with T2DM who were on thiazolidinediones had higher odds (2.2) of screening positive for an ED.(p = 0.03).

Conclusions: Our study reveals that eating disorders are not very common in our clinical population of T2DM, and the prevalence is comparable to BMI matched individuals without T2DM. The prevalence rates of eating disorders are lower (in both controls and patients with T2DM) than those reported from developed western countries.
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http://dx.doi.org/10.1016/j.dsx.2020.07.048DOI Listing
August 2020

Impact of parental origin of X-chromosome on clinical and biochemical profile in Turner syndrome.

J Pediatr Endocrinol Metab 2020 Sep;33(9):1155-1163

Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India.

Objectives To evaluate if the parental origin of X-chromosome has an impact on the phenotype and biochemical profile in Turner syndrome (TS). Result of the previous studies have been equivocal and could be attributable to the multicentric study design with different experts examining heterogeneous TS population of various ethnic background. Methods A cross-sectional single center study from Northern India. Fifty nine diagnosed subjects of TS and their parents participated in the study. Parental origin of intact X-chromosome was determined using 12 highly polymorphic short tandem repeats (STR) on X-chromosome. For the evaluation of parent-of-origin effects, typical phenotypic traits including congenital malformations, anthropometry, body composition by dual energy X-ray absorptiometry (DXA) and biochemical profile were compared. Clinical stigmata of TS in all subjects were examined by a single expert. Results The intact X-chromosome was of maternal origin (Xm) in 49.1% subjects while 50.9% had paternal origin (Xp). Skeletal anomalies were more common in Xm group, out of which prevalence of short neck and short fourth metatarsal reached statistical significance (p=0.04 and 0.01 respectively). A strong correlation was observed between subject's baseline height standard deviation score (Ht SDS) and paternal height (r=0.593, p<0.001), maternal height (r=0.564, p<0.001) and mid-parental height (MPH) (r=0.372, p=0.047) in Xp group. This effect was not seen in Xm subjects whose baseline Ht SDS showed no significant correlation with maternal height, paternal height or MPH. No differences were detected between the groups with regard to biochemical profile or body composition. Conclusions We speculate that the differences in skeletal anomalies and height correlations between Xm and Xp groups could be due to the modifying effect of epigenetic signature on short stature homeobox (SHOX) gene of Xm. SHOX gene is not modified on Xp thereby explaining the paucity of skeletal changes and height correlations in Xp subjects.
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http://dx.doi.org/10.1515/jpem-2020-0104DOI Listing
September 2020

Improvement in Angiotensin 1-7 precedes and correlates with improvement in Arterial stiffness and endothelial function following Renin-Angiotensin system inhibition in type 2 diabetes with newly diagnosed hypertension.

Diabetes Metab Syndr 2020 Sep - Oct;14(5):1253-1263. Epub 2020 Jun 23.

Autonomic & Vascular Function Lab, Department of Physiology, All India Institute of Medical Sciences, New Delhi, India. Electronic address:

Background And Aim: Studies in cell cultures and animal models have revealed the possible pathophysiological factors associated with vascular endothelial dysfunction. However, the same in human subjects has not been clearly established. The current study uses a novel approach to identify the factors associated with endothelial function and arterial function by altering these vascular parameters using Angiotensin-Converting-Enzyme (ACE) inhibition.

Methods: Diabetic patients with newly diagnosed hypertension (n = 60) were recruited for the study. Flow-mediated-dilation (FMD), carotid-femoral (cf), carotid-radial (cr) Pulse-wave-velocity (PWV), Augmentation-Index, Carotid-Intima-Media-Thickness (CIMT), serum levels of Renin, Angiotensin II (AngII), Angiotensin-Converting-Enzyme2 (ACE2), Angiotensin1-7 (Ang1-7), E-selectin, Vascular-Cell-Adhesion-Molecule-1 (VCAM-1), Highly-sensitive-C-Reactive-Protein (hsCRP) and Interleukin-10 were measured at baseline (V1), after 1 week (V2) and 3 months (V3) of ACE inhibition in patients of diabetes with newly diagnosed hypertension. The amplitude of change after 1 week (V-V) and 3 months (V-V) for the clinical and various parameters were correlated with the change in endothelial function and arterial stiffness.

Results: Carotid radial-PWV (p = 0.001) and Ang1-7 (p = 0.01) emerged as independent predictors of FMD. Renin and VCAM-1 independently predicted E-selectin [(p = 0.01) and (p = 0.001), respectively]. ACE 2 was the only independent predictor of cf-PWV. The same parameters remained as independent predictors of the respective vascular factors after 3 months of ACE inhibition.

Conclusion: The study highlights the role of AngII/Ang1-7 balance in alteration of endothelial function and central arterial stiffness in humans in addition to identifying the interrelationship between the renin-angiotensin-aldosterone-system components and clinically ascertainable parameters.
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http://dx.doi.org/10.1016/j.dsx.2020.06.043DOI Listing
June 2020

Prevalence of scrub typhus in a tertiary care centre in Telangana, south India.

Iran J Microbiol 2020 Jun;12(3):204-208

Department of Microbiology, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad, Telangana, India.

Background And Objectives: Scrub typhus is re-emerging as an important cause of acute undifferentiated fever in the last decade from various parts of India. Complexity in performing the "gold standard" immunofluorescent assay and the unreliable nature of Weil Felix test often results in delayed or misdiagnosis in a majority of cases. The present study seeks to integrate the results of rapid diagnostic tests, clinical and laboratory features to aid the diagnosis and management of scrub typhus patients.

Materials And Methods: A total of 645 serum samples with suspected scrub typhus sent to the Department of Microbiology were included in the study. Scrub typhus was tested by rapid immunochromatographic test (SD Diagnostics) and IgM ELISA (Inbios International, USA). Clinical features, laboratory parameters and final outcome were analysed from the clinical records of positive patients.

Results: Scrub typhus was diagnosed in 13.7% of patients and majority of them were observed in the month of August. 58.6% of scrub typhus patients presented with fever of one to two weeks duration. Eschar was documented in 13.7% of patients and 24% of patients gave a history of working outdoors or exposure to vegetation. All the patients responded to Doxycycline treatment and there was no mortality.

Conclusion: High index of suspicion for scrub typhus is necessary in febrile patients not responding to conventional antibiotics especially during outbreak situations. Rapid immunochromatographic tests with excellent specificity and acceptable sensitivity can be used as potential point of care tests for quick diagnosis of scrub typhus especially in delayed presentation.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7340608PMC
June 2020

Intensive Speech Therapy Programme Combined with a Speech Bulb Prosthesis in the Prosthodontic Rehabilitation of Velopharyngeal Dysfunction.

Cureus 2020 Feb 11;12(2):e6951. Epub 2020 Feb 11.

Prosthodontics and Crown & Bridge, Buddha Institute of Dental Sciences and Hospital, Patna, IND.

Velopharyngeal insufficiency resulting from a defect in the soft palate, acquired or congenital, causes incomplete closure of the palatopharyngeal sphincter. An individual with such a defect suffers from multiple problems in eating, speaking, breathing, as well as psychological trauma, in society. This case report describes the rehabilitation of a patient with a congenital velopharyngeal defect using a definitive speech bulb obturator and an intensive speech therapy program. The patient underwent speech therapy for a period of three months. A speech and voice assessment was conducted before and after speech therapy. A speech intelligibility test was conducted, and nasalance was measured using a nasometer. Significant improvement in speech, mastication, and velopharyngeal function was achieved after bulb reduction and speech therapy.
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http://dx.doi.org/10.7759/cureus.6951DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7067348PMC
February 2020

Dynamic Testing for Evaluation of Adrenal and Gonadal Function in Pediatric and Adult Endocrinology: An Overview.

Indian J Endocrinol Metab 2019 Nov-Dec;23(6):593-601

Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India.

Dynamic tests are often considered as the backbone of endocrinology. These tests involve the use of an exogenous agent to manipulate the body's hormonal milieu for the diagnosis and characterization of an endocrine disorder. They are especially helpful in the evaluation of certain endocrine conditions, such as disorders of growth and pubertal maturation and disorders of sex development. A great deal of heterogeneity exists across clinicians with regard to the usage, methodology, and interpretation of these tests. This review outlines various dynamic tests used to evaluate adrenal and gonadal function in pediatric and adult endocrinology, along with their clinical application and interpretation.
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http://dx.doi.org/10.4103/ijem.IJEM_553_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6987775PMC
February 2020

Effectiveness of a Video-Based Lifestyle Education Program Compared to Usual Care in Improving HbA1c and Other Metabolic Parameters in Individuals with Type 2 Diabetes: An Open-Label Parallel Arm Randomized Control Trial (RCT).

Diabetes Ther 2020 Mar 31;11(3):667-679. Epub 2020 Jan 31.

Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India.

Introduction: This study was designed to investigate the effectiveness of a video-based lifestyle education program (VBLEP) in improving glycemic control in people with type 2 diabetes mellitus compared with usual care.

Methods: Patients on stable oral glucose-lowering agents for at least 3 months and HbA1c 7.5-10% were randomized in a 1:1 ratio. Primary outcome measure was the difference in change in mean HbA1c between groups.

Results: The participants (n = 81) had mean (± SD) age of 50.1 (± 9.4) years and HbA1c of 8.5 ± 0.7% (68.87 ± 7.56 mmol/mol). The follow-up data were available in 96% (78/81) of participants. Of 40 participants, 36 (90%) attended ≥ 75% (≥ 3 out of 4) of the sessions in the VBLEP. In the intention-to-treat analysis, a significant reduction [0.6% 95% CI (0.1, 1.1), p = 0.013] in HbA1c was seen in the VBLEP group compared with usual care. A ≥ 1% reduction in HbA1c was observed in 39.5% of participants in the VBLEP compared with 15% in the usual care arm. However, a ≥ 0.5% reduction in HbA1c was observed in 65.8% of participants in the VBLEP compared with 37.5% in the usual care arm (p = 0.012). There was a significant change in weight and body mass index in the VBLEP group compared with usual care. The participants who were employed, had a family history of diabetes, had no diabetes-related complications, and were in the VBLEP group had higher odds of having a favorable HbA1c reduction (≥ 0.5%, combined analysis both groups) from baseline.

Conclusion: The VBLEP demonstrated a significant and clinically relevant HbA1c reduction compared with usual care. A simple VBLEP, when delivered in an interactive manner, can aid in improving glycemic outcomes in the Indian population.

Trial Registration: CTRI/2017/05/008564.
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http://dx.doi.org/10.1007/s13300-020-00769-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7048880PMC
March 2020

Susceptibility of betanodavirus in a newly established vertebra-derived cell line from Mosquitofish (Gambusia affinis).

J Fish Dis 2020 Feb 16;43(2):263-273. Epub 2019 Dec 16.

Centre for Ocean Research, Col. Dr Jeppiaar Research Park, Sathyabama Institute of Science and Technology, Chennai, India.

In the present study, a new cell line from the vertebra of mosquitofish Gambusia affinis was successfully established and characterized. The cell line is named as bone Gambusia affinis (BGA) and subcultured for more than 55 passages in Leibovitz's/L15 medium supplemented with 15% FBS at 28°C. The cell line has a modal chromosome number of 48. Molecular characterization of the partial sequence of the coi gene confirmed the origin of the BGA cell line from mosquitofish. These cells exhibited epithelial morphology confirmed by the cytokeratin marker. The BGA cells showed mineralization of their extracellular matrix when stained with alizarin red and von Kossa stain. BGA cells were found to be susceptible to RGNNV and SJNNV strains of betanodavirus (NNV) showing cytopathic effect with multiple vacuolations in the cells. The RT-PCR confirmed the betanodavirus infections in BGA cells. The SEM micrograph showed the morphological changes observed in the cell during virus infection. The in vivo challenge experiment also showed the viral replicating efficiency in the Gambusia affinis with increasing viral titre. Thus, our present results show that the BGA cell line is a useful tool for isolating betanodavirus and could be used to investigate bone cell differentiation and extracellular matrix mineralization.
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http://dx.doi.org/10.1111/jfd.13127DOI Listing
February 2020

Comparison Between Automatic and Volitional Swallow in Healthy Individuals Using Tongue Array and Cervical Auscultation Modules.

Indian J Otolaryngol Head Neck Surg 2019 Dec 26;71(4):520-530. Epub 2019 Jun 26.

2Department of Speech Language Pathology, All India Institute of Speech and Hearing, Mysore, Karnataka India.

In healthy normal individuals, the act of swallowing can be performed volitionally or can occur spontaneously. Several attempts have been made to look into the possible differences that might exist between automatic swallow (AS) and volitional swallow (VS). The present study is an attempt to physiologically differentiate AS from that of VS, using combined modules of tongue array and cervical auscultation of Digital Swallowing Workstation. 15 males and 15 female participants in the age range of 18-25 participated in the present study. They performed an AS task and a VS task. These were analyzed for parameters of maximum amplitude, duration and pressure. The result of the study revealed higher values for all the parameters of VS, but a statistically significant difference only for the duration parameter of cervical auscultation. This finding leads to the impression that the duration of vocal fold closure plays a major role in airway protection. Similar interesting findings on effect of gender and nature and organization of AS and VS have been discussed.
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http://dx.doi.org/10.1007/s12070-019-01699-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6838267PMC
December 2019

Long-term Response to Recombinant Human Growth Hormone Therapy in Indian Children with Growth Hormone Deficiency.

Indian J Endocrinol Metab 2019 Jul-Aug;23(4):446-451

Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India.

Background: Growth hormone deficiency (GHD) remains the most common indication for use of recombinant human growth hormone (rhGH) therapy in clinical practice. However, there is a paucity of studies focusing on long-term response to rhGH therapy in the Indian context.

Aim: To determine the response to rhGH therapy and its predictors in children with GHD followed up at a tertiary care center in North India.

Materials And Methods: We performed a retrospective review of the records of children with GHD who received rhGH therapy for at least 1 year. The relevant anthropometric, biochemical and radiological data at baseline and follow-up were recorded.

Results: A total of 99 children (64 boys, 35 girls; 61 isolated GHD, 38 multiple pituitary hormone deficiency) were studied. The mean (±SD) age and height SDS at treatment initiation were 12.4 (±3.0) years and -4.0 (±1.1) respectively, while median (IQR) serum insulin-like growth factor 1 (IGF-1) and peak growth hormone level on clonidine stimulation were 73 (25-167) ng/ml and 1.1 (0.4-3.6) ng/ml respectively. The height velocity was highest during the first year of treatment (10.6 ± 3.0 cm/year), declining to 8.7 ± 2.7 and 7.9 ± 2.2 cm/year during second and third year, respectively. Over the subsequent years, there was further graded fall in height velocity, declining to 4.8 ± 3.6 cm/year ( = 2) during the seventh year. The height gain during first year was negatively correlated with age at initiation of treatment, baseline height SDS, baseline serum IGF-1 and peak serum GH level on GH stimulation test, while it showed a positive correlation with bone age delay at baseline. Only baseline height SDS was found to have a significant negative correlation with height gain during the second year.

Conclusions: This study provides data on long-term response to rhGH therapy and its predictors in Indian children with GHD.
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http://dx.doi.org/10.4103/ijem.IJEM_300_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6844160PMC
November 2019

Study on Health Problems Faced by Workers of Sericulture Industry: A Cross-Sectional Study in the North Coastal Andhra Pradesh.

Indian J Community Med 2019 Apr-Jun;44(2):173-174

Post Graduate, Department of Community Medicine, Maharajah's Institute of Medical Sciences, Vizianagaram, Andhra Pradesh, India.

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http://dx.doi.org/10.4103/ijcm.IJCM_300_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6625272PMC
July 2019

Imbalance between Angiotensin II - Angiotensin (1-7) system is associated with vascular endothelial dysfunction and inflammation in type 2 diabetes with newly diagnosed hypertension.

Diabetes Metab Syndr 2019 May - Jun;13(3):2061-2068. Epub 2019 Apr 23.

Autonomic & Vascular Function Lab, Department of Physiology, All India Institute of Medical Sciences, New Delhi, India.

Aim: Diabetes is associated with Renin-angiotensin-aldosterone-system (RAAS) activation. Protective role of Angiotensin (1-7) has been recently identified. The study aims to identify associations between imbalance in RAAS components with vascular endothelial dysfunction and inflammation in diabetics with newly diagnosed hypertension.

Methods: Brachial Flow-mediated-dilation (FMD), Carotid Intima-media-thickness (CIMT), pulse-wave-velocity (PWV), Serum E-selectin, Vascular-Cell-Adhesion-Molecule-1 (VCAM-1), high-sensitivity C-Reactive Protein (hsCRP), Interleukin-10 (IL-10), Renin, AngiotensinII, Angiotensin-Converting-Enzyme 2 (ACE2) and Angiotensin1-7 were measured in 60 diabetic patients with newly diagnosed hypertension. Patients with AngiotensinII/Angiotensin1-7 ratio <1 were classified as Favourable-Axis (FA) group (n = 22) and those with ratio >1 were classified as Unfavourable-Axis (UA) group (n = 38).

Results: hsCRP was higher [9.52 (4.64-16.19) vs 3.62 (1.77-13.09) (mg/l), p = 0.04], IL-10 was lower [2.26 (1.34-12.05) vs 10.98 (4.44-17.78) (pg/ml),p = 0.006], %FMD was lower [(5.51 ± 2.97) vs (7.66 ± 3.38) (%), p = 0.01] and CIMT was higher in UA compared to FA group [0.7 (0.55-0.79) vs 0.51 (0.49-0.65) (mm), p = 0.001]. Renin correlated positively with pressure, PWV, E-selectin and VCAM-1, opposing associations were obtained for Angiotensin1-7 and ACE2.

Conclusion: Imbalance between AngiotensinII - Angiotensin1-7 is associated with increased inflammation and vascular dysfunction in diabetics and can contribute to development of hypertension in these patients.
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http://dx.doi.org/10.1016/j.dsx.2019.04.042DOI Listing
December 2019

Pattern of Lipid Abnormalities Among South Asian Indians With Cushing's Syndrome and the Short Term Impact of Surgical Correction of Hypercortisolism.

Horm Metab Res 2019 May 9;51(5):309-314. Epub 2019 May 9.

Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India.

Atherosclerotic cardiovascular events are one of the common causes of mortality in patients with Cushing's syndrome (CS). Atherogenic dyslipidemia is more common among South Asian Indians as compared to other ethnicities and is likely to worsen among patients with CS. This retrospective study was done over 5 years at a single institute to evaluate the pattern of lipid abnormalities in subjects with CS and the changes in lipid parameters after surgical control of hypercortisolemia. The study was done in two parts. In the first part, records of patients with CS diagnosed over 3 years were retrospectively reviewed. Hormonal and metabolic parameters including fasting plasma glucose (FPG), post prandial plasma glucose (PPPG), HbA1c, serum lipids, serum cortisol and plasma ACTH were recorded. In the second part, lipid parameters were rechecked among patients who underwent surgery and a median follow up of 4±2 months after remission. Out of the 126 patients diagnosed with endogenous CS over 3 years, 100 patients were eligible for inclusion in the study. At baseline, sixty five (65%) patients had dyslipidemia as defined by the NCEP-ATPIII criteria. 47 out of 63 (74.6%) subjects achieved remission after surgical management of CS. 32 (68.1%) of these patients had dyslipidemia prior to surgery. After excluding 1 death, 26 of 46 (56.5%) subjects had dyslipidemia after the follow up period. Lipid abnormalities are common among South Asian Indian subjects with endogenous CS and the pattern persists in most of them, 3 months after surgical correction of hypercortisolism.
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http://dx.doi.org/10.1055/a-0879-5122DOI Listing
May 2019

Development and Validation of a Questionnaire Assessing Knowledge, Attitude, and Practices about Obesity among Obese Individuals.

Indian J Endocrinol Metab 2019 Jan-Feb;23(1):102-110

Department of Medicine, All India Institute of Medical Sciences, New Delhi, India.

Aim: The objective of this study was to develop and validate a knowledge, attitude, and practice (KAP) questionnaire about obesity among obese individuals.

Materials And Methods: The questionnaire was developed following a standardized protocol that consisted of literature review, focused group discussions, and expert opinion. A cross-sectional survey on 100 obese individuals was carried out to validate the tool. Exploratory factor analysis was performed, using principal component with varimax rotation, to establish the construct validity of the questionnaire. Internal consistency of the questionnaire was tested using Cronbach's α coefficient.

Results: KAP questionnaire with 42 items categorized under three domains knowledge, attitude, and practices was developed. The KAP sections have 14, 15, and 13 items, respectively. Independent Cronbach's α for KAP domains were 0.75, 0.75, and 0.63, respectively, indicating good internal consistency.

Conclusion: The developed questionnaire will be helpful in achieving better understanding of the patients' KAP about obesity. It has satisfactory validity and good internal consistency.
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http://dx.doi.org/10.4103/ijem.IJEM_487_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6446687PMC
April 2019

Role of fluoroethyl tyrosine positron emission tomography-computed tomography scan in differentiating ewing's sarcoma from osteomyelitis.

World J Nucl Med 2019 Jan-Mar;18(1):77-80

Department of Nuclear Medicine and PET Imaging, Institute of Nuclear Medicine and Allied Sciences, New Delhi, India.

Ewing's sarcoma is a kind of undifferentiated reticulocytic sarcoma, which was first reported in 1921 by James Ewing. It is difficult to differentiate Ewing's sarcoma from osteomyelitis on computed tomography (CT) and X-ray and hence cytological confirmation is needed. Fluorodeoxy glucose being a nonspecific tracer cannot differentiate between malignant and inflammatory lesions. However, it is found that Ewing's sarcoma has increased LAT1 transporter expression at the cell surface. This property has been utilized to specifically target the tumor cells and differentiate them from inflammatory lesions. F-fluoroethyl tyrosine (FET) is a radiotracer which shows increased uptake in tumors having LAT1 expression and no uptake in inflammatory lesions. Thus, FET positron emission tomography-computed tomography can serve as a useful tool in diagnosing recurrence or residual Ewing's sarcoma from infective pathology. Besides, it is also helpful in monitoring response to therapy.
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http://dx.doi.org/10.4103/wjnm.WJNM_23_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6357705PMC
February 2019

Bone Health in Patients with Cushing's Syndrome.

Indian J Endocrinol Metab 2018 Nov-Dec;22(6):766-769

Department of Endocrinology, AIIMS, New Delhi, India.

Introduction: Osteoporosis is a well-recognized complication of Cushing's syndrome (CS). Data on bone health in patients with CS from south Asian countries, which are vitamin D deficient, are scarce.

Aims: We assessed bone mineral density (BMD) in patients with CS in comparison to controls. We also looked into how BMD differs in different types of endogenous CS.

Materials And Methods: Thirty-seven cases of CS and 48 matched controls were studied for clinical, biochemical, hormonal, and bone densitometry parameters.

Results: BMD (both total lumbar spine (LS) and hip) as well as scores were significantly lower in CS patients as compared to controls. Neither LS nor hip BMD was significantly different among different etiological groups of CS. The difference in BMD was also not significant between eumenorrhoeic and oligo-/amenorrhoeic patients with CS.

Conclusion: Patients with CS are at increased risk of having fracture secondary to osteopenia and osteoporosis. There is no significant association of vitamin D and intact parathormone with low BMD in patients with CS.
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http://dx.doi.org/10.4103/ijem.IJEM_160_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6330848PMC
February 2019

Effect of Implementation of ADA/AACE Guidelines on the Management of Hospitalized Hyperglycemic Patients Through Training of Residents: A Tertiary Care Center Study.

Indian J Endocrinol Metab 2018 Sep-Oct;22(5):616-620

Department of Medicine, All India Institute of Medical Science, New Delhi, India.

Background: Hyperglycemia is a common comorbidity in hospitalized patients and may add to adverse outcomes. Various associations have issued guidelines for optimal management of hyperglycemia in ill patients. This study aims to assess the adherence to current guidelines in inpatient setting and the impact of educational interventions on the improvement in adherence to guidelines as well as its effect on the level of blood sugar control and patient outcomes.

Materials And Methods: It was a quasi-experimental pretest and posttest study and was done in three phases, viz., observation of current practices, intervention in the form of educational interventions, and its effect on change in practices and patient outcomes.

Results: There was statistically significant 22% increase in the use of recommended insulin regimens ( = 0.028). The proportion of blood sugars within recommended range in the first 48 h, mean daily blood sugars, and the incidence of severe hyperglycemia improved in phase 3 vs phase 1 and was statistically significant. On comparing the subgroups, viz., those who followed and those who did not follow the guidelines, the results of the proportion of blood sugar in recommended range and proportions of blood sugar of more than 250 were found to be statistically significant.

Conclusion: Dedicated educational interventions help in improving healthcare practices. According to current guidelines, rapid improvement in hyperglycemia and better glycemic control occur with adherence to protocol-based management of hyperglycemia.
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http://dx.doi.org/10.4103/ijem.IJEM_698_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6166556PMC
October 2018

Study of Pituitary Morphometry Using MRI in Indian Subjects.

Indian J Endocrinol Metab 2018 Sep-Oct;22(5):605-609

Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India.

Aim: To establish normative measurements of pituitary gland in Indian population.

Material And Methods: In this cross-sectional study, we measured dimensions of pituitary gland in 482 (213 females and 269 males) Indian subjects with apparently normal pituitary gland function. Mid-sagittal T1-weighted image (T1-WI) on magnetic resonance imaging (MRI) was used to measure height and length of pituitary gland. Pituitary gland width was measured using coronal T1-WI and pituitary gland volume was calculated.

Results: Mean height, length and calculated volume of pituitary gland was significantly higher in females compared to males ( = <0.001, = 0.03 and = <0.001, respectively) when all age groups were combined but pituitary gland width was not statistically different in male and female subjects. When subjects were divided into different age groups, except for 10-14 years age group where pituitary height was significantly higher in females as compared to male, no significant difference was observed between male and female in any of the parameters (height, length, width and volume). The mean pituitary gland height was 5.80 ± 1.32 mm and 5.37 ± 1.25 mm in female and male subjects, respectively. Females achieved peak pituitary gland height in 10 to 14-year age group, while males achieved their peak pituitary gland height in 15 to 19-year age group.

Conclusion: Our study provides age and sex wise normative data for pituitary measurements derived from Indian population.
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http://dx.doi.org/10.4103/ijem.IJEM_199_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6166545PMC
October 2018

Invasive fungal rhinosinusitis in patients with diabetes.

J Infect Dev Ctries 2018 09 30;12(9):787-793. Epub 2018 Sep 30.

All India Institute of Medical Sciences, New Delhi, India.

Introduction: We report the clinical and radiological features as well as outcomes of invasive fungal rhinosinusitis in patients with diabetes from a tertiary care center in North India.

Methodology: All patients admitted with a diagnosis of invasive fungal rhinosinusitis with pre-existing or newly diagnosed diabetes from 1st January 2008 to 31st December 2015 were included. Hospital records were used to identify clinical features, biochemical investigations and treatment modalities used. The imaging findings were reported at baseline, 30, 60,90 and 120 days of admission and progression of disease was reported as static, worse or improved. The outcomes were sight loss and survival at end of hospital stay.

Results: 22 patients of invasive fungal sinusitis and diabetes were identified. At presentation, 5 had ketoacidosis, all of whom died at the end of hospital stay. Loss of vision in one eye was seen in 70% cases. The survival at end of hospital stay was 72.7% and at six months after end of study period was 57.8%. No patients had radiological improvement at day 30 imaging (including those who subsequently improved).

Conclusion: Radiological improvement is not apparent before two months of therapy. Ketoacidosis is a predictor of mortality in invasive fungal sinusitis with diabetes.
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http://dx.doi.org/10.3855/jidc.9699DOI Listing
September 2018

Medulloblastoma with extensive nodularity: A rare variant with a favorable outcome.

Neurol India 2018 Sep-Oct;66(5):1517-1518

Department of Pathology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India.

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http://dx.doi.org/10.4103/0028-3886.241357DOI Listing
September 2019

Gorlin-Goltz Syndrome: A Rare Case Report.

Contemp Clin Dent 2018 Jul-Sep;9(3):478-483

Departments of Oral Medicine and Radiology, Vydehi Institute of Dental Sciences and Research Centre, Bengaluru, Karnataka, India.

Gorlin-Goltz syndrome (GGS) is an autosomal dominant disorder with a high degree of penetrance and variable expressivity. It is a rare phakomatosis characterized by multiple odontogenic keratocysts (OKCs), bifid ribs, and other abnormalities. The incidence of the GGS is estimated at 1 in 57,000-1 in 256,000 in the general population. The OKC is frequently the presenting manifestation of this syndrome. We report a case of a 25-year-old male patient, presenting with a swelling in the right side of the face which was diagnosed as GGS by correlating the clinical findings, histological findings, and evaluating the various tools of imaging. In the case of GGS, it is of great importance to make an early diagnosis since the severity of complications such as maxillofacial deformities related to the jaw cysts can be avoided.
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http://dx.doi.org/10.4103/ccd.ccd_96_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6104368PMC
September 2018

Procedural Results and Immediate Outcomes following De Novo Saphenous Venous Graft Interventions.

Int J Angiol 2018 Sep 26;27(3):144-150. Epub 2018 Mar 26.

Department of Cardiology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India.

 Distal embolization is the detrimental factor in SVG intervention. There is no specific treatment for it except prevention. Guidelines have endorsed the use of embolic protection devices; however, their use is not without complications, and increases the procedural time and cost for the patient. The objective of this study is to analyze the procedural results and immediate outcome in de novo SVG stenting.  A retrospective observational study of patients who have undergone SVG-percutaneous coronary intervention at our institute. Baseline clinical, demographic data, intervention details, and in-hospital events are analyzed. Statistical analysis was done using Mini tab version 17. Chi-square testing, odds ratio, and 95% confidence intervals were calculated.  The study population included 96 lesions in 80 patients. Average age of the graft was 8.2 ± 4 years. Embolic protection devices were used only in 10%. Angiographic and clinical success was seen in 92.5%. Distal embolization was seen in 7.5%. Drug-eluting stent and shorter stents were associated with lesser distal embolization. Stent length (> 20 mm) proved to be an independent predictor of distal embolization. There was no correlation between distal embolization and age of patient, sex, hypertension, diabetes, and smoking, left ventricular function, age of graft, direct stenting, use of embolic device, and glycoprotein 2b/3a inhibitors.  De novo SVG lesions can be stented with a high rate of angiographic and procedural success. Stent length is the only independent predictor of distal embolization. SVG interventions can be safely done in the absence of embolic protection devices irrespective of the graft age.
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http://dx.doi.org/10.1055/s-0038-1636937DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6103757PMC
September 2018

Emerging Rhizopus microsporus Infections in India.

J Clin Microbiol 2018 06 25;56(6). Epub 2018 May 25.

Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India

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http://dx.doi.org/10.1128/JCM.00433-18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5971529PMC
June 2018

Effectiveness of a Patient Education Module on Diabetic Foot Care in Outpatient Setting: An Open-label Randomized Controlled Study.

Indian J Endocrinol Metab 2018 Jan-Feb;22(1):74-78

Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India.

Background: A large number of patients with diabetes mellitus are unaware of foot care and are at risk of developing foot ulcer and amputation. This increases healthcare burden due to preventable complication of diabetes.

Aims: We conducted this study to assess the effectiveness of a foot care education module for diabetes developed by us.

Materials And Methods: One hundred and twenty-seven patients with diabetes mellitus attending our outpatient were randomized into intervention ( = 63) and control groups ( = 64). At first visit, 1 and 3 months later, both groups filled a questionnaire regarding foot care knowledge and practice. The intervention group was administered foot care education module and the control group received routine care at baseline and 1 month. Patient education module consisted of an audio-visual display and a pamphlet on diabetes foot care. Change in score at 3 months was assessed by Student's -test.

Results: Knowledge scores in the intervention group at first, second, and third visits were 9.8 ± 1.8, 10.2 ± 1.6, and 11.0 ± 1.7, respectively. The knowledge scores in the control group at first, second, and third visits were 9.9 ± 1.7, 9.8 ± 1.6, and 10.0 ± 1.8, respectively. The change in knowledge score was statistically significant ( < 0.001) at third visit compared to first in the intervention group but not in the control group ( = 0.62). Practice score also improved significantly ( < 0.001) in the intervention group in the second visit but not in the control group.

Conclusion: Audio-visual foot care patient education module in outpatient setting is an effective means to improve foot care knowledge and practice in patients with diabetes.
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http://dx.doi.org/10.4103/ijem.IJEM_148_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5838916PMC
March 2018

Radiation Dose to the Occupational Worker during the Synthesis of Re-labeled Radiopharmaceuticals in the Nuclear Medicine Department.

Indian J Nucl Med 2018 Jan-Mar;33(1):1-5

Department of Nuclear Medicine, Fortis Memorial Research Institute, Gurgaon, Haryana, India.

Aim: The aim of this study is to estimate whole-body radiation dose to the radiopharmacist involved in labeling of three different Re-labeled compounds, namely, Re-Lipiodol, Re-tin colloid, and Re-hydroxyl-ethylidene-diphosphonate (HEDP) and to compare the occupational burden with the dose limits recommended by Atomic Energy Regulatory Board, India.

Materials And Methods: The Department of Nuclear Medicine at Fortis Memorial Research Institute currently synthesizes three different Rhenium-188 labeled compounds, namely, Re-Lipiodol, Re-HEDP, and Re-tin colloid. To estimate the radiation exposure to the radiopharmacist involved in the synthesis, a survey meter was used to measure radiation level before the start of labeling procedure in the radiopharmacy by keeping it at the location where the radiopharmacist normally stands during preparation. Data were collected for 6 syntheses of each Re-Lipiodol, 4 for Re-HEDP, and 3 for Re-tin colloid followed by the quality control. The pocket dosimeter was used by the radiopharmacistat chest level, performing the labeling of Re-labeled compounds. All radiopharmaceuticals were synthesized by a single radiopharmacist.

Results: 1850 MBq (50 mCi) W-Re generator was eluted before the preparation of each radiopharmaceutical. The amount of ReO4 used for labeling with lipiodol/4-hexadecyl-1,2,9,9-tetramethyl-4,7-diaza-1,10-decanethiol, HEDP, and Tin colloid was in the range of 3182-4440 MBq (86-120 mCi), 2812-3774 MBq (76-102 mCi), and 962-1295 MBq (26-35 mCi), respectively. Meantime required to complete the synthesis was 95, 40, and 131.5 min, respectively. Mean whole-body effective dose received was 0.052, 0.009, and 0.004 mSv, respectively, as measured by using the pocket dosimeter.

Conclusion: From this small study, we observed that the whole-body radiation dose to the radiopharmacist in radiolabeling and quality control of Re-labeled radiopharmaceuticals is within prescribed limits at the current synthesis frequency.
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http://dx.doi.org/10.4103/ijnm.IJNM_133_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5798090PMC
February 2018

Serum Cortisol Level in Indian Patients with Severe Sepsis/Septic Shock.

J Emerg Trauma Shock 2017 Oct-Dec;10(4):194-198

Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India.

Background: The relationship between cortisol level and sepsis is not known in Indian patients of severe sepsis/septic shock.

Aims: The study was done to determine the optimal range of cortisol levels, defining the adrenocortical response, and predicting the mortality, if possible, in the above type of patients.

Settings And Designs: The study was a single-centered prospective cohort study, conducted in a tertiary referral center, North India.

Materials And Methods: Sixty patients with severe sepsis ( = 30) and septic shock ( = 30) were recruited. Basal and postcosyntropin (1 μg)-stimulated cortisol levels were measured, and all patients were closely monitored with daily assessments of clinical and laboratory variables. Western diagnostic criteria were followed for defining adrenal insufficiency (AI). The end point was the survival assessed at day 28 or death, whichever came earlier.

Results: The mean basal (T0) and poststimulation (T30) cortisol levels were 31.77 ± 15.9 μg/dL and 37.58 ± 17.31 μg/dL, respectively. In all sepsis patients, 48.33% qualified as AI at T0 ≤ 24 μg/dL, 61.67% at delta cortisol (Δ = T30-T0) ≤7 μg/dL, and 78.33% at Δ ≤9 μg/dL. Using receiver operating characteristic curve, the area under the curve (AUC) was 0.4954, signifying poor prediction to death.

Conclusions: Indians have completely different characteristics of cortisol levels in sepsis patients, in comparison to the Western data. They have higher range of basal cortisol levels, higher percentage of AI, and an inability to predict mortality with the cortisol levels. Hence, there is requirement of an international study to confirm the dichotomy of the results.
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http://dx.doi.org/10.4103/JETS.JETS_123_16DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5663138PMC
November 2017