Prevalence of thyroid dysfunction in patients with type 2 diabetes

 Background: Diabetes mellitus, a leading cause of death worldwide, is the most common endocrine disorder. Type 2 Diabetes (T2D) and Thyroid Dysfunction (TD) often present together and complicate each other at many levels. Recent studies find out the prevalence of TD in T2D in Malwa Region. Objective of the purpose of this study was to find out the prevalence of TD in patients with T2D.Methods: A match cross-sectional study design was conducted at Department of Medicine, Sri Aurobindo Medical College, from March 2018 to April 2019. Source populations were all patients who live in Malwa Region, Indore. A total of 150 cases were enrolled in this study, 75 cases (TD in T2D) and 75 controls were taken into study.Results: There was no significant difference in age and body mass index (BMI) between groups. The average duration of diabetes was 7.76±5.57 years and mean Hemoglobin A1c (HBA1c) was 8.17±1.66%. Only 29(38.6%) of patients had HbA1c below 7%. There was significant difference (p=0.001) in HbA1c. Prevalence of TD in T2D was significantly more in females. Out of TD in T2D patients, sub-clinical hypothyroid was present in 14.6% hypothyroidism was present in 8% patients and sub-clinical hyperthyroidism and hyperthyroidism was present in 1.3% patients.Conclusions: This study reveals about one in four people living with T2D are suffering from TD in Malwa Region. TD is common in T2D patients and can produce significant metabolic disturbances.

Evaluate the differences in serum magnesium levels and lipid profile with correlation of hemoglobin A1C levels in type 2 diabetes patients: a case control study

Background: Magnesium deficiency is a common problem in diabetic patients. Magnesium deficiency may increase the incidence of Type 2 Diabetic (T2D) and occurrence complications. Objective of this study aimed at determining the differences in serum magnesium levels and lipid profile among patients newly diagnosed with T2D and normoglycemic individuals.Methods: The cross sectional observation study design was conducted at Sri Aurobindo Medical College, from March 2018 to April 2019. Source populations were all patients who attending to the OPD, Department of General Medicine. A total of 75 patients were enrolled in this study. This study was divided in two group’s cases group (T2D) and second control group (Non-diabetic). First group not initiated on any oral-hypoglycaemic, anti-hypertensive or lipid lowering drugs, and healthy patients were included in control group.Results: Triglycerides (TG), Total Cholesterol (TC), low-density lipoprotein-cholesterol (LDL-C) showed significantly (p<0.001) higher mean levels in T2D compared to the controls. The Magnesium and High-Density Lipoproteins-cholesterol (HDL-C) levels were significantly (p<0.001) lower among the T2D group compared to the control group. There was a significant inverse correlation (r2= 0.567, p<0.001) between Hemoglobin A1C (HbA1c) levels and serum magnesium.Conclusions: Serum magnesium levels and lipid profile were significantly different in T2D patients compared to control group.

Evaluate the relation between microalbuminuria and with other biochemical parameters related to complications of type 2 diabetes

Background: Type 2 Diabetes (T2D) with microalbuminuria have increased risk of progression to overt proteinuria, and after some time, renal failure. It is the leading cause of end-stage renal disease as a sequalae of Diabetic Nephropathy (DN) and an independent risk factor for Cardio-Vascular Diseases (CVD). Initial finding for microalbuminuria can prevent long-term complications. The objective of the present investigation was to study the relation between microalbuminuria and with other biochemical parameters related to complications of T2D.Methods: This observational study was conducted among 150 T2D patients attending to the OPD, Department of General Medicine during the time period March 2018 to April 2019. The patients were interviewed for socio-demographic details, history and clinical examination and subjected to blood investigations and Electrocardiogram (ECG).Results: Microalbuminuria was present in 47(31.3%) of the diabetics. The age group 48-63 years 18(38.3%), male gender 33(70.2%) duration of diabetes >5 years 11(23.4%). The smokers, Diabetic Retinopathy, Peripheral Neuropathy, Ischemic Heart Disease, SBP 160-170 mmHg, DBP 95-100 mmHg and 100-105 mmHg, BMI 30-35 Kg/m2, TG >250 mg/dl, LDL >110 mg/ dl and HbA1c 7.5-9 % showed a greater odds ratio and significant association (p<0.001) with microalbuminuria.Conclusions: There was an increased prevalence of microalbuminuria among patients with T2D. It also showed a significant association of major microvascular and macrovascular complications of T2D and microalbuminuria

The prevalence and assessment of chronic kidney disease with diabetes: single center study

Background: The prevalence of chronic kidney disease (CKD) and Type 2 diabetes (T2D) is increasing worldwide, information on Indian populations regarding the CKD patients with T2D is lacking. In this study, we examined the association of gender and age on the prevalence of other complications in CKD with T2D patients.Methods: A cross-sectional study was conducted at Sri Aurobindo Medical College, from March 2018 to April 2019. Source populations were all patients who came our medicine department for routine check-up.Results: A total of 163 CKD patients were included in the study. All the patients were randomly divided in two groups 61(37.4%) patients in CKD with T2D case group and 102 (62.5%) patients in CKD control group. Out of this 107 were males (65.6%) and 56 were females (34.3%). Male-to-female ratio and mean age were higher in the CKD with T2D group. The clinicopathological characteristics of CKD patients with T2D are even more complicated and severe disease in many ways.Conclusions: A male presents was higher as compare to female in CKD with T2D and control group. In present study there is significant difference in older and younger age in CKD with T2D and control group. Age, HNT, CVD, smoking, BMI, and 24-h urinary protein level were identified as possible contributors’ factors of CKD patients with T2D

Effects of glucocorticoids on plasma levels of thyroid hormones (T4 and T3) and testicular activity in catfish, Clarias gariepinus during different phases of annual breeding cycle.

Effects of short-term administration of corticosterone and cortisol on plasma levels of thyroid hormones, gonado-somatic index and testicular histology have been reported in catfish, Clarias gariepinus during different phases of its breeding cycle. Corticosterone administration had no significant effect on plasma levels of T4, T3 and T3/T4 ratio, irrespective of doses and phases of breeding cycle. However, 5 µg dose of cortisol significantly increased plasma levels of T3 and the T3/T4 ratio during quiescent and regressive phases, while it significantly decreased plasma levels of T4 during progressive phase. During breeding phase, 2 µg and 5 µg doses of cortisol significantly decreased plasma levels of T4 and T3, respectively, while 5 µg dose of cortisol alone reduced T3/T4 ratio. Irrespective of phases of annual breeding cycle and doses, short-term administration of corticosterone and cortisol had no significant effect either on GSI or testicular histology. These findings suggest that corticosterone is ineffective in stimulating plasma levels of thyroid hormones, while cortisol, depending on dose and phase/season, may differentially increase, decrease or have no effect on plasma levels of thyroid hormones in C. gariepinus.

Risk factors and survival analysis of the esophageal cancer in the population of Jammu, India.

Objective: To identify the risk factors of esophageal cancer and study their effect on the survival rates patients of Jammu region, India. Materials and Methods: Detailed information was collected on socio-demographic, dietary and clinico-pathological parameters for 200 case control pairs. Discrete (categorical) data of 2 independent groups (control and cases) were summarized in frequency (%) and compared by using Chi-square (χ2 ) test. The mean age of two independent groups was compared by independent Student's t-test. To find out potential risk factor (s), the variable (s) found significant in univariate analysis were further subjected to multivariate logistic regression analysis. The association of potential risk factors with patients survival (3-year overall survival) was done by Kaplan-Meier survival curve analysis using Log-rank test. A 2-tailed (a = 2) P < 0.05 was considered statistically significant. Results: Out of the 63 response parameters, seven were found highly significant on multivariate analysis. The mean (± SD) age was 56.74 ± 10.76 years, the proportions of males were higher than females, mostly illiterate and lower income group. Among dietary characteristics, snuff was highest (OR = 3.86, 95% CI = 2.46-6.08) followed by salt tea (OR = 2.53, 95% CI = 1.49-4.29), smoking (OR = 1.97, 95% CI = 1.18-3.30), sundried food (OR = 1.77, 95% CI = 1.10-2.85) and red chilly (OR = 1.76, 95% CI = 1.07-2.89). Probability of survival lowered significantly (P < 0.05 or P < 0.01 or P < 0.001) in those consuming tobacco in the form of snuff (Log-rank c 2 = 24.62, P = 0.000) and smoking (Log-rank c 2 = 5.20, P = 0.023) as compared to those who did not take these. Conclusions: The analysis finally established snuff (smokeless tobacco) as the most powerful risk factor of esophageal cancer in Jammu region, followed by the salt tea, smoking and the sundried food.

In vitro effects of 5-hydroxytryptophan, indoleamines and leptin on arylalkylamine N-acetyltransferase (AA-NAT) activity in pineal organ of the fish, Clarias gariepinus (Burchell, 1822) during different phases of the breeding cycle.

Arylalkylamine N-acetyltransferase (AA-NAT) is the rate-limiting enzyme of melatonin biosynthetic pathway. In vitro effects of 5-hydroxytryptophan (5-HTP) and indoleamines (serotonin, N-acetylserotonin and melatonin) were studied on AA-NAT activity in the pineal organ of the fish, C. gariepinus during different phases of its annual breeding cycle. Further, in vitro effects of leptin on AA-NAT activity in the pineal organ were studied in fed and fasted fishes during summer and winter seasons. Treatments with 5-HTP and indoleamines invariably stimulated pineal AA-NAT activity in a dose-dependent manner during all the phases. However, leptin increased AA-NAT activity in a dose-dependent manner only in the pineal organ of the fed fishes, but not of the fasted fishes irrespective of the seasons.

Scrub Typhus:Jammu Outbreak-2009.

This is a first report of 20 adult cases describing clinical feature, epidemiological profile and treatment outcome of clinically diagnosed scrub typhus confirmed by test for antibodies (IgM) to O.tsutsugamushi using ELISA kit. Majority of the cases belonged to the district Rajouri (45%) froming hilly & rural belts.Outbreak was Autumn Winter type as all cases reported in month of September and October. The common clinical features were fever 100%, myalgia 50%, headache 30%, conjunctival congestion 30%, eschar 35%, rash 25%, lymphadenopathy 45%, splenomegaly 40%, hepatomegaly 40%, edema 25%, ARDS 35%, altered sensorium 10%, hypotension 20% & metrorrhagia in 5% of patients. Use of Immunological test helped to establish diagnosis of scrub typhus.Thus all the cases were managed successfully without any mortality with doxycycline and or azithromycine & one with addition of rifampicin.

In vitro effects of steroid hormones on arylalkylamine N-acetyltransferase (AA-NAT) activity in the pineal of fish, Clarias gariepinus (Burchell, 1822) during different phases of breeding cycle.

In vitro effects of gonadal hormones (testosterone, 17beta-estradiol estriol and estrone) and corticosteroid hormones (corticosterone and cortisol) were studied on arylalklyamine N-acetyltransferase (AA-NAT) activity in the pineal organ of the fish, C. gariepinus during quiescent, progressive, breeding and regressive phases of its annual breeding cycle. The pineals were collected under dim red light, maintained in organ culture for 7 hr and incubated with three concentrations (10(-6), 10(-5) and 10(-4) M) of hormones for 6 hr. The treatments with gonadal hormones and corticosteroid hormones inhibited pineal AA-NAT activity in a dose-dependent manner during all the phases of the breeding cycle. AA-NAT activity was comparatively more sensitive to the inhibitory effects of the gonadal hormones during the regressive phase and less sensitive during the quiescent phase. Further, the enzyme activity was more sensitive to the inhibitory effects of corticosteroid hormones (corticosterone and cortisol) during the breeding phase and less sensitive during the quiescent phase. These findings seem to suggest that gonadal hormones and corticosteroid hormones have direct inhibitory influence on AA-NAT activity and, hence melatonin synthesis in the photoreceptive pineal organ of C. gariepinus.

Molecular components and mechanism of adrenergic signal transduction in mammalian pineal gland: regulation of melatonin synthesis.

Rhythmic neural outputs from the hypothalamic suprachiasmatic nucleus (SCN), which programme the rhythmic release of norepinephrine (NE) from intrapineal nerve fibers, regulate circadian rhythm of melatonin synthesis. Increased secretion of NE with the onset of darkness during the first half of night stimulates melatonin synthesis by several folds. NE binds to both alpha1- and beta-adrenergic receptors present on the pinealocyte membrane and initiates adrenergic signal transduction via cyclic adenosine monophosphate (cAMP) and cyclic guanosine monophosphate (cGMP) generating pathways. The NE-induced adrenergic signal transduction switches 'on' melatonin synthesis during the early hours of night by stimulating expression of the rate-limiting enzyme of melatonin synthesis, N-acetyltransferase (AA-NAT) via cAMP-protein kinase A (PKA)-cAMP response element binding protein (CREB)-cAMP response element (CRE) pathway as well as by increasing AA-NAT activity via cAMP-PKA-14-3-3 protein pathway. Simultaneously, adrenergically-induced expression of inducible cAMP early repressor (ICER) negatively regulates aa-nat gene expression and controls the amplitude of melatonin rhythm. In the second half of night, increased release of acetylcholine from central pinealopetal projections, inhibition of NE secretion by SCN, withdrawal of adrenergic inputs and reversal of events that took place in the first half lead to switching 'off' of melatonin synthesis. Adrenergic signal transduction via cGMP-protein kinase G (PKG)-mitogen activated protein kinase (MAPK)-ribosomal S6 kinase (RSK) pathway also seems to be fully functional, but its role in modulation of melatonin synthesis remains unexplored. This article gives a critical review of information available on various components of the adrenergic signal transduction cascades involved in the regulation of melatonin synthesis.

Role of thyroidal and testicular hormones in regulation of tissue respiration in male air-breathing fish, Clarias batrachus (Linn.).

In vivo and in vitro effects of thyroidal hormones (MIT, DIT, T3, T4), propyl thiouracil (PTU), testosterone and cyproterone acetate were studied on the rate of tissue (liver, muscle, kidney and brain) respiration of adult male C. batrachus during winter and summer/rainy seasons. Monoiodotyrosine (MIT) and diiodothyrosine (DIT) increased the respiratory rate in a dose-dependent and temperature-independent manner. Triiodothyronine (T3) and thyroxine (T4) stimulated tissue respiration during summer/rainy months but not during winter. PTU decreased tissue respiration during summer/rainy season and also at simulated low temperature. Testosterone invariably stimulated the rate of respiration of the tissues, while in vivo treatment with cyproterone acetate significantly decreased the metabolic rate of all the tissues. The findings suggest that in C. batrachus MIT and DIT may be more important than T3 and T4 at low temperature, endogenous thyroid hormones are involved indirectly in energy metabolism even during winter/at low temperature and testicular hormones are actively involved in the respiration.

In vivo effects of a single dose of norepinephrine and epinephrine on tissue respiration of hibernating and non-hibernating species of frogs.

In vivo effects of a single dose of norepinephrine (NE) and epinephrine (EP) were studied on the rate of tissue (liver and skeletal muscle) respiration in Rana limnocharis (hibernating Sp.) and Rana cyanophlyctis (non-hibernating Sp.) during winter and summer months after 10 and 30 min, 1, 6, 12 and 24 hr of administration. During winter both NE and EP induced significant increase in the rate of tissues respiration only after 30 min after their administration in both the species and the stimulatory effect lasted up to 6 hr. During summer, however, NE and EP stimulated respiratory rate of tissues comparatively after a shorter lag period (10 to 30 min) in R. limnocharis than that of R. cyanophlyctis (30 min to 6 hr). These findings seem to suggest that NE and EP can stimulate tissue respiration very quickly, and, therefore, might be suitable as emergency hormones for instant/faster stimulation of energy metabolism in amphibians.

Involvement of adrenal hormones in tissue respiration of sub-tropical hibernating and non-hibernating species of frogs.

Effects of norepinephrine (NE), epinephrine (EP), corticosterone and cortisol were studied both in vivo and in vitro on the rate of oxygen consumption of tissues (liver, skeletal muscle and kidney) of sub-tropical Indian frogs Rana limnocharis (a hibernating species) and Rana cyanophlyctis (a non-hibernating species) exposed to natural climatic conditions during winter and summer/rainy seasons. Further, the effects of NE and EP were also studied in vitro in the presence of specific beta- and alpha-adrenergic antagonists (propranolol and prazosin). NE, EP and corticosterone, when administered in vivo or in vitro, significantly stimulated the respiratory rate of the tissues of both the species irrespective of the seasons/temperature. Results suggest that NE, EP and corticosterone are directly involved in regulation of the energy metabolism of both hibernating and non-hibernating species of sub-tropical frogs. The calorigenic action of NE and EP seems to be mediated by both beta- and alpha-adrenergic receptors. However, the temporal involvement of beta- and alpha-adrenergic receptors seems to be tissue-dependent.

In vivo and in vitro effects of metabolic hormones on tissue respiration in toad, Bufo melanostictus during hibernation and active phase.

In vivo and in vitro effects of L-T3, L-T4, estradiol, corticosterone, epinephrine and norepinephrine were studied on the rate of liver and muscle tissue respiration in B. melanostictus during hibernation and active phase under natural climatic conditions. Thyroid hormones were found to be calorigenic only during the active phase. Estradiol stimulated the respiratory rate directly during hibernation and indirectly during the active phase. Adrenal hormones invariably increased the respiratory rate of the tissues in all the experiments. On the basis of the present findings it can be concluded that the sensitivity of the tissues to various hormones is altered during the active phase and hibernation. The calorigenic action of thyroid hormones seems to be associated with activity-linked energy demand. Direct stimulation of tissue respiration by estradiol during hibernation may be of great adaptative significance. Due to their temperature-independent calorigenic action, adrenal hormones may be considered as emergency hormones for the regulation of the oxidative metabolism in the toad.

Controlled trial of twice a day versus once a day cimetidine therapy for duodenal ulcer.

A randomized controlled trial was carried out to compare the efficacy of conventional 400 mg twice daily dose of cimetidine with single bedtime 800 mg dose, in 40 patients with endoscopically proven duodenal ulcer. At repeat endoscopy after four weeks of therapy, complete ulcer healing was achieved in 78% of patients on twice daily dosage and 79% of patients on single daily dosage. A more convenient single nocturnal dosage of cimetidine is as effective in the treatment of duodenal ulcer as a twice daily dosage in the Indian population.

Albendazole in pulmonary hydatid disease.

A case of bilateral pulmonary hydatid disease successfully treated with six courses of albendazole obviating need for surgery is being reported. No side-effects of the drug were observed. Though the cysts ruptured initially but disappeared completely. No recurrence has been observed.

Effects of thyroidal, gonadal and adrenal hormones on tissue respiration of streaked frog, Rana limnocharis, at low temperature.

In vivo and in vitro effects of thyroidal, gonadal and adrenal hormones were studied on the rate of liver and skeletal muscle respiration in both the sexes of R. limnocharis during active and inactive phases of the annual activity cycle. Triiodothyronine (L-T3) and thyroxine (L-T4) did not stimulate tissue (liver and muscle) respiration in any of the experiments irrespective of season, sex and temperature. Testosterone, estradiol and corticosterone stimulated O2 uptake significantly irrespective of season, sex and temperature. Adrenaline and nor-adrenaline also stimulated tissue respiration significantly during the winter month. Since the ambient temperature was low even during the active phase (max. temperature 21 degrees C), it seems that the frog might have developed tissue sensitivity for gonadal and adrenal hormones at low temperatures when thyroid hormones are calorigenically ineffective.

Ultrasonography in non-cirrhotic portal hypertension: correlation with splenoportography.

Real time sonography followed by splenoportography was performed in 38 cases with non-cirrhotic portal hypertension. Eleven of these cases, in whom porto-systemic shunt surgery was done, were also evaluated by real time sonography post-operatively. The ultrasound findings correlated well in 37 cases (98%) with splenoportography. All the post-operative cases also revealed a patent portosystemic shunt on sonography. Ultrasonography, a valuable, non-invasive, initial investigation of portal hypertension, may thus be used as the only investigation to distinguish intra- from extra-hepatic obstruction and to evaluate patency of surgically created porto-systemic shunts. Invasive portography may be performed only if surgical treatment is anticipated.