Hippocampal Volume And Type 2 Diabetes Mellitus Without Comorbid Malady.

BACKGROUND: Evidence of type 2 diabetes mellitus (T2DM) associated with hippocampal atrophy is reported by researchers all around the globe. The majority of such studies were conducted among the geriatric and elderly populations with other substantial co-morbid diseases. Hence, the present study aims to evaluate the hippocampal volume of T2DM subjects below 60 years without any concomitant disorders and assess the declarative memory. MATERIALS AND METHODS: The cross-sectional observational study was conducted among the ethnic population of Manipur. A total of 17 T2DM subjects and 17 healthy controls, who are apparently healthy, matched by age, sex, and comparable education, were enrolled in the study. Magnetic Resonance Imaging (MRI) of high-resolution sagittal structural T1-weighted anatomical sequence was acquired using a three-dimension magnetization-prepared rapid-acquisition gradient echo (MPRAGE). The hippocampus volume was measured using the volBrain Automated MRI Brain Volumetry System. Declarative memory was estimated by the Rey Auditory Verbal Learning Test (RAVLT). RESULTS: No statistically significant differences were found in hippocampal volume, and RAVLT scores between T2DM subjects, and healthy controls group (P > 0.05). CONCLUSIONS: The study data indicates that there is no particular hippocampal volume vulnerability in T2DM participants within the ethnic population of Manipur.

Managing type 1 diabetes in remote and challenging locations in India.

Type 1 diabetes mellitus is a challenging situation for both physician and patient, as it requires a very disciplined lifestyle with regular monitoring and follow-up. It becomes even more difficult when facilities are limited. Manipur has a difficult terrain and due to lack of adequate facilities patients face frequent hypoglycemic episodes and hyperglycemic crises. Continuous availability of insulin is not possible at all times. The health care workers in the state are not fully aware of right practices and incorrect injection sites and erroneous techniques are also quite prevalent. Some quacks and traditional healers claim that they can cure diabetes by their indigenous preparation.

Seroprevalence of hepatitis C infection in type 2 diabetes mellitus.

INTRODUCTION: Hepatitis C is an emerging disease with different studies showing varying prevalence rates across India. In several studies, prevalence of hepatitis C infection was found to be higher in diabetics than nondiabetics. However, none has been reported from India. OBJECTIVES: The aim was to determine the sero-prevalence of hepatitis C infection in type 2 diabetes mellitus (T2DM). SETTINGS AND DESIGN: Cross-sectional study of all T2DM patients attending endocrine clinic in Regional Institute of Medical Sciences, Imphal from October 2011 to September 2013. SUBJECTS AND METHODS: All T2DM patients included and exclusion criteria are patients with other forms of diabetes, liver failure, renal failure, malignancy or other chronic illness. Patient's age, sex, height, weight, body mass index, history of risk factors, etc., collected and investigated for blood glucose fasting and prandial levels, transaminases levels, hepatitis C virus (HCV) screening, etc.. STATISTICAL ANALYSIS: Statistical analysis was performed using Statistical Package for the Social Sciences version 20; appropriate test used where applicable. RESULTS: Out of the 192 T2DM patients screened, prevalence rate of HCV sero-positivity is found to be 5.7% (11/192), higher in males. History of jaundice in the past was the only significant history among sero-positive patients. Transaminases levels are significantly higher in sero-postive cases. They had higher fasting and postprandial blood glucose, fasting glucose levels being significantly higher. CONCLUSION: Our study shows a slightly higher prevalence of hepatitis C infection in type 2 diabetics.

Thyroid dysfunction in human immunodeficiency virus-infected children and its correlation with CD4(+) T lymphocyte count.

CONTEXT: Thyroid dysfunction has been reported in human immunodeficiency virus (HIV)-infected individuals including children. Some studies have reported that thyroid dysfunction may be a marker of severity or progression of HIV. AIMS: The aim was to study thyroid function in HIV-infected children with and without highly active anti-retroviral therapy (HAART). SETTINGS AND DESIGN: Cross-sectional study carried out at a teaching hospital with Anti-Retroviral Therapy Centre (Centre of Excellence) of National AIDS Control Organization. SUBJECTS AND METHODS: Thyroid stimulating hormone (TSH), total thyroxine (T4), and total tri-iodothyronine (T3) were analyzed in 60 pediatric HIV cases: 30 on HAART and 30 HAART naive. Correlation of T3, T4, and TSH with CD4 count was assessed. STATISTICAL ANALYSIS USED: Data reported as mean ± standard deviation and as the number of cases and percentages. Comparison between groups was done by independent sample t-test and χ(2)-test. Spearman's correlation coefficient is used to assess the association between thyroid dysfunction and CD4 count. RESULTS: Thyroid function abnormality was seen in five out of 30 patients in both patients on HAART or without HAART therapy. Among patients on HAART, three had hypothyroidism, and two had biochemical feature of sick euthyroid syndrome. Among the HAART naive group, sub-clinical hypothyroisim was seen in four, and one had biochemical feature of sick euthyroid syndrome. None of the patients had clinical features of thyroid dysfunction. There is a highly significant correlation (P = 0.01) between TSH and CD4 count. CONCLUSIONS: Thyroid dysfunction is quite common among pediatric HIV cases. An inverse correlation is seen between TSH and CD4 count indicating trend for hypothyroidism as HIV disease progress.

Metabolic abnormalities in human immunodeficiency virus patients with protease inhibitor-based therapy.

CONTEXT: Several studies have reported metabolic abnormalities in patients taking protease inhibitor (PI) based therapy from several parts of the world. But there is no prospective study in India after switching from PI sparing regimen to PI based regimen. AIMS: To assess whether North-East Indian Human Immunodeficiency Virus (HIV) patients also develop similar metabolic abnormalities to PI. SETTINGS AND DESIGN: This prospective study was conducted in Anti-retroviral therapy (ART) Centre of Excellence, at a tertiary care Medical Institute. MATERIALS AND METHODS: Fifty-five patients taking PI based ART were taken for the study. These patients were started on Ritonavir based therapy, after treatment with first line drugs had failed according to National AIDS Control Organization (NACO) guidelines 2008. Glucose and lipid profiles were evaluated. American Diabetes Association (ADA) and NCEP ATP III criteria were used to categorize glucose and lipid abnormalities. International Diabetes Federation (IDF) 2006 cut-off was used for waist circumference and blood pressure. STATISTICAL ANALYSIS USED: Paired t-test was done whenever applicable. RESULTS: There was a significant increase in waist circumference after 6 months of 2(nd) line ART from 78.0 cm to 80.2 cm (P value < 0.001). There was significant increase in both systolic and diastolic blood pressure after 6 months. In 29.8% of patients blood pressure rose to hypertensive level after 6 months. Total cholesterol, triglyceride and low density lipoprotein cholesterol also rose significantly after 6 months but not high density lipoprotein cholesterol. CONCLUSIONS: Our study showed that North-Eastern Indian patients also develop metabolic abnormalities to protease inhibitors similar to people of other races.

Familial vitamin D resistant rickets: End-organ resistance to 1,25-dihydroxyvitamin D.

Rickets is softening of bones due to defective mineralization of cartilage in the epiphyseal growth plate, leading to widening of ends of long bones, growth retardation, and skeletal deformities in children. The predominant cause is deficiency or impaired metabolism of vitamin D. The observation that some forms of rickets could not be cured by regular doses of vitamin D, led to the discovery of rare inherited abnormalities of vitamin D metabolism or vitamin D receptor. Vitamin D dependent rickets (VDDR) is of two types: Type I is due to defective renal tubular 25-hydroxyvitamin D 1-α hydroxylase and type II is due to end-organ resistance to active metabolite of vitamin D. Typical signs are observed from the first month of life. The patient with rickets described below had markedly increased serum alkaline phosphatase and 1,25-dihydroxyvitamin D. We attribute these abnormalities to impaired end-organ responsiveness to 1,25-dihydroxyvitamin D.

Prevalence of gestational diabetes mellitus and its correlation with blood pressure in Manipuri women.

OBJECTIVE: The aim and objective was to study the prevalence of gestational diabetes mellitus (GDM) by using National Diabetes Data Group (NDDG) and American Diabetes Association (ADA) (2004) criteria and the correlation of GDM with gestational blood pressure (BP) and maternal age. STUDY DESIGN: This was a cross-sectional study in which 300 pregnant women in 24-28 weeks of pregnancy who screened positive with 1-h glucose load ≥ 140 mg/dL underwent a diagnostic 3-h oral glucose tolerance test (OGTT). BP was obtained by review of the medical records. RESULTS: Thirty-seven (12.33%) women were screened positive with 50 g glucose challenge test (GCT) (≥140 mg%) out of the 300 participants. With 100 g 3-h OGTT among these 37 women, none of them fulfilled the NDDG diagnostic criteria for GDM. However, on using the ADA (2004) criteria, three (8.1%) women were diagnosed to have GDM. All three of them had systolic BP between 120 and 139 mmHg; two of them had diastolic BP between 80 and 89 mmHg. Among 37 subjects with GCT > 140 mg%, majority were older than 26 years. CONCLUSION: Using the ADA (2004) guideline, 1% of the total study population had GDM. The BP of these patients fell within the prehypertensive range, thus suggesting an association between GDM and BP.

Nephrolithiasis: Endocrine evaluation.

Nephrolithias is a common problem in populations around the world, and contribute significantly to the development of end stage renal disease. It is a matter of debate whether the metabolic factors responsible for renal stone formation are similar or variable in different populations around the globe. This review discusses the influence of different metabolic and dietary factor, and some other co-morbid conditions on the etiopathogenesis Nephrolithiasis. Evaluation and medical management of Nephrolithiasis is summarized in the later part of the article.

Thyroid dysfunction in type 2 diabetes mellitus: A retrospective study.

INTRODUCTION: Type 2 diabetes mellitus (DM) is a growing problem in our country and we have observed that many patients are associated with thyroid dysfunction later in their life. However, the prevalence of thyroid dysfunction in these patients has not been investigated. AIMS AND OBJECTIVES: To find the prevalence of thyroid dysfunction in type 2 DM in Manipur, India. MATERIALS AND METHODS: In this retrospective study, data of 202 Type 2 DM patients who attended the diabetic clinic of the Regional Institute of Medical Sciences, Imphal from January 2011 to July 2012, and whose thyroid stimulating hormone (TSH) level was investigated were included. The inclusion criteria are known cases of type 2 DM. Exclusion criteria are patients with previous history of hypothyroidism and those on drugs affecting the thyroid profile. RESULTS: Out the 202 type 2 DM patients for the study of which 61 are males and 141 are females, 139 (68.8%) are euthyroid, 33 (16.3%) have subclinical hypothyroidism (10 males and 23 females), 23 (11.4%) have hypothyroidism (6 males and 17 females), 4 (2%) have subclinical hyperthyroidism and 3 (1.5%) are hyperthyroidism cases. Maximum cases were of hypothyroidism (subclinical and clinical) seen in the age group of 45-64 years. Patients with BMI > 25 were at increased risk of having hypothyroidism (P < 0.016). CONCLUSION: Prevalence of hypothyroidism is quite high in type 2 DM patients above 45 years and more so if their BMI is over 25.

Pituitary apoplexy.

Pituitary apoplexy is rare endocrine emergency which can occur due to infarction or haemorrhage of pituitary gland. This disorder most often involves a pituitary adenoma. Occasionally it may be the first manifestation of an underlying adenoma. There is conflicting data regarding which type of pituitary adenoma is prone for apoplexy. Some studies showed predominance of non-functional adenomas while some other studies showed a higher prevalence in functioning adenomas amongst which prolactinoma have the highest risk. Although pituitary apoplexy can occur without any precipitating factor in most cases, there are some well recognizable risk factors such as hypertension, medications, major surgeries, coagulopathies either primary or following medications or infection, head injury, radiation or dynamic testing of the pituitary. Patients usually present with headache, vomiting, altered sensorium, visual defect and/or endocrine dysfunction. Hemodynamic instability may be result from adrenocorticotrophic hormone deficiency. Imaging with either CT scan or MRI should be performed in suspected cases. Intravenous fluid and hydrocortisone should be administered after collection of sample for baseline hormonal evaluation. Earlier studies used to advocate urgent decompression of the lesion but more recent studies favor conservative approach for most cases with surgery reserved for those with deteriorating level of consciousness or increasing visual defect. The visual and endocrine outcomes are almost similar with either surgery or conservative management. Once the acute phase is over, patient should be re-evaluated for hormonal deficiencies.

Diabetic cardiomyopathy in Manipur.

OBJECTIVE: To assess the prevalence of diabetic cardiomyopathy in patients with diabetes mellitus in Manipur and its correlation with different parameters like obesity, blood pressure, lipids, duration of diabetes, and glycemic control. MATERIALS AND METHODS: A total of 100 type 2 diabetic patients were selected randomly. Anthropometric parameters were recorded, blood glucose levels and lipid profiles were determined, and the echocardiographic examinations were performed in all patients according to standard techniques. Ejection fraction (EF) was calculated by the formula LVEF% = (LVID)2 - (LVIDS)2. Left ventricular EF was considered normal when EF was 55 to 75%. Diastolic dysfunction was calculated by measuring E and A transmitral inflow velocity. Left ventricular mass in grams is calculated by the formula LVM (gm) = 1.04 × 0.8 [(LVID + PWT + IVST)3 - LVID3] + 0.6. RESULTS AND CONCLUSIONS: Diabetic cardiomyopathy was found in 40 patients (40%) of the total study, 29 males (44.6%) and 11 females (31.4%).

Clinical and biochemical profile of lean type 2 diabetes mellitus.

BACKGROUND: Type 2 diabetes mellitus is the most prevalent form of diabetes worldwide. In western countries majority of the cases are obese. The scenario may be different in certain parts of India. Various studies have reported a high prevalence of lean type 2 diabetes mellitus with a body mass index < 19 kg/m(2). MATERIALS AND METHODS: We evaluated 100 cases of lean type 2 diabetes mellitus (62 males and 38 females). RESULTS AND CONCLUSION: The mean duration of diabetes was 51.7 months (range 5-180 months). The glycemic control was poor according to standard guidelines. The majority of them showed response to oral hypoglycemic agents. Secondary failure to oral hypoglycemic agents was seen in 27 patients. The prevalence of microvascular complications was much higher than macrovascular complications. Neuropathy was the commonest complication seen in 70%, followed by retinopathy in 25%. Only 12 patients had hypertension, one had coronary artery disease and two had cerebrovascular accident. Lipid profile was not significantly deranged in our patients.

Stress and hormones.

In the modern environment one is exposed to various stressful conditions. Stress can lead to changes in the serum level of many hormones including glucocorticoids, catecholamines, growth hormone and prolactin. Some of these changes are necessary for the fight or flight response to protect oneself. Some of these stressful responses can lead to endocrine disorders like Graves' disease, gonadal dysfunction, psychosexual dwarfism and obesity. Stress can also alter the clinical status of many preexisting endocrine disorders such as precipitation of adrenal crisis and thyroid storm.