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OBJECTIVE: The skeletal maturity of any individual is known as bone age and it can be reliably estimated by a roentgenologic study of osseous development since the appearance and union of the centers of ossification occur in a fairly definite pattern and time sequence from birth to maturity. This is particularly helpful in the clinical workup of children with endocrinological disorders where skeletal and pubertal growth is affected. Therefore the bone age can be advanced, delayed or appropriate for chronological age in various endocrinological disorders. We present cases which affect skeletal maturation in a way that a simple investigation like the bone age estimation can lead to their diagnosis or can help therapeutic interventions. The present study aims to reiterate the importance of bone age in the diagnosis and management of endocrinological disorders. MATERIAL AND METHODS: X rays of both hands of cases and for bone age estimation we used the Greulich - Pyle atlas to accord a bone age to each bone of the hand and obtain an average reading. RESULT: The endocrinological disorders were classified as advanced, delayed and bone age appropriate for chronological age. Cases with advanced bone age were a child with hypothalamic hamartoma and a child with congenital adrenal hyperplasia. Those with delayed bone age were hypothyroidism and growth hormone deficiency. The case with bone age appropriate for chronological age was that of a Turner girl. In each of these cases the bone age helped in the diagnosis and also in the therapeutic decisions. CONCLUSIONS: Assessing bone age through radiographs of both hands graded according to Greulich Pyle method provided the endocrinologists an inexpensive tool to obtain an objective measure of the child's developmental status and also an effective tool for the diagnosis and differential diagnosis of various endocrinological disorders. It also guides the endocrinologist of the timing and effectiveness of the therapeutic measures employed.

Context: Renal calculus disease has a lifetime recurrence rate of 80%. Protocol-based metabolic evaluation in high-risk subjects for recurrent renal stones reveals abnormalities in a large subset of subjects. However, such information is not available in Indian subjects. Aims: To evaluate the abnormalities by a protocol-based metabolic evaluation in patients at a high risk for recurrent renal stones. Settings and Design: Prospective, academic tertiary care center. Materials and Methods: Fifty North Indian patients (38 males and 12 females; mean age 38 ± 10.2 years) with recurrent or bilateral renal stones were evaluated. All subjects underwent a protocol-based evaluation involving estimation of serum total calcium, phosphorus, creatinine, albumin, iPTH, 25(OH)D 3 , 1,25(OH) 2 D 3 , and a calcium load test. Estimation of daily urinary excretion of volume, oxalate, calcium, uric acid, and citrate, and urinary acidification studies were performed. Statistical Analysis Used: Descriptive statistics and t-test. Results: An underlying disorder was detected in 48 (96%) patients. Almost half had two or more metabolic abnormalities. The metabolic abnormalities detected were: Hypercalciuria 26 (52%) patients, renal hypercalciuria 16 (32%), absorptive hypercalciuria 6 (12%), unclassified hypercalciuria 4 (8%), hyperoxaluria 27 (54%), hyperuricosuria 9 (18%), distal renal tubular acidosis 4 (8%; 2 complete and 2 partial), primary hyperparathyroidism 3 (6%), and hypocitraturia 14 (n=18, 77%). In two patients, the etiology could not be detected. Conclusions: Protocol-based metabolic evaluation reveals metabolic abnormalities in majority of patients with nephrolithiasis. The spectrums of metabolic abnormalities are different in Indian subjects as compared to the western population.

This communication presents verses from the Bhagavad Gita which help define a good clinician's skills and behavior. Using the teachings of Lord Krishna, these curated verses suggest three essential skills that a physician must possess: Excellent knowledge, equanimity, and emotional attributes. Three good behaviors are listed (Pro-work ethics, Patient-centered care, and Preceptive leadership) and supported by thoughts written in the Gita.

Religion has been proposed as a means of enhancing patient and community acceptance of diabetes and cultural specific motivational strategies to improve diabetes care. Sikhism is a young and vibrant religion, spread across the world and the Holy Scripture Sri Guru Granth Sahib (SGGS) is regarded as the living Guru by all Sikhs. The three key pillars of Sikhism are Kirat Karni (honest living), Vand Chakna (sharing with others) and Naam Japna (focus on God). They can help encourage the diabetes care provider, patient and community to engage in lifestyle modification, shared responsibility, positive thinking and stress management. The verses (Sabads) from the SGGS, with their timeless relevance, span the entire spectrum of diabetes care, from primordial and primary, to secondary and tertiary prevention. They can provide us with guidance towards a holistic approach towards health and lifestyle related diseases as diabetes. The SGGS suggests that good actions are based on one's body and highlights the relevance of mind-body interactions and entraining the mind to cultivate healthy living habits. The ethics of sharing, community and inclusiveness all lay emphasis on the need for global and unified efforts to manage and reduce the burden of the diabetes pandemic.

This review describes the various fasts observed by adherents of the Jain religion. It attempts to classify them according to their suitability for people with diabetes and suggests appropriate regime and dose modification for those observing these fasts. The review is an endeavor to encourage rational and evidence-based management in this field of diabetology.

Primary haemochromatosis is characterized by iron overload in the body tissues. It is common in populations of northern European descent. In such populations, 85%-90% of patients with this disease have a C282Y mutation in the HFE gene. In India, the disease is uncommon and the genetic defects associated with it are unknown. We therefore looked for mutations in the HFE and other genes involved in iron metabolism in Indian patients with primary haemochromatosis.Five patients (including a brother-sister pair) with primary haemochromatosis diagnosed on clinical, biochemical and histological findings were studied. Genomic DNA was analysed by sequencing for the presence of mutations in all the 6 exons of the HFE gene and for previously described mutations in genes encoding hepcidin antimicrobial peptide and ferroportin.No patient had the C282Y mutation. One had homozygous H63D mutation. No other mutation was found in any HFE exon. Two previously reported splice site mutations in the HFE gene (IVS3 + 1 G/T and IVS5+1 G/A) were not detected. Four of the 5 patients had an HFE splice site mutation (IVS2 + 4 T/C; homozygous 2, heterozygous 2); however, this change was as frequent in 29 healthy subjects (homozygous 9, heterozygous 7), and was present in only 1 of the sibling pair patients, indicating that this represented a polymorphism. No patient had any of the previously described mutations in the genes for hepcidin and ferroportin.Our patients with primary haemochromatosis lacked mutations in the HFE, hepcidin and ferroportin genes. Further genetic analysis may help identify novel mutations responsible for primary haemochromatosis in these patients.

Carotenemia with its yellowish-red tint is found in diabetes. The frequency of this phenomenon is unknown and the relationship between skin color and blood carotenoid level is controversial. Frequently the suspicion of diabetes arising from inspection of the skin color is in fact confirmed by the usual laboratory tests. As it is known that increased intake of carotenoid-rich fruit and vegetables leads to the yellowish-red skin discoloration, in the present case the patient was a known diabetic with uncontrolled blood sugar and showed the yellowish skin discoloration in spite of not taking any carotenoid-rich foods. After controlling his blood sugar level the patient showed improvement in his skin discoloration.