Sodium-glucose Cotransporter-2 Inhibitors in Primary and Secondary Prevention of Cardiovascular and Renal Outcomes in Patients with Type 2 Diabetes Mellitus: A Meta-analysis

Background: The available evidence was systematically reviewed to evaluate the effects of sodium-glucose cotransporter 2 (SGLT2) inhibitors (SGLT2i) on cardiovascular (CV) and renal outcomes in people with type 2 diabetes mellitus (T2DM) and atherosclerotic cardiovascular disease (ASCVD) or multiple risk factors (MRF), with or without heart failure (HF), and per estimated glomerular filtration rate (eGFR) rate at baseline. Methods: We comprehensively searched three electronic databases to retrieve publications up to 30th November 2019, which were screened for inclusion. The data extracted for the outcomes according to baseline ASCVD, HF, and eGFR levels were meta-analyzed using fixed effects model. Results: Of the 735 screened citations, 15 primary and secondary publications from five CV or renal outcome trials were included. SGLT2is reduced the risk of CV death or hospitalization for HF (HHF), HHF alone, and composite renal-specific outcome, irrespective of ASCVD and HF at baseline. The three-point major adverse cardiovascular events (3P-MACE) risk was reduced by 14% (p<0.001) in patients with ASCVD and by 10% (p = 0.018) in those without baseline HF compared with their counterparts. SGLT2is significantly reduced the risk of MACE (18%) in patients with mild kidney dysfunction (eGFR within the range of 60–<90 mL/min/1.73 m2 and <60 mL/min/1.73 m2 ). Conclusion: SGLT2is are effective for both secondary and primary prevention of composite CV outcomes, and secondary prevention of MACE. The upcoming evidence may strengthen the primary prevention benefits of SGLT2is.

Treatment satisfaction among diabetics attending a tertiary care hospital of Rohtak, Haryana: a cross-sectional study

Background: The epidemic of diabetes mellitus is rising globally due to urbanization, population growth, aging, obesity and sedentary life style. Treatment satisfaction is defined as the individual’s rating of important attributes of the process and outcomes of his/her treatment experience and it represents an important outcome as it is related to adherence and willingness to continue treatment.Methods: A cross-sectional descriptive hospital-based study was conducted at endocrinology OPD attached to Pt. B.D. Sharma PGIMS Rohtak, Haryana from May 2014 to April 2015. Five hundred diabetics (type 1 and 2) were recruited for the study. Patients registered on the day of interview were selected using systematic random sampling. A predesigned, pretested, semi-structured schedule which included socio-demographic variables of the study subjects along with information about family history of diabetes was filled by interviewing the study subjects in their vernacular language individually. DiabMedSat was used to assess the treatment satisfaction.Results: Nearly two third of the study participants were treated on oral hypoglycaemic agents (76.2%) followed by subjects treated on insulin+OHA (21.4%). 2.4% of the study subjects were on treatment with insulin alone. 87.8% of female subjects were satisfied with their treatment as compared to 86.3% of their male counterparts.Conclusions: Treatment satisfaction has a positive influence on quality of life of the study subjects as those who are satisfied tend to better adhere to their drug regimen thereby achieving a desirable glycaemic control and averting the complications associated with the disease thereby leading to a healthier life.

De La Chapelle Syndrome: A rare case of male infertility / Journal of the ASEAN Federation of Endocrine Societies

@#<p style="text-align: justify;">A 25-year-old Indian male presented to Endocrine Outpatient Department of PGIMS Rohtak with chief complaints of inability to father a child in spite of 2 years of unprotected sexual intercourse. Patient had a normal male phenotype, however seminal fluid analysis was suggestive of azoospermia. Karyotyping chromosomal analysis showed 46, XX chromosomes. The frequency, etiology and diagnosis of this syndrome are reviewed here.</p>

Evaluation of Body Dysmorphic Disorder in Hair Loss Patients and Benefit After Hair Transplant.

Introduction: Body dysmorphic disorder (BDD) is excessive concern about physical appearance leading to mental, social & functional distress. Patients seek cosmetic surgery not psychiatry & may remain dissatisfi ed after surgery. Study includes 100 hair transplant patients. Materials and Methods: From 1st Jan to 31st July 2013. Patient’s Personal Evaluation, Yale Brown Obsessive Scale, Sheehan Lifestyle Disability Scale & Derriford Appearance Scale were used for evaluation. Patients deformities were corrected with hair transplant and these patients were reassessed. Results: 10 months later to judge the benefi t. BDD prevalence in hair loss is 28%, which is higher than rhinoplasty 20.7%. Preoccupation of hair loss on the minds of the patients is much higher than perceived by their doctors. After hair transplant 52% patients considered their baldness has been corrected, 32% patients, had milder perception of their defect but 16% continue to feel that they have less hair than others. Conclusion: Th e study shows that hair loss patients who display BDD like concerns, can have signifi cant benefi t in personal life, social life and work performance after hair transplant. Study also shows that four diff erent psychiatry scales can be used for evaluation and follow up of BDD in hair loss patients.

Prevalence of gestational diabetes mellitus & associated risk factors at a tertiary care hospital in Haryana.

Background & objectives: Prevalence of gestational diabetes mellitus (GDM) is known to vary widely depending on the region of the country, dietary habits, and socio-economic status. This study was undertaken to determine the prevalence of GDM and risk factors associated with it, in women attending an antenatal care (ANC) clinic at a tertiary care hospital in Haryana. Methods: This study enrolled women, with their estimated gestational age between 24th and 28th week, attending antenatal care (ANC) clinic at a tertiary care hospital in Rohtak. After informing, women who consented to participate were given a standardized 2-h 75 g oral glucose tolerance test (OGTT). A proforma containing general information on demographic characteristics, socio-economic status, education level, parity, family history of diabetes and/or hypertension and past history of GDM was filled up. American Diabetes Association (ADA) criteria for 75 g 2-h OGTT was used for diagnosing GDM. Results: A total of 607 women participated in the study and GDM was diagnosed in 43 (7.1%) women. A single abnormal value was observed in additional 66 (10.87%) women. On bivariate analysis risk factors found to be significantly associated with GDM were age, educational level, socio-economic status, pre-pregnancy weight and BMI, weight gain, acanthosis nigricans, family history of diabetes or hypertension and past history of GDM but on multivariate analysis only upper middle class and presence of acanthosis nigricans were found to be significantly associated with GDM. Interpretation & conclusions: The prevalence of GDM was found to be 7.1 per cent in a tertiary care hospital in Haryana. Appropriate interventions are required for control and risk factor modifications.

Clinico-Radiological Correlation in Childhood Hypopituitarism.

Non-tumor etiology constitutes a major group of childhood hypopituitarism. Magnetic resonance imaging has enormously complimented hormonal assessment in these patients. We describe clinico-radiological correlates in thirtyone children (23 boys), aged 1-17 years with a peak GH (growth hormone) levels <7 ng/mL after pharmacological stimuli. Hypoplastic pituitary gland was the most frequent abnormality in children with isolated growth hormone deficiency (IGHD) as compared to stalk abnormalities in children with multiple pituitary hormone deficiencies. MRI tetrad (hypoplastic/absent pituitary, hypoplastic stalk, absent/ ectopic posterior pituitary bright spot and empty sella) was more prevalent in IGHD. MRI abnormalities correlated with the severity of growth hormone deficiency.

A pilot study on hypothalamo-pituitary-adrenocortical axis in primary hyperparathyroidism.

Background & objectives: Parathormone (PTH) and calcium, both have been shown to stimulate adrenal steroidogenesis in animal models and in vitro experiments. This is attributed to structural similarity between 15-25 amino acid region of the parathyroid hormone (PTH) and 1-11 amino acid region of adrenocorticotropin (ACTH). However, there are no in vivo human data regarding the effect of PTHcalcium axis on adrenocortical function. Materials: Ten patients with primary hyperparathyroidism underwent evaluation for cortisol dynamics including 0800 h and 2000 h plasma cortisol on day 1, cortisol response to insulin induced hypoglycaemia (IIH) on day 2, and 1 mg overnight dexamethasone suppression test (ONDST) on day 4. Serum aldosterone was also measured at 0800 h in fasting state on salt ad libitum for three days. These parameters were repeated 3 months after curative parathyroidectomy. Results: Basal plasma cortisol level at 0800 h and 2000 h were within upper normal range and loss of circadian rhythm in cortisol secretion was observed in half and forty per cent of patients had nonsuppressibility with ONDST. The defined peak cortisol response to insulin induced hypoglycaemia (>550 nmol/l) was achieved in all and nearly one third of patients had exaggerated response (>2000 nmol/l). After curative parathyroidectomy, the abnormalities in circadian rhythm and non-suppressibility with ONDST continued to prevail in 40 per cent of patients. The peak cortisol response to IIH showed a decrement but remained higher than normal. No correlation was observed between circulating parathyroid hormone and calcium with cortisol levels. Serum aldosterone was in upper normal range pre - and postoperatively, though it decreased postoperatively, but it could not attain a statistical significance (p = 0.5). Interpretation & conclusion: Abnormalities in hypothalamo-pituitary-adrenocortical axis in primary hyperparathyroidism do occur, however these are inconsistent and do not recover in majority of patients even after 3 months of curative parathyroidectomy.

Rational use of glucocorticoid during pituitary surgery--a pilot study.

BACKGROUND & OBJECTIVE: The conventionally used perioperative glucocorticoid replacement protocol in patients with pituitary tumours is far from optimal. In this study we evaluated the validity of a modified protocol for perioperative glucocorticoid replacement in non-functioning pituitary macroadenomas. METHODS: A total of 24 consecutive patients with non functioning pituitary macroadenomas were included in this interventional study. Patients with a pre-operative 0800 h cortisol of > or = 350 nmol/l (> or = 12.6 microg/dl) did not receive glucocorticoid replacement during perioperative (d(0)-d-(2)) period, while those with < or = 100 nmol/l (< or = 3.6 microg/dl) received glucocorticoid replacement. Those patients with 0800 h cortisol value between > 100-349 nmol/l (> 3.6-12.6 microg/dl) required them to undergo an insulin induced hypoglycaemia (IIH). In response to IIH, patients with a peak cortisol of < 550 nmol/l (< 19.8 microg/dl) received glucocorticoid replacement. Post-operatively, patients on day 3 with 0800 h cortisol of < or = 100 nmol/l (< or = 3.6 microg/dl) received hydrocortisone 10 mg/m(2) per day; those between > 100-449 nmol/l (> 3.6-16 microg/dl) received hydrocortisone replacement only if they had symptoms of adrenal insufficiency (AI) or during stress; while patients with > or = 450 nmol/l (> or = 16.0 microg/dl) did not receive any glucocorticoid replacement. Retesting was done at 12 wk in 23 subjects based on the algorithm. RESULTS: Pre-operatively, 8 (35%) patients were hypocortisolic and received glucocorticoid supplementation, thereby sparing 15 (65%) subjects from glucocorticoid replacement. On d(3) of surgery, 13 (57%) patients were hypocortisolic, but only 6 with serum cortisol of < or = 100 nmol/l (< or = 3.6 microg/dl), had symptoms and were substituted with glucocorticoid. Remaining seven patients, with serum cortisol between >100-349 nmol/l (> 3.6-12.6 microg/dl), were asymptomatic and advised glucocorticoid support only during stress but none required. Overall, 17 (74%) patients were spared from unnecessary glucocorticoid support. At 12 wk, 13 (57%) patients were hypocortisolic and only 6 either with serum cortisol level of < or = 100 nmol/l (< or = 3.6 microg/dl) or symptomatic for AI received glucocorticoids. Post-operative complications including diabetes insipidus and CSF leak remarkably decreased. INTERPRETATION & CONCLUSION: The protocol used was safe and spared unnecessary use of glucocorticoids peri- and post-operatively. However, more number of patients are to be studied to substantiate the validity of this protocol.

Chronic lymphocytic leukemia manifested by steroid responsive polyneuropathy.

We report a patient of acute demyelinating polyneuropathy who on investigations turned out to be suffering from chronic lymphocytic leukaemia (stage 0). Response to steroid therapy suggests an autoimmune process as a cause of polyneuropathy. Chronic lymphocytic leukaemia manifested by acute polyneuropathy has been described rarely in literature.