Vitamin B12 Deficiency is Endemic in Indian Population: A Perspective from North India.

BACKGROUND: Vitamin B12 deficiency is believed to be widespread in Indian population. However, more data is needed to fuel a meaningful debate on preventive and therapeutic strategies. AIMS AND OBJECTIVES: Objective of the current study is to evaluate status of vitamin B12 levels in people from a tier 3 city and among people living in an urban area with or without diabetes. SETTINGS AND DESIGN: Retrospective, cross-sectional study. METHODOLOGY: Data captured in electronic medical records (EMR) of an endocrine practice and from a diagnostic laboratory was analysed. STATISTICAL ANALYSIS USED: Statistical analysis was done using open source software "Jamovi". RESULTS: Prevalence of vitamin B12 deficiency (Vitamin B12 levels <200 pg/ml) in tier 3 city was 47.19% (n = 267). From an urban endocrine practice, database of 11913 patients was searched for reports of vitamin B12 levels. Prevalence of vitamin B12 deficiency was 37.76% in people with pre-diabetes (n = 92), 31.23% in people with endocrine problems other than diabetes and pre-diabetes (n = 285) and 18.25% in people with diabetes (n = 378). Tier 3 city population had significantly lower vitamin B12 levels than people living in an urban area and attending an endocrine clinic. Vitamin B12 levels were significantly higher in people with diabetes as compared to people with other endocrine problems. CONCLUSION: Prevalence of vitamin B12 deficiency is 47% in north Indian population. People with diabetes have higher vitamin B12 levels than general population though still have high prevalence of deficiency. This data shows that Vitamin B12 deficiency is widespread in Indian population.

Friendly Fat Theory - Explaining the Paradox of Diabetes and Obesity.

Obesity has been called the mother of all diseases and, historically, has been strongly linked to diabetes. However, there are still some paradoxes that exist in diabetes epidemiology and obesity and no unifying hypothesis has been proposed to explain these paradoxical phenomena. Despite the ever-increasing prevalence of both obesity and diabetes, differential relationships exist between diabetes and the extent of obesity in various different ethnic groups. In addition, people with a higher body mass index have been shown to have an improved survival advantage in terms of chronic diabetes complications, especially cardiovascular complications. This narrative review attempts to explain these paradoxical and complex relationships with a single unifying theory. We propose that adipocytes are actually friends of the human body to prevent the occurrence of diabetes and also help in mitigating the complications of diabetes. Adipose tissue actually acts as a reservoir of free fatty acids, responsible for insulin resistance, and prevents their overflow into insulin-sensitive tissues and, therefore, friendly fat theory.

Nine Syndrome: Case Report and Review of Clinical Signs in Internuclear Ophthalmoplegia.

The pathologic involvement of brainstem and midbrain nuclei and white matter tracts in various combinations may result in a spectrum of arithmetically derived syndromes. They include 'one and a half syndrome', 'eight and a half syndrome' and 'fifteen and a half syndrome'. We report a case of 'nine syndrome', which has been reported more recently, caused by caused by acute pontine infarcts and characterised clinically by a combination of internuclear ophthalmolplegia, ipsilateral horizontal gaze palsy, lower motor neuron type of facial palsy, contralateral hemiparesis and hemianesthesia. We highlight the genesis of this combination of clinical signs, revisit the different variants of INO and review the literature on 'Nine syndrome'.

Temporal Change in Profile of Association between Diabetes, Obesity, and Age of Onset in Urban India: A Brief Report and Review of Literature.

CONTEXT: Indian population is known to develop diabetes at lower body mass index (BMI) and younger age than their western counterparts. However, data on the prevalence of overweight/obesity in people with diabetes have not been well documented in the Indian literature. The current study also establishes time trends for the age of onset of diabetes mellitus type 2 in Urban India. AIMS: The aim of this study was to analyze the current trend in the presentation of people with diabetes in a metropolitan city (Urban residents) in context to age, sex, and BMI. SETTINGS AND DESIGN: Retrospective cross-sectional study. SUBJECTS AND METHODS: Data captured in clinic electronic medical records from May 2015 to March 2017 are analyzed. The profile of newly diagnosed diabetes is also presented. STATISTICAL ANALYSIS USED: Data were analyzed descriptively and for statistical analysis, SPSS software was used. RESULTS: A total of 1473 patients with age 52.6 ± 12.7 (mean ± standard deviation) and BMI of 27.86 ± 4.83 kg/m2 were analyzed. About 17.6% were overweight; 71.5% were obese. The significant higher proportion of females was overweight/obese (91.2% vs. 82% of males; P < 0.0001). Females had significantly higher mean BMI than males (29.19 ± 4.99 vs. 26.93 ± 4.83; P ≤ 0.001). Overall, mean HbA1c of patients was 7.84% ±1.61% with no significant difference between genders. However, there was no difference in mean HbA1c based on either gender or BMI category. Among people with new-onset diabetes, there was even higher proportion of people with BMI ≥23 kg/m2 (overall 89.1%, males 87.6%, and females 91.6%). About 43.8% of people presented at <40 years age. Totally, 49.5% of males presented at age <40 years as compared to 33.9% of females. CONCLUSIONS: The prevalence of obesity among people with diabetes in Indian setting is now as high as in western studies. Indians are now presenting with diabetes at even earlier age with higher BMI.

Inverse relationship between stigma and quality of life in India: is epilepsy a disabling neurological condition?

OBJECTIVE: Stigma associated with epilepsy has negative effects on psychosocial outcomes, affecting quality of life (QOL) and increasing disease burden in persons with epilepsy (PWEs). The aim of our study was to measure the impact of stigma on the QOL of PWEs and the prevalence of neurological disability due to stigmatized epilepsy. METHOD: A prospective observational study with a sample of 208 PWEs was conducted. Neuropsychological Tests used were the Indian Disability Evaluation Assessment Scale (IDEAS) to measure disability, the Dysfunctional Analysis Questionnaire (DAQ) to measure QOL, and the Stigma Scale for Epilepsy (SSE) to assess stigma. RESULTS: Spearman correlation was calculated, and stigma (SSE) was highly significant with QOL (DAQ) (0.019) and disability due to stigmatized epilepsy (IDEAS) (0.011). CONCLUSION: The present study supports the global perception of stigma associated with epilepsy and its negative impact on their overall QOL and its contribution to the escalation of the disease burden.

Interventional endocrinology: A futuristic perspective.

Interventions in endocrinology make a huge impact on life of patients with endocrine diseases. This brief communication discusses the role played by both medical and surgical interventions in practice of endocrinology. Endocrinology is branch of medicine where treatment is as close to ideal as possible. For people with hormone deficiencies, medical intervention in form of replacement with hormones generated by recombinant technologies is a perfectly natural treatment. Hormone excess is also being evaluated and treated with exceedingly precise surgical interventions with minimal morbidity.

Prevalence of coronary risk factors in type 2 diabetics without manifestations of overt coronary heart disease.

AIMS: To find the prevalence of cardiovascular risk factors in type-2 diabetics without manifestations of overt coronary heart disease and to estimate the prevalence of silent myocardial ischaemia in these patients. METHODS: Seventy seven patients of type 2 diabetes were recruited for the study (one patient lost after recruitment; 76 completed the study). History and physical examination were recorded. Laboratory investigations included fasting and 2-hour post-prandial blood sugar, blood urea, serum creatinine, lipid profile, glycated haemoglobin, and microalbuminuria. Ultrasonographic scanning of the carotid arteries was performed to measure the carotid IMT. For identification of cases of silent ischaemia, treadmill test (TMT) was performed. RESULTS: The study group was divided into a non-CAD group (n=54), and a silent CAD group (n=22). Twenty-two diabetics were found to have silent CAD as evidenced by a positive TMT result (28.9%). The prevalence of silent myocardial ischaemia was almost similar in both males and females. Serum LDL levels more than 140 mg% had a significant correlation with the prevalence of silent CAD (p = 0.04). The difference in CCA-IMT values was found to be statistically significant between the silent CAD and non-CAD groups (p = 0.019). CONCLUSION: High LDL level and greater carotid intima-media thickness are particularly important parameters that can predict if a patient of type 2 diabetes is at risk for silent ischaemia. A high carotid IMT is a surrogate and reliable marker of higher risk of CAD amongst type 2 diabetic patients, even in those without overt CAD. The study also underlines the utility of carotid IMT as a simple, non-invasive, safe, and cheap screening test for the assessment of risk of CAD in type 2 diabetics.