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A letter to the editor is presented in response to the article "Type 1 diabetes and osteoporosis: Review of literature,."

The article examines developments on treatment of osteporosis in India. Topics discussed include two cases that represented a paradox of inappropriate omission and commission of osteoporosis treatment, osteporosis as a neglected public health problem in India, a comparison of the prevalence of diabetes and osteoporosis in India and the cost of annual therapy and risk factors for osteoporosis.

Introduction: Hypothyroidism is one of the most prevalent endocrine diseases. Though the treatment of hypothyroidism is straightforward, data from several studies show that only around 60% of patients on thyroxine replacement have normal thyroid stimulating hormone (TSH) levels. We, therefore, undertook an audit of hypothyroid patients attending a tertiary care center. Objectives: To determine the prevalence of various etiologies causing hypothyroidism. To ascertain the dose of thyroxine required to attain euthyroid status and its determinants. Materials and Methods: A retrospective audit of hypothyroid patients attending the thyroid clinic in Bai Yamunabai Laxman Nair Charitable Hospital, Mumbai (excluding patients with follow up of less than 3 months, pregnancy, thyroid carcinoma, known gastrointestinal (GI) disorders, and medical illness) has been undertaken. Hospital records and clinical evaluation are being used to collect data on various parameters like etiology, frequency of TSH monitoring, recent value of TSH, current weight, and dose of thyroxine. Results: Eighty-one (73 females) patient's interviews have been conducted in this ongoing study. Of these patients 69% have autoimmune hypothyroidism (AH), 17.28% have post operative hypothyroidism (POH), 8.64% have post radioactive iodine hypothyroidism (PRH) and 4.93% have congenital hypothyroidism (CH). Euthyroidism and iatrogenic hyperthyroidism were observed in 61.7% and 9.8% cases, respectively. Average dose requirement of thyroxine is 1.53 ±0.35 μg/kg in AH, 1.5 ± 0.41 μg/kg in POH, and 1.5 ± 1.34 μg/kg in PRH. Euthyroid status is better attained in POH (71.42%) as compared to AH (62.5%) and PRH group (57.14%). Conclusion: Autoimmune Hypothyroidism is the commonest etiology of hypothyroidism. Euthyroid status was achieved in 61.7% of overall patients. Adherence to therapy and attainment of euthyroid status is best in POH. Dose requirement is similar across all major etiologies of hypothyroidism. Periodic monitoring is essential to maintain and improve standard of patient care especially of chronic illnesses. [ABSTRACT FROM AUTHOR]

Introduction: Vitamin D (VitD) deficiency is highly prevalent in India. VitD deficiency during pregnancy causes impaired insulin release and insulin resistance due to VitD receptors in the pancreatic beta cells and peripheral tissues. Association of VitD deficiency and Gestational diabetes mellitus (GDM) is controversial. Objectives: To determine the prevalence of GDM in the ante-natal clinic of a tertiary care center. To correlate VitD deficiency in the first half of pregnancy with the development of GDM. Materials and Methods: Consecutive subjects registering at the antenatal clinic were recruited for this study (excluding those with known diabetes mellitus and on diabetogenic medications). They underwent VitD estimation, homeostasis model of assessment-insulin resistance (HOMA-IR) measurement in first half and 75 gm oral glucose tolerance test (OGTT) at 26-28 weeks of pregnancy. GDM and gestational glucose intolerance (GGI) were defined as per Diabetes In Pregnancy Study group India (DIPSI) criteria. Thirty-eight women with GDM and GGI and thirty- eight age and parity matched controls were selected for subgroup analysis. VitD deficiency and insufficiency were defined as VitD < 20 ng/ml and 20-30 ng/ml, respectively. Results: The prevalence of GDM and GGI was 7.27% and 27.27%, respectively. Ninety-two percent had deficient and 5% had insufficient VitD levels. The mean serum 25-hydroxy vitamin D (25(OH) D) levels in the GDM/GGI and non GDM group were 10.7 ± 7.5 ng/ml and 8.6 ± 6.4 ng/ml, respectively. There was a strong negative correlation between VitD values and HOMA-IR with P = 0.055. No correlation between VitD levels and fasting and 2 hours OGTT blood glucose values was found. Conclusions: VitD deficiency is highly prevalent in pregnant women. There is a strong negative correlation between VitD values and HOMA IR, which did not translate in the development of GDM/GGI. No significant difference was found between VitD levels of the GDM/GGI and non GDM group. [ABSTRACT FROM AUTHOR]

Polycystic ovary syndrome (PCOS) is often the first manifestation, in adolescents and young adults, of metabolic problems that may occur later. Early identification, timely referral and appropriate treatment can result in improved reproductive, metabolic and comprehensive health. However, unlike other components of metabolic syndrome, which can be diagnosed at primary care level, there is no inexpensive, clinical tool to screen for PCOS. We share a simple six-item questionnaire, structured in three domains, which can be used as a screening tool for the syndrome. This allows early diagnosis and management of the condition, facilitates a life course approach to health promotion, and lays the foundation for the prevention of other comorbid metabolic disorders. It also helps integrate national programmes concerning non-communicable disease and women's healthcare under one umbrella, thus optimizing and strengthening delivery of community care. [ABSTRACT FROM AUTHOR]

The past three decades have seen a quadruple rise in the number of people affected by diabetes mellitus worldwide, with the disease being the ninth major cause of mortality. Type 2 diabetes mellitus (T2DM) often remains undiagnosed for several years due to its asymptomatic nature during the initial stages. In India, 70% of diagnosed diabetes cases remain uncontrolled. Current guidelines endorse the initiation of insulin early in the course of the disease, specifically in patients with HbA1c > 10%, as the use of oral agents alone is unlikely to achieve glycemic targets. Early insulin initiation and optimization of glycemic control using insulin titration algorithms and patient empowerment can facilitate the effective management of uncontrolled diabetes. Early glucose control has sustained benefits in people with diabetes. However, insulin initiation, dose adjustment, and the need to repeatedly assess blood glucose levels are often perplexing for both physicians and patients, and there are misconceptions and concerns regarding its use. Hence, an early transition to insulin and ideal intensification of treatment may aid in delaying the onset of diabetes complications. This opinion statement was formulated by an expert panel on the basis of existing guidelines, clinical experience, and economic and cultural contexts. The statement stresses the timely and appropriate use of basal insulin in T2DM. It focuses on the seven vital Ts—treatment initiation, timing of administration, transportation and storage, technique of administration, targets for titration, tablets, and tools for monitoring. Funding: Sanofi. [ABSTRACT FROM AUTHOR]

Competing Interests: Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article.

Multiple observation studies and meta-analysis have linked growth hormone (GH) deficiency with metabolic-dysfunction-associated steatotic liver disease (MASLD). No meta-analysis has analysed the efficacy and safety of GH therapy on different aspects of MASLD. We undertook this meta-analysis to address this gap in knowledge. Electronic databases were searched for RCTs involving patients with MASLD receiving GH therapy. Primary outcome was to evaluate changes in radiologic measures of MASLD (magnetic resonance spectroscopy (MRS) and ultrasonography) and liver enzymes. Secondary outcomes were to evaluate alterations in body composition parameters [dual-energy X-ray absorptiometry (DXA)], lipids, glycaemia and side effects. From initially searched 1047 articles, data from three RCTs (120 patients) which fulfilled all criteria were analysed. After 6 months of GH therapy in MASLD, the per cent reduction in intrahepatic lipid (MRS) was significantly higher with GH as compared to placebo [MD -5.85% (95%CI:-11.41- -0.30); P = 0.04; I 2 = 63%]. Visceral adipose tissue (VAT) area reduction (DXA) was significantly higher with GH [MD-9.94 cm 2 (95%CI:-19.04- -0.84); P = 0.03; I 2 = 0%]. Serum insulin-like growth factor-1 (IGF-1) was significantly raised in MASLD patients receiving GH as compared to placebo [MD +166.86 ng/ml (95%CI: 79.19-254.53); P < 0.0.001; I 2 = 90%]. High-sensitivity C-reactive protein (hsCRP) was significantly lower in patients receiving GH [MD -0.89 mg/L (95%CI:-1.40--0.38); P = 0.0.0006; I 2 = 0%]. Patients receiving GH had similar changes in triglycerides [MD-1.06 mg/L (95%CI:-20.45-18.34); P = 0.91; I 2 = 15%] and fasting glucose [MD -0.56 mg/L (95%CI:-4.67-3.55); P = 0.79; I 2 = 39%]. Gamma-glutamyl transpeptidase was significantly lower in patients receiving GH [MD -7.86 U/L (95%CI:-12.46--3.27); P = 0.0008; I 2 = 0%]. No increase in new-onset hypothyroidism was noted [OR 5.49 (95%CI: 0.25-121.18); P = 0.28]. Short-term 6-month GH therapy in MASLD is associated with a significant reduction in intrahepatic lipid content, visceral adiposity, GGT and hsCRP without any increased occurrence of dysglycaemia or hypothyroidism., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Indian Journal of Endocrinology and Metabolism.)

Background: Resmetirom, a liver-directed, thyroid hormone receptor beta-selective agonist, has recently been approved to treat nonalcoholic steatohepatitis (NASH). This meta-analysis aimed to summarize the efficiency and safety of resmetirom in treating NASH., Methods: Electronic databases were searched for randomized controlled trials (RCTs) of resmetirom vs placebo in patients with NASH. The primary outcomes were the changes from baseline in hepatic fat content, liver histology, including NASH resolution, and noninvasive markers of hepatic fibrosis., Results: Three randomized controlled trials (n = 2231) met the inclusion criteria. Compared to placebo, resmetirom achieved greater reductions from baseline in hepatic fat content assessed by magnetic resonance imaging proton density fat fraction (for resmetirom 80 mg: MD -27.76% [95%CI: -32.84, -22.69]; for resmetirom 100 mg: MD -36.01% [95%CI: -41.54, -30.48]; P < .00001 for both) and FibroScan controlled attenuation parameter (for resmetirom 80 mg: MD -21.45 dBm [95%CI: -29.37, -13.52]; for resmetirom 100 mg: MD -25.51 dBm [95%CI: -33.53, -17.49]; P < .00001 for both). Resmetirom 80 mg outperformed placebo in NASH resolution and ≥2-point nonalcoholic fatty liver disease activity score reduction. Moreover, resmetirom 80 mg and 100 mg were superior to placebo in cytokeratin-18 (M30) reduction. Greater reductions in liver enzymes, lipids, and reverse triiodothyronine were observed in the resmetirom arms with no impact on triiodothyronine. Nausea and diarrhea were more common with resmetirom than with placebo; other adverse events were comparable., Conclusion: Resmetirom improves hepatic fat content, liver enzymes, and fibrosis biomarkers in NASH patients. Resmetirom generally does not affect thyroid function and is well-tolerated., Competing Interests: Disclosure The authors assert the absence of any identifiable financial conflicts or personal relationships that could be perceived as impacting the integrity of the findings reported in this manuscript., (Copyright © 2024 AACE. Published by Elsevier Inc. All rights reserved.)

Competing Interests: Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article.

Background: A significant number of patients face the issue of weight gain (WG) or inadequate weight loss (IWL) post-bariatric surgery for obesity. Several studies have been published evaluating the role of glucagon-like peptide-1 receptor agonists (GLP1RA) for weight loss post-bariatric surgery. However, no systematic review and meta-analysis (SRM) till date has evaluated the efficacy, safety and tolerability of GLP1RA in this clinical scenario. Hence, this SRM aimed to address this knowledge gap., Methods: Databases were searched for randomized controlled trials (RCTs), case-control, cohort and observational studies involving use of GLP1RA in the intervention arm post-bariatric surgery. Primary outcome was weight loss post at least 3 months of therapy. Secondary outcomes were evaluation of body composition parameters, total adverse events (TAEs) and severe adverse events (SAEs)., Results: From initially screened 1759 articles, 8 studies (557 individuals) were analysed. Compared to placebo, patients receiving liraglutide had significantly greater weight loss after 6-month therapy [MD - 6.0 kg (95% CI, - 8.66 to - 3.33); P < 0.001; I 2  = 79%]. Compared to liraglutide, semaglutide had significantly greater percent reduction in body weight after 6-month [MD - 2.57% (95% CI, - 3.91 to - 1.23); P < 0.001; I 2  = 0%] and 12-month [MD - 4.15% (95% CI, - 6.96 to - 1.34); P = 0.004] therapy. In study by Murvelashvili et al. (2023), after 12-month therapy, semaglutide had significantly higher rates of achieving > 15% [OR 2.15 (95% CI, 1.07-4.33); P = 0.03; n = 207] and > 10% [OR 2.10 (95% CI, 1.19-3.71); P = 0.01; n = 207] weight loss. A significant decrease in fat mass [MD - 4.78 kg (95% CI, - 7.11 to - 2.45); P < 0.001], lean mass [MD - 3.01 kg (95% CI, - 4.80 to - 1.22); P = 0.001] and whole-body bone mineral density [MD - 0.02 kg/m 2 (95% CI, - 0.04 to - 0.00); P = 0.03] was noted with liraglutide., Conclusion: Current data is encouraging regarding use of GLP1RAs for managing WG or IWL post-bariatric surgery. Deterioration of bone health and muscle mass remains a concern needing further evaluation., Trial Registration: The predefined protocol has been registered in PROSPERO having registration number of CRD42023473991., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Vildagliptin, a dipeptidyl peptidase-4 (DPP-4) inhibitor is effective in reducing HbA1c levels in patients with type 2 diabetes (T2DM) when administered as monotherapy, dual or triple combination therapy. In India, Vildagliptin is commonly prescribed in T2DM patients because it reduces mean amplitude of glycemic excursion (MAGE), has lower risk of hypoglycemia and is weight neutral. Early combination therapy with vildagliptin and metformin is effective and well-tolerated in patients with T2DM, regardless of age or ethnicity. In view of already existing data on vildagliptin and the latest emerging clinical evidence, a group of endocrinologists, diabetologists and cardiologists convened for an expert group meeting to discuss the role and various combinations of vildagliptin in T2DM management. This practical document aims to guide Physicians and Specialists regarding the different available strengths and formulations of vildagliptin for the initiation and intensification of T2DM therapy., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)

Background: No meta-analysis has holistically analysed and summarized the effect of prolactin excess due to prolactinomas on bone mineral metabolism. We undertook this meta-analysis to address this knowledge-gap., Methods: Electronic databases were searched for studies having patients with hyperprolactinemia due to prolactinoma and the other being a matched control group. The primary outcome was to evaluate the differences in BMD Z-scores at different sites. The secondary outcomes of this study were to evaluate the alterations in bone mineral density, bone mineral content and the occurrence of fragility fractures., Results: Data from 4 studies involving 437 individuals was analysed to find out the impact of prolactinoma on bone mineral metabolism. Individuals with prolactinoma had significantly lower Z scores at the lumbar spine [MD -1.08 (95 % CI: -1.57 - -0.59); P < 0.0001; I 2  = 54 % (moderate heterogeneity)] but not at the femur neck [MD -1.31 (95 % CI: -3.07 - 0.45); P = 0.15; I 2  = 98 % (high heterogeneity)] as compared to controls. Trabecular thickness of the radius [MD -0.01 (95 % CI: -0.02 - -0.00); P = 0.0006], tibia [MD -0.01 (95 % CI: -0.02 - -0.00); P=0.03] and cortical thickness of the radius [MD -0.01 (95 % CI: -0.19 - -0.00); P = 0.04] was significantly lower in patients with prolactinoma as compared to controls. The occurrence of fractures was significantly higher in patients with prolactinoma as compared to controls [OR 3.21 (95 % CI: 1.64 - 6.26); P = 0.0006] Conclusion: Bone mass is adversely affected in patients with hyperprolactinemia due to prolactinoma with predominant effects on the trabecular bone., Competing Interests: Conflict of Interests None., (Copyright © 2023 The International Society for Clinical Densitometry. Published by Elsevier Inc. All rights reserved.)

Objectives: Type 2 Diabetics have elevated risk for acute coronary syndrome (ACS). The current management algorithm focuses on atherosclerotic cardiovascular (ASCVD) risk score to stratify this risk. However, in medically managed subjects, this algorithm may not be accurate. This study compares the ASCVD risk score in an Indian population with T2DM under medical supervision and the actual incidence of ACS. It also compared the ASCVD risk scores in cases with T2DM who developed ACS to controls and tried to estimate whether the ASCVD risk score is different in the two subsets, evaluating the utility of the ASCVD risk score in predicting ACS., Methodology: This is an electronic medical record (EMR) based case-control study. Only records of subjects with T2DM where details of age, sex, body mass index, blood pressure, duration of diabetes, family history of ACS, lipid profile, renal and liver function tests were included. The incidence of ACS was calculated in the selected records, and the records of subjects with ACS were compared with age and sex-matched subjects without ACS. Data are summarized as median and interquartile range (IQR). Wilcoxon rank-sum test was used for checking differences in continuous variables and Pearson's Chi-squared test for categorical data. Univariate and multivariate logistic regression analyses were used to check the effect of ASCVD scores and other variables on the occurrence of ACS.Statistical data analyses were performed using JASP, version 0.16.4 (JASP Team [2022]) for MS Windows., Results: Of the 1226 EMRs included in the analysis, 207 had ACS. The actual incidence of ACS was 16.85% in 6 years, higher than the mean predicted 10-year incidence of 14.56 percent ( p <0.05). The cases were age and sex-matched with controls and the ASCVD incidence was estimated in the two groups. The mean ASCVD score in the cases was 14.565 ± 8.709 (Min: 1.5, Max: 38.3) and controls 13.114 ± 8.247 (Min: 1.4, Max: 45). The chance of development of ACS increases with elevated systolic blood pressure (per mmHg rise OR: 1.04, 95% CI: 1.03, 1.06; p <0.001), positive family history (OR: 5.70, 95% CI: 3.41, 9.77; p <0.001), statin use (OR: 2.26, 95% CI: 1.46, 3.52; p <0.001), and longer duration of diabetes (for every year increase OR: 1.19, 95% CI: 1.13, 1.25; p <0.001)., Conclusion: The ASCVD risk score underestimates the ACS risk in subjects with T2DM under medical supervision and may not differ in those who developed and did not develop ACS. We also conclude that factors like a negative family history (30% less risk), longer duration of diabetes, and higher SBP are relevant in those who developed ACS., Competing Interests: The authors declared no conflict of interest., (© 2024 Journal of the ASEAN Federation of Endocrine Societies.)

Objective: To understand the national pattern of proton-pump inhibitor (PPI) prescriptions and to disseminate evidence-based recommendations for using probiotics as an adjunct to PPIs across diverse clinical indications., Methods: Healthcare professionals' (HCPs) inputs and views were collected through a survey ( n = 1,007) and four round table meetings (RTMs, n = 4). A standardized questionnaire focusing on the utilization of PPIs in clinical practice was developed, deliberated upon, and assessed by experts specializing in the treatment of diverse acid-related gastrointestinal (GI) conditions across various geographical regions., Results: Of the total 1,007 contributors, most (43.40%) opined that 10-30% of their patients were prescribed PPI for a long duration. The majority of contributors commonly prescribed PPIs for the prophylaxis of gastroesophageal reflux disease (GERD)-induced gastritis (70.90%), peptic ulcer disease (58.39%), and various GI conditions. The majority of contributors (91%) agreed or strongly agreed that long-term use of PPIs disturbs the GI flora. Antibiotic-associated diarrhea (AAD) (78.05%) was the most preferred indication for using pre- and probiotics. The duration for co-prescription varied, with a substantial portion advocating for 1-4 weeks (49.65%), while others supported durations of 4-8 weeks or beyond. Around 85% of contributors/HCPs agreed or strongly agreed on prescribing pre- and probiotics as prophylaxis to prevent GI disturbances. The study emphasized the growing trend of patient-centered co-prescription of PPIs and pre-/probiotics, with a majority of contributors favoring this approach., Conclusion: The results underscore the importance of informed prescribing practices, including the co-prescription of probiotics, to mitigate potential side effects associated with long-term PPI use and optimize patient well-being., (© Journal of the Association of Physicians of India 2023.)

Aim: To assess the impact on 30-day mortality with ulinastatin (ULI) used as add-on to standard of care (SOC) compared to SOC alone in coronavirus disease (COVID-19) patients requiring admission to the intensive care unit (ICU)., Materials and Methods: In this multicentric, retrospective study, we collected data on clinical, laboratory, and outcome parameters in patients with COVID-19. Thirty-day mortality outcome was compared among patients treated with SOC alone and ULI used as add-on to SOC. Odds ratio (OR) and 95% confidence intervals (CI) were determined to identify the predictors of 30-day mortality., Results: Ninety-four patients were identified and enrolled in both groups with comparable baseline parameters. On univariate analysis, 30-day mortality was significantly lower in ULI plus SOC group than SOC alone group (36.2 vs 51.1%, OR 0.54, 95% CI 0.30-0.97, p = 0.040). The effect on mortality was more pronounced in patients who did not require intubation (10.9 vs 34.0%, OR 0.24, 95% CI 0.09-0.66, p = 0.006) and with early administration (within 72 hours of admission) of ULI (30.7 vs 57.9%, OR 0.32, 95% CI 0.11-0.91, p = 0.032). On multivariate analysis, only intubation predicted mortality (adjusted OR 10.13, 95% CI 3.77-27.25, p&lt;0.0001) and the effect of ULI on survival was not significant (adjusted OR 0.58, 95% CI 0.22-1.52, p = 0.270)., Conclusion: Given the limited options for COVID-19 patients treated in ICU, early administration of ULI may be helpful, especially in patients not requiring intubation to improve the outcomes. Further, a large, randomized study is warranted to confirm these findings., (© Journal of the Association of Physicians of India 2011.)

Bone health is an important, but neglected aspect of diabetes care. People with type 1 diabetes are known to have a lower bone mineral density (BMD), which put them at a greater risk of osteoporosis and fractures. While BMD in those with type 2 diabetes is often misleading, multiple factors operate to increase the risk of falls and fractures in them. This article provides an overview of osteoporosis in diabetes. It proposes a LEMON mnemonic to understand the multifaceted aspects of bone care.

Background: India, along with the rest of the world, faced the challenging severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. The second wave in India lagged behind that in the Western world, due to different timing of seasons. There is scarce data about the differences between the two waves, for intensive care unit (ICU) patients. We present the data of 3,498 patients from 9 ICUs of western Maharashtra., Materials and Methods: We collected prospective data of hospitalized, RT-PCR confirmed, coronavirus-2019 (COVID-19) patients, from nine tertiary centers, after institutional ethics committee (IEC) approval. Then, we segregated and analyzed the data of patients admitted to the ICU, for comorbidities, high-resolution computed tomography (HRCT) score, ventilatory support, etc. The primary outcomes were ICU and hospital mortality. We also performed multivariable analysis for predictors of ICU mortality., Results: Overall, there were 3,498 ICU patients. In the first wave, 1,921 patients needed ICU admission, while in the second wave, 1,577 patients. Patients in the second wave had significantly higher ICU (26.1 vs 13.4%, p <0.001) and hospital mortality (29.9 vs 18.2%, p <0.001) and need for ventilatory support of any type. More patients received steroids during the second wave. On multivariable regression, male gender, ICU admission during the second wave, increasing HRCT score, and need for intubation and mechanical ventilation were significant predictors of ICU mortality., Conclusion: ICU patients admitted during the two waves were of the similar age, but there were more females, and more patients had comorbidities during the second wave. The ICU and hospital mortality were significantly higher during the second wave., How to Cite This Article: Zirpe KG, Dixit S, Kulkarni AP, Pandit RA, Ranganathan P, Prasad S, et al. The Second- vs First-wave COVID-19: More of the Same or a Lot Worse? A Comparison of Mortality between the Two Waves in Patients Admitted to Intensive Care Units in Nine Hospitals in Western Maharashtra. Indian J Crit Care Med 2021; 25(12):1343-1348., Competing Interests: Source of support: Nil Conflict of interest: None, (Copyright © 2021; Jaypee Brothers Medical Publishers (P) Ltd.)

Mashi is a black colored powder formulation obtained after combustion of the plant or animal drug. It is prepared by bahirdhum padhati (outside) or anterdhum padhati (in the close vessel). In this dosage form, bulk of raw material is reduced to a greater extent by the application of a certain quantum of energy. Due to this treatment, hidden chemical constituents become prominent and/or a new chemical moiety is formed which is therapeutically active. This formulation is cost-effective and easy to prepare. This review article aims to highlight the different mashi formulations mentioned in Ayurvedic text and also incorporate the formulation not mentioned in the Ayurvedic text but used by Ayurvedic practitioners. The objective was to introduce researchers to the simple yet excellent formulation mashi which should be studied in detail to establish its identity, purity, and therapeutic activity., (Copyright © 2021 The Authors. Published by Elsevier B.V. All rights reserved.)

The Indian Society for Bone and Mineral Research (ISBMR) has herein drafted clinical practice guidelines for the diagnosis and management of osteoporosis for the people of India. Implementation of the position statement in clinical practice is expected to improve the overall care of patients with osteoporosis in India., Purpose: In India, osteoporosis is a major public health problem. However, in the absence of any robust regional guidelines, the screening, treatment, and follow-up of patients with osteoporosis are lagging behind in the country., Methods: The Indian Society for Bone and Mineral Research (ISBMR), which is a multidisciplinary group of physicians, researchers, dietitians, and epidemiologists and who study bone and related tissues, in their annual meeting, drafted the guidelines for the diagnosis and management of osteoporosis that would be appropriate in a resource constraint setting like India., Results: Diagnosis of osteoporosis can be made in a patient with minimal trauma fracture without the aid of any other diagnostic tools. In others, bone mineral density measured by dual-energy X-ray absorptiometry remains the modality of choice. Data indicates that osteoporotic fractures occur at an earlier age in Indians than in the West; hence, screening for osteoporosis should begin at an earlier age. FRAX can be used for fracture risk estimation; however, it may underestimate the risk of future fractures in our population and still needs validation. Maintaining optimum serum 25-hydroxyvitamin D levels is essential, which, in most cases, would require regular vitamin D supplementation. Pharmacotherapy should be guided by the presence/absence of vertebral/hip fractures or the severity of risk based on clinical factors, although bisphosphonates remain the first choice in most cases. Regular follow-up is essential to ensure adherence and response to therapy., Conclusions: Implementation of the position statement in clinical practice is expected to improve the overall care of patients with osteoporosis in India.

The concept of SGLT2-inhibition, once regarded as a non-physiological approach to glycemia control, now finds a foundational relevance in risk-modification for cardiovascular, kidney, and metabolic outcomes, spanning beyond type-2 diabetes. Major studies have proven meaningful improvements in various clinical outcomes, with different SGLT2-i agents. Apart from glycosuria, SGLT2-inhibition is associated with several patho-physiological effects, which may contribute to the clinical benefits seen with these agents. This narrative review is an attempt to appraise the different patho-physiological effects mediated by SGLT2-inhibition, based on contemporary evidence. The review classifies these effects in the acronym of EUPHORIA, and grades the possible relevance of each effect, in improving clinical outcomes., (© Journal of the Association of Physicians of India 2011.)

The problem of the efficient design of material microstructures exhibiting desired properties spans a variety of engineering and science applications. The ability to rapidly generate microstructures that exhibit user-specified property distributions can transform the iterative process of traditional microstructure-sensitive design. We reformulate the microstructure design process using a constrained generative adversarial network (GAN) model. This approach explicitly encodes invariance constraints within GANs to generate two-phase morphologies for photovoltaic applications obeying design specifications: specifically, user-defined short-circuit current density and fill factor combinations. Such invariance constraints can be represented by differentiable, deep learning-based surrogates of full physics models mapping microstructures to photovoltaic properties. Furthermore, we propose a multi-fidelity surrogate that reduces expensive label requirements by a factor of five. Our framework enables the incorporation of expensive or non-differentiable constraints for the fast generation of microstructures (in 190 ms) with user-defined properties. Such proposed physics-aware data-driven methods for inverse design problems can be used to considerably accelerate the field of microstructure-sensitive design., (© 2021. The Author(s), under exclusive licence to Springer Nature America, Inc.)

Psychiatry and Endocrinology share a deep rooted, multifaceted bidirectional relationship. Both have seen a surge in cases due to change in lifestyle. Time has come where these two rapidly growing fields interact and exchange knowledge leading to emergence of Psychocrinology. This communication describes the rationale behind using the term psychocrinology, and provides an overview of it's vast spectrum.

More often than not, the root cause of unsatisfactory diabetes care can be traced to in appropriate communication. In this brief article, we share the four pillars of communication that a successful physician should be able to address: person, patient, public and peers. A good physician should be able to understand herself or himself, communicate with patients and the society at large, and handle professional relationships. This quadruple helps us identify our strengths and shortcomings and facilitates attempts at self-improvement, so as to improve the quality of our life.

Ample evidence implicating diet as the root cause of diseases exists in the scientific arena. It is always intruiging to know the diet pattern of our ancestors. Leonardo da Vinci was a 'universal genius' with universal appeal. This article describes the basic principles of the diet that he followed. "Dining discipline" and moderation in eating should be coupled with the aim of savouring smell, taste, and texture of food. Fresh, fibre rich, vegetarian food forms the bulk of the da Vinci diet. Saturated fat, salt and sugar use is minimal, but water and water-rich food intake is encouraged.

Alstrom syndrome is an autosomal recessive multisystem disorder caused by mutation in ALMS1 (2p13). Very few cases of same are reported so far of same. We report a case of Alstrom syndrome (AS) who presented with type II diabetes mellitus and portal hypertension. Unilateral anorchia with hypergonadotropic hypogonadism is another unique feature of our case., (© Journal of the Association of Physicians of India 2011.)

Background and Study Aims: Coeliac autoimmunity (CA) has a known association with type 1 diabetes mellitus (T1DM) for which screening is routinely recommended but less frequently followed. The impact of CA in T1DM has been variably reported. The aims of this study are as follows: (1) to study the prevalence of CA in patients with T1DM and (2) to study the impact of CA not only on nutritional parameters but also on glycaemic control, endocrine axes and bone health., Patients and Methods: Eighty-six consecutive patients with T1DM were screened for CA using immunoglobulin A (IgA) tissue transglutaminase as a marker (TTG; IgG anti-gliadin in IgA-deficient case). CA positive (CA+) cases were compared with age-matched and sex-matched CA negative (CA-) T1DM cases for anthropometry, glycaemic control (assessed by glycated haemoglobin (HbA1c) and hypoglycaemic/hyperglycaemic episodes), endocrine (thyroid function, cortisol, growth hormone (GH) axis, gonadal axes), haematological (haemoglobin, iron profile and vitamin B12 status) and calcium metabolism parameters and bone densitometry (by dual-energy X-ray absorptiometry (DXA)). Consenting patients with CA also underwent upper gastrointestinal (GI) endoscopy with duodenal biopsy., Results: Out of 86 patients, 11 (12.75%) screened positive for CA (seven patients underwent duodenal biopsies which were suggestive of Marsh grade III(2), II(3) and I(2) disease). The CA+ T1DM patients were comparable with CA- T1DM in terms of anthropometry. CA+ patients had higher HbA1c (10.7±1.8 vs. 8.4±1.0 (93±19 vs. 68±11 mmol/mol); p<0.01), more hypoglycaemic episodes (five vs. two; p<0.05), higher prevalence of iron and vitamin B12 deficiency, lower insulin-like growth factor-1 (IGF-1) levels and lower bone mineral density (BMD) z-score at total body (-1.91±1.05 vs. -0.63±0.73; p<0.05) and lumbar spine (-1.69±0.92 vs. -0.36±0.93; p<0.05). The incidence of fractures in the past 3years was also more in CA+ patients than in CA- patients (four vs. one; p<0.05)., Conclusion: CA has an important autoimmune association with T1DM. The concomitant presence of CA adversely affects stature, bone health, glycaemic control and iron and B12 levels in T1DM. IgA sufficiency should be ensured before using an IgA-based screening test for CA., (Copyright © 2014 Arab Journal of Gastroenterology. Published by Elsevier Ltd. All rights reserved.)