Is Teneligliptin Safe in Patients with Diabetes Mellitus Mainly with Reference to QT Prolongation.

Diabetes mellitus (DM) is a chronic disease associated with polyurea, polydipsia, and polyphagia. It is associated severe complication if not controlled properly. The probability of developing cardiac arrythmia is more in patients with diabetes compared to general population. Previously, studies which used a maximum dose of 40 mg of Teneligliptin didn’t show any QT prolongation. There are hardly any studies which was done to prove the cardio safety of Teneligliptin. Therefore, we wanted to evaluate the prevalence of QT prolongation with teneligliptin in diabetic patients. MethodsWe analysed all patients who were treated with teneligliptin. We analysed ECG of all patients before and after therapy with teneligliptin. Our main aim was to compare the QT interval in ECG before and at the end of 3 months. We also analysed their HbA1c, fasting plasma glucose (FPG), and postprandial plasma glucose (PPG) before and after therapy. ResultsThe mean age of these patients was 55.5 ± 10.6 years. They were on treatment for diabetes with a mean duration of diabetes of 7.9 ± 5.7 years. All patients responded well to the treatment with a reduction in HbA1c, FBS and PPBS, all of those being statistically significant. When we analysed the QT interval of all patients before and after three months of therapy, there was no significant increase in the mean QTc interval at the end of 3 months. All of them tolerated the drug without any serious adverse effects. ConclusionsTeneligliptin in dose of 20 mg didn’t prolong QTc interval; meanwhile, it was found to be very effective in reducing the HbA1c, fasting plasma glucose, and post prandial plasma glucose at the end of 3 months.

Study of clinical characteristics of women with polycystic ovarian syndrome

Background: Polycystic ovarian syndrome (PCOS) is one of the most common endocrinal disorders of the reproductive age group causing anovulation, infertility incidence being 8.7-17.8%. It is associated with obesity, insulin resistance, dyslipidaemia and metabolic syndrome. This study was aimed to study the different clinical characteristics of women diagnosed with PCOS, attending a tertiary care hospital outpatient department.Methods: This was a hospital-based cross-sectional observational study of 200 patients with PCOS meeting the revised Rotterdam criteria from January 2018-June 2019 excluding pregnant and women with other systemic disorders. A detailed history and examination done, data collected regarding menstrual complaints, features of hyperandrogenism, hirsutism, acne, oily skin and Acanthosis Nigricans (AN) was documented. All data were statistically analyzed and compared using the chi-square or fissures’ exact test. p-value <0.05 considered significant.Results: A total of 200 patients with PCOS were included in the study, of which 41% were obese, 18% lean. The mean age was 24.44±5.62 years. Menstrual complaints were present in 88% -oligomenorrhea (49%) being the most common. 59% had hirsutism,38% of severe grade. Acanthosis nigricans was present in 33% of the patients. Correlation between hirsutism and alopecia, waist to hip ratio (WHR); acanthosis and WHR were statistically significant.Conclusions: PCOS is an ill-defined symptom complex where ethnicity plays a vital role, hence creating a greater need to know the characteristics of the syndrome in different populations and ethnicity. All women presenting with oligomenorrhea or other menstrual complaint should be investigated for PCOS and treated accordingly. The syndrome usually occurs with multiple characters. Though obesity is common in PCOS, non-obese are also at risk. The prevalence of AN and Hirsutism in PCOS were comparable. This mandates a need to increase awareness regarding the syndrome in the general population.

Clinical profile of insulinoma: analysis from a tertiary care referral center in India.

Objective To describe the clinical presentation, localization techniques, surgical procedures and outcome in patients with insulinoma. Methods Retrospective analysis of case records of patients diagnosed with insulinoma between January 1993 and June 2009 at a tertiary-care hospital was done. Seventeen patients underwent diagnostic 72-h fast. The sensitivity of computed tomography (CT) of pancreas was judged using intraoperative findings as the gold standard. Results Twenty-six patients (19 women) with mean age 42.2 years (median age 39.5 years) with biochemical/ imaging evidence of insulinoma were included. All patients who underwent 72-h fast developed symptomatic hypoglycemia within 48 h. The sensitivity and positive predictive value (PPV) of CT of pancreas was 68.4% and 92.8%, respectively. Twenty patients underwent surgery, of whom four were operated on without preoperative localization. Four patients had recurrence of symptoms. Of the six patients who were not operated upon, the lesion was localized in four. Conclusion This audit shows that all patients with insulinoma develop hypoglycemia within 48 h of fasting. CT of pancreas localizes the lesion in two thirds of cases and would be a useful initial investigation in patients with suspected insulinoma.

Prepubertal gynecomastia a rare complication of growth hormone therapy.

We report a case of prepubertal gynecomastia diagnosed during growth hormone (GH) treatment. In our patient gynecomastia appeared 6 months after GH was started. This condition appears to be self-limited and benign. In our patient gynaecomastia resolved on its own.

Primary hyperparathyroidism in children and adolescents.

Objective. Primary hyperparathyroidism (PHPT) in children and adolescents is a rare condition. Awareness should improve in order to lower threshold for screening and allow intervention before serious and permanent sequelac occur. Methods. A retrospective analysis of 15 children and adolescents with PHPT (age <20 yr) seen in our clinic between 1993 and 2006. Results. Mean age of patients was 17.73 yr (Range - 13-20, Male-3: Female-12). Average duration of symptoms was 18.87 (range: 0-48) mo. Clinical features at presentation included bone pain (86.67%), proximal myopathy (46.67%), bony deformities (53.33%), fractures (60%), palpable osteitis fibrosa cystica (33.3%), renal calculi (40%), palpable neck swelling (13.3%) and acute pancreatitis (6.67%). None had positive family history or features suggestive of multiple endocrine neoplasia (MEN). After biochemical confirmation, tumor was localised in all prior to surgery. Histopathology confirmed adenoma in all cases. Post-operative hungry bone syndrome occurred in 33.3%. Conclusion. PHPT is more common in females. Presentation of the disease is similar to their adult counterparts except for more severe bone disease and less severe renal disease. MEN and familial non-MEN PHPT do not constitute a major cause of pediatric PHPT as against to worldwide data. The incidence of hyperplasia as a cause of PHPT is rare in our pediatric population.

Pheochromocytoma in children and adolescents.

Eleven subjects aged <20 yr with histologically proven pheochromocytoma between 1987 and 2006 were analyzed. Family history was present in 18%. In 2 patients, pheochromocytoma was part of VHL and in one it was associated with MEN 2. Twenty four hour urine VMA level was elevated in 100% and metanephrine level in 73%. CT/ MRI were showing the tumor in all. Prazosin extended release tablets (maximum 30 mg/day) were used in 73% and doxazosin (maximum 12 mg/ day) in 27%. Intraoperative BP fluctuations were seen in 27%. All were biochemically cured after surgery. Preoperative á blockade with extended release prazosin and doxazosin were effective in controlling perioperative BP fluctuations. Hence these drugs can be used in children and adolescents without fear of postoperative hypotension.

Clinical profile of adrenoleukodysrophy.

X-linked Adrenoleukodystrophy (ALD) is the most common of the peroxisomal disorder and is associated with functional defect of the very long chain fatty acid (VLCFA) oxidation leading to the accumulation of VLCFA in the white matter and adrenal cortex. Retrospective evaluation of medical records of ALD patients were carried out. In all the 5 patients the duration of the symptoms varied from 1-7 years. Most of them presented with Addisonian crisis (4/5) and hyperpigmentation (5/5), white half of them (3/5) had neurological symptoms. All patients had biochemical evidence of the adrenal insufficiency. All siblings of patients should be screened for the possibility of ALD with VLCFA.