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Byline: Mahesh. Belhekar, Sarayu. Pai, Parimal. Tayade, Pradip. Dalwadi, Renuka. Munshi, Prema. Varthakavi Insulin is an important agent for the treatment of diabetes mellitus (DM). Allergic reactions to insulin therapy, [...]

Byline: Rickson. Pereira, Sangeeta. Amladi, Prema. Varthakavi Background: The association between psoriasis, diabetes, and cardiovascular disease remains largely unelucidated in the Indian population. Aims: To study the prevalence of diabetes, [...]

Objectives: To assess the change in the bone mineral density (BMD) score, bone-specific biomarkers (serum vitamin D3, tartrate-resistant acid phosphatase 5b [TRAP-5b], and osteocalcin), quality of life, Ayurvedic symptoms (Asthikshaya Lakshanas), and fracture risk assessment tool (FRAX) scores following treatment with Panchatikta Ghrita (PG), a classical herbal formulation as add-on therapy to calcium and vitamin D3 supplements. Study design: Randomized, open-labeled, comparative, controlled clinical study. Location: TN Medical College and BYL Nair Hospital, Mumbai, India. Study participants: Eighty adult patients, aged between 40 and 75 years, diagnosed to have osteopenia (BMD T-score between −1 and −2.5 in at least two of the three joints tested—lumbar spine L1–L4, left femur-neck, left forearm-radius total). Study intervention: Treatment group received two tablespoons of PG (10 mL in lukewarm milk) along with calcium and vitamin D3 supplements twice a day, whereas control group received only calcium and vitamin D3 supplements twice a day for a period of 12 months. Outcome measures: BMD, bone-specific biomarkers (vitamin D3, TRAP-5b, and osteocalcin), quality of life, Ayurvedic symptoms, and FRAX scores were evaluated before and at 6 and 12 months. Results: Eighty patients were enrolled; of which, 65 patients completed the study while 15 patients dropped out. Improvement in the BMD scores was observed at 6 and 12 months with the maximum benefit in the lumbar spine region. Significant improvement in the bone-specific biomarkers, namely serum vitamin D3 (p < 0.001), osteocalcin (p < 0.001), and TRAP-5b (p < 0.05), was observed in the PG-treated group compared with the standard treatment group. Improvement in the quality of life, Ayurvedic symptoms scores, and risk reduction in FRAX scores of major osteoporotic fracture risk and hip fracture risk was greater with PG, although not statistically significant. Conclusions: The study findings demonstrate that PG slows down the bone degeneration processes by its stabilizing effect on the bone-specific biomarkers, indicating its potential usefulness as preventive therapy in osteopenia. The positive improvement noted in this study needs to be confirmed in studies with a larger sample size and longer duration. [ABSTRACT FROM AUTHOR]

Background: Subclinical Hypothyroidism (ScHt) affects 3-15% of the adult population. It's clinical and biochemical profile is not well defined, especially in Indian scenario. Our study aimed at screening normal population to define normative ranges of thyroid hormones and Serum thyroid stimulating hormone (S.TSH) and prevalence of ScHt and thyroid autoimmunity. Materials and Methods: Two-hundred thirty-seven normal subjects without family history of thyroid disease were evaluated for symptoms and laboratory tests for thyroid dysfunction and autoimmunity. Results: The thyroid function tests were as follows: Euthyroid Group: Mean values were: T3: 1.79 ± 0.42 ng/ mL, T4: 10.23 ± 2.25 μg/dL, FT3: 1.88 ± 0.19 pg/mL, FT4: 1.12 ± 0.21 ng/dL, S.TSH: 2.22 ± 1.06 μlu/mL. 10.2% of euthyroid subjects had antimicrosomal antibodies (AMA) +ve (mean titer 1:918) and 23.6% were anti-thyroid peroxidase autoantibody (anti-TPO) +ve (mean titer 15.06 Au/mL). The euthyroid outlier range for S.TSH was 0.3-4.6 μlu/mL. The values were comparable in both the sexes. Those with S.TSH ≥ 5 μlu/mL were defined to have ScHt. ScHt Group : Prevalence of ScHt was 11.3% (M:F ratio 1:3.7). 74% belonged to 35-54 years age group and prevalence increased with age (post-menopausal females: prevalence 20%). S.TSH was 9.8 ± 7.22 μlu/mL, mean S.AMA was 1:5079 (40.7% positivity) and mean S.anti-TPO was 260 Au/mL (47.6% positivity). Majority were agoitrous (74%), and stage I goiter was seen in 26% of this population. Symptom score of 5-8 was seen in 55% ScHt subjects versus 35% normal subjects. Conclusion: Mean S.TSH in our population was 2.22 μlu/mL (euthyroid outliers: 0.3-4.6 μlu/mL); hence, S.TSH above 4.6 μlu/mL should be considered as abnormal. The prevalence of thyroid autoimmunity increases after age of 35 years. ScHt presents mainly in agoitrous form and with positive antibodies, suggesting autoimmunity as the cause. [ABSTRACT FROM AUTHOR]

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]

Objectives: To assess the change in the bone mineral density (BMD) score, bone-specific biomarkers (serum vitamin D 3 , tartrate-resistant acid phosphatase 5b [TRAP-5b], and osteocalcin), quality of life, Ayurvedic symptoms ( Asthikshaya Lakshanas ), and fracture risk assessment tool (FRAX) scores following treatment with Panchatikta Ghrita (PG), a classical herbal formulation as add-on therapy to calcium and vitamin D 3 supplements. Study design: Randomized, open-labeled, comparative, controlled clinical study. Location: TN Medical College and BYL Nair Hospital, Mumbai, India. Study participants: Eighty adult patients, aged between 40 and 75 years, diagnosed to have osteopenia (BMD T-score between -1 and -2.5 in at least two of the three joints tested-lumbar spine L1-L4, left femur-neck, left forearm-radius total). Study intervention: Treatment group received two tablespoons of PG (10 mL in lukewarm milk) along with calcium and vitamin D 3 supplements twice a day, whereas control group received only calcium and vitamin D 3 supplements twice a day for a period of 12 months. Outcome measures: BMD, bone-specific biomarkers (vitamin D 3 , TRAP-5b, and osteocalcin), quality of life, Ayurvedic symptoms, and FRAX scores were evaluated before and at 6 and 12 months. Results: Eighty patients were enrolled; of which, 65 patients completed the study while 15 patients dropped out. Improvement in the BMD scores was observed at 6 and 12 months with the maximum benefit in the lumbar spine region. Significant improvement in the bone-specific biomarkers, namely serum vitamin D 3 ( p  < 0.001), osteocalcin ( p  < 0.001), and TRAP-5b ( p  < 0.05), was observed in the PG-treated group compared with the standard treatment group. Improvement in the quality of life, Ayurvedic symptoms scores, and risk reduction in FRAX scores of major osteoporotic fracture risk and hip fracture risk was greater with PG, although not statistically significant. Conclusions: The study findings demonstrate that PG slows down the bone degeneration processes by its stabilizing effect on the bone-specific biomarkers, indicating its potential usefulness as preventive therapy in osteopenia. The positive improvement noted in this study needs to be confirmed in studies with a larger sample size and longer duration.