Idiopathic post prandial glucose lowering, a whistle blower for subclinical hypothyroidism and insulin resistance. A cross-sectional study in Tertiary Care Centre of northeast India.

BACKGROUND AND AIMS: There has been a lot of confusion in management of apparently healthy individuals whose post prandial plasma glucose levels were lower than fasting levels. It has been observed that many clinicians do send for repeat tests to rule out analytical error since there is common knowledge that post prandial glucose should be higher than fasting glucose level. Blood glucose level is regulated by a fully integrated mechanism with complex interplay of hormones and enzymes on metabolic pathways. Increase or decrease of thyroid hormones can break this equilibrium leading to alterations of carbohydrate metabolism. The objective for this study was to look for subclinical hypothyroidism (SCH) and insulin resistance (IR) in Idiopathic Post prandial glucose lowering and the correlation between thyroid stimulating hormone (TSH) with IR in them. METHODS: A cross-sectional study with subgroup analysis, 34 cases and 34 controls. Cases comprises of otherwise healthy individuals whose post prandial glucose is lower than fasting glucose and controls as those healthy individual whose post prandial glucose is higher than fasting. Thyroid hormones and insulin were measured in fasting serum samples. Homeostasis model assessment for IR was calculated as per formula. RESULTS: Among the 34 cases with idiopathic post prandial glucose lowering, 76% (n = 26) had subclinical hypothyroidism and 61% (n = 21) had insulin resistance. A positive correlation (r = 0.55) was observed between Thyroid-Stimulating hormone (TSH) and Index of insulin resistance and homeostatic model assessment (HOMA-IR) and was statistically significant with P < 0.1. CONCLUSIONS: The study highlights the importance of evaluating glycoregulatory hormones like thyroid hormones and insulin in cases with idiopathic post prandial glucose lowering for early diagnosis and prevention of overt clinical diseases like Hypothyroidism and Diabetes Mellitus.

No association of 25-hydroxyvitamin D and parathormone levels with glucose homeostasis in type 2 diabetes - a study from Shillong, Meghalaya.

Background: Although inadequate vitamin D and altered parathyroid hormone (PTH) are implicated in deranged glucose metabolism and risk of future diabetes, their role in regulating glucose homeostasis in established cases of diabetes is unclear. We aimed to (i) evaluate vitamin D status, and (ii) determine if vitamin D and PTH were associated with parameters of glucose homeostasis in type 2 diabetes (T2D) patients from Meghalaya, India. Methods: We determined 25-hydroxyvitamin D (25-OH-D) and PTH concentrations in 251 T2D patients (not on insulin), and examined their associations with the following parameters of glucose homeostasis: fasting blood sugar (FBS), post-prandial blood sugar (PPBS), glycated hemoglobin (HbA1c), fasting insulin (FI), homeostasis model assessments of insulin resistance (HOMA-IR) and ß-cell function (HOMA-ß). Results: None of the patients had adequate vitamin D (mean 25-OH-D = 19.3 ng/mL); 47.8% patients were deficient (25-OH-D < 20 ng/mL), while 52.2% were insufficient (25-OH-D < 30 ng/mL) vitamin D. Significant (P < 0.05) univariate associations were observed between: 25-OH-D and FI (r = 0.14); 25-OH-D and HOMA-ß (r = 0.13); PTH and FI (r = -0.18), and PTH and HOMA-ß (r = -0.11). However these associations disappeared after controlling for potential confounders. The 25-OH-D and PTH levels were not associated with any of the tested parameters of glucose homeostasis. Conclusion: There was widespread prevalence of vitamin D deficiency/insufficiency in our sample T2D patients. However, neither vitamin D nor PTH appeared to play a major role in influencing glucose homeostasis in this present selection of T2D cases.

Evaluation of thyroid function in type 2 diabetes in north-eastern part of India: A hospital-based study.

BACKGROUND: Diabetes mellitus (DM) and thyroid dysfunctions are the two most common endocrine disorders to come across in any clinical practice. Both thyroid hormones and insulin act antagonistically in metabolic pathways or cycles of cells. The aim of our study is to look for thyroid dysfunction in patients with type 2 DM and its correlation with insulin resistance (IR). METHODS: A cross-sectional study was carried out among 80 newly diagnosed type 2 diabetic patients. Thyroid-stimulating hormone (TSH), free triiodothyronine, free thyroxine, and insulin were measured in fasting serum sample. Homeostasis model assessment for IR was calculated as per formula. RESULTS: Among 80 diabetic patients, 20 were hypothyroid, 4 were hyperthyroid, and 56 were found to be euthyroid. IR was found to be significantly higher in hypothyroid as compared to euthyroid patients. A positive association was found between TSH and IR (r = 0.230) among hypothyroid patients though association was not significant. In hyperthyroid patients, a strong negative correlation (r = -0.94933) was found between TSH and IR, but no association was found among euthyroid patients. CONCLUSION: The inability to recognize the presence of thyroid hormone dysfunction may be one of the important causes of poor management of type 2 DM. Therefore, there is a need for routine assay of thyroid hormones in type 2 diabetic patients to improve the medical management as well as to reduce the morbidity in them.

Monoclonal gammopathy with double M-bands: An atypical presentation on serum protein electrophoresis simulating biclonal gammopathy.

Monoclonal gammopathies, such as multiple myeloma, typically exhibit high levels of a monoclonal immunoglobulin (M-protein), produced by a clone of abnormally proliferating B-lymphocytes and/or plasma cells. The M-protein can be evaluated by serum protein electrophoresis (SPEP), which yields a single discrete band (M-band), usually in the γ-globulin region. Rarely, two M-bands appear simultaneously at different positions during SPEP - a condition known as biclonal gammopathy, which is a result of clonal expansion of two different neoplastic cell lines. Here, we describe an atypical case of IgA-λ multiple myeloma, where double M-bands (one in ß- and the other in γ-globulin region) were found during SPEP simulating biclonal gammopathy, although it was monoclonal in nature. This peculiar presentation of double M-bands in monoclonal gammopathy was attributed to polymeric forms of IgA by systematic workup. Further, we discuss how true and apparent biclonality can be distinguished by inexpensive analytical techniques in resource-constrained settings.

Presence of Concurrent Derangements of Liver Function Tests in Type 2 Diabetes and Their Relationship with Glycemic Status: A Retrospective Observational Study from Meghalaya.

BACKGROUND AND OBJECTIVES: The liver plays a pivotal role in carbohydrate metabolism. Therefore, functional state of the liver in patients with diabetes is of interest. The objectives of the current study were to (i) identify co-existent biochemical derangements of liver function tests (LFTs) in type 2 diabetes and (ii) determine the association between liver function parameters and glycemic status in type 2 diabetics from Shillong, Meghalaya. MATERIALS AND METHODS: Data from 320 type 2 diabetes patients were screened retrospectively for abnormalities in LFTs. Relationship of fasting serum glucose was assessed with the following tests in the LFT panel: Total bilirubin, aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), and albumin. Correlation coefficient was computed between individual LFT and fasting glucose status. These bivariate analyses were supplemented by multivariate linear regression analyses. RESULTS: 71.25% subjects had an abnormality in at least one LFT. Elevated ALT (46.8%) and elevated ALP (48.5%) were the most common abnormality in males and females, respectively. ALP correlated positively with fasting glucose in both sexes. AST, ALT, and ALP were found to be independent determinants of glycemic status. CONCLUSION: Derangements in liver function are widely co-existent in type 2 diabetics from Shillong. Deranged liver enzymes are associated with glycemic status. Screening for liver dysfunction in diabetics and subsequent workup may lead to the identification of hepatic co-morbidities and better management.

Association of Serum Calcium Levels with Infarct Size in Acute Ischemic Stroke: Observations from Northeast India.

BACKGROUND: Calcium is known to be major mediator in ischemic neuronal cell death. Recent studies have shown that elevated serum calcium levels at admission in patients with stroke have been associated with less severe clinical deficits and with better outcomes. AIM: The aim of this to determine the correlation between serum calcium (total, corrected, and ionized) and infarct size (IS) in patients with acute ischemic stroke. MATERIALS AND METHODS: Data were collected from 61 patients presenting with acute ischemic stroke from May 2015 to April 2016 at a tertiary care institute in Northeast India. Only patients aged ≥40 years and diagnosed as having acute ischemic cerebrovascular stroke with clinical examination and confirmed by a computed tomography scan were included in the study. Serum calcium levels (total, albumin corrected, and ionized) were collapsed into quartiles, and these quartile versions were used for calculating correlation. Pearson's correlation coefficient was used for comparing calcium levels with IS. RESULTS: Total calcium, albumin-corrected calcium, and ionized calcium had a statistically significant negative correlation with IS with r = -0.578, -0.5396, and -0.5335, respectively. Total and ionized calcium showed a significant negative correlation with IS across all four quartiles. Albumin-corrected calcium levels showed a significant negative correlation with IS only across the lowest and highest quartiles. CONCLUSION: The findings in our study suggest that serum calcium can be used as a prognostic indicator in ischemic stroke as its levels directly correlates with the IS.

Thyroid profile status of patients treated for multidrug-resistant tuberculosis in state of Meghalaya, India.

BACKGROUND: Meghalaya has high tuberculosis burden with increasing multidrug-resistant tuberculosis (MDR-TB) cases. Drug-induced hypothyroidism is one of the well-documented adverse effects in treatment of MDR-TB, the data of which are unavailable in the population residing in this part of the Indian subcontinent. AIM: This study was undertaken to assess the thyroid profile status of patients under DOTS Plus treatment and to evaluate the effects of anti-tubercular drugs on thyroid functions with respect to the pre-treatment thyroid status. METHODS: A prospective study of 114 patients who initiated treatment for MDR-TB between June 2012 and August 2013 was performed. Thyroid hormones, viz., TSH, Total T3, Total T4, Free T3 and Free T4 were estimated. RESULTS: Out of our study group of 114 MDR-TB patients, 15 dead patients and defaulters were excluded. So, out of 99 patients, till now, 76 patients have completed 6 months of DOTS Plus treatment and were re-evaluated for thyroid status. 52(68%) patients showed TSH levels more than the reference limit of 5.60 µIU/mL and 5(7%) patients had TSH >10 µIU/mL suggesting presence of sub-clinical hypothyroidism. CONCLUSION: We suggest the need for Mandatory TSH screening at baseline and then six months interval for all patients taking DOTS Plus so that no adverse effect goes under-reported and early intervention if required should be done to maintain proper adherence.

Association of secondary hyperparathyroidism with hemoglobin level in patients with chronic kidney disease.

PURPOSE: Secondary hyperparathyroidism (SHPT) is one of the less recognized reasons of anemia in chronic kidney disease (CKD). In this study, we evaluated the role of SHPT as a cause of anemia and correlation of intact parathyroid hormone (iPTH) and hemoglobin (Hb) level in hemodialysis (HD) patients. METHODS: This cross-sectional study was carried out in 63 individuals admitted in HD unit of the institute. Serum samples were collected and urea, creatinine, Hb, ferritin and iPTH levels were measured. Statistical analysis was carried out using the SPSS software (IBM, NY, USA). RESULTS: Mean ± standard deviation for serum urea, creatinine, Hb, ferritin and intact PTH were 177 ± 15.52, 15.16 ± 2.28 mg/dl, 7.03 ± 2.26 g/dl, 654.7 ± 563.4 ng/ml, 539.18 ± 493.59 pg/ml respectively. A reverse correlation was found between intact PTH and Hb level. CONCLUSIONS: A variety of postulated pathophysiological mechanisms linking SHPT and anemia in CKD are discussed. An efficient control of parathyroid hormone hypersecretion may be required to achieve a better management of anemia in HD patients.

Lipid peroxidation and antioxidant vitamins in urolithasis.

The present, study was conducted to determine the level of malondialdehyde (MDA) as an index of free radial induced lipid peroxidation and antioxidant vitamins-vitamins A, vitamin C and vitamin E in 75 confirmed cases of urolithiasis. Significantly high level of MDA (p<0.001) with significantly low levels of vitamin E (p<0.001) and vitamin A (p<0.001) with no significant decrease in vitamin C (p>0.05) were observed in the plasma of urolithiasis cases as compared to normal controls. In conclusion, it appears that a role of lipid peroxidation and oxidative function exists in the pathogenesis of urolithiasis. But, the exact mechanism how this occurs remains to be elucidated.