A study on hypogonadism in male HIV patients in northeastern part of India.

CONTEXT: After the introduction of highly active antiretroviral therapy (ART), the prevalence of hypogonadism among human immunodeficiency virus (HIV)-infected males is decreasing. AIMS: The aim of this study was (i) to estimate the prevalence of hypogonadism among HIV-infected males and (ii) to determine the risk factors for hypogonadism. SETTINGS AND DESIGN: This was a cross-sectional study undertaken at ART center of a medical Institute. SUBJECTS AND METHODS: The study recruited HIV-infected males aged 18-65 years receiving ART. Patients with any debilitating chronic illness, diabetes mellitus, chronic smokers or alcoholic, currently on opioids, or methadone were excluded from the study. Androgen Deficiency in Aging Male (ADAM) questionnaire was used to screen patients for the possible presence of hypogonadism. For those screened positive on ADAM questionnaire underwent biochemical evaluation for serum total testosterone, luteinizing hormone (LH), and CD4 count. STATISTICAL ANALYSIS USED: The Chi-square test was used to compare different parameters. Pearson's correlation coefficient was used to assess any relationship between CD4 count, LH, and testosterone. P < 0.05 was considered statistically significant. RESULTS: In the study, 426 were initially screened and 120 patients who had probable hypogonadism were further evaluated. The mean age of the patients was 41.61 years. The mean body mass index (BMI) of the patients was 22.47 kg/m2. The mean duration of ART was 6.13 years and the mean CD4 count was 442.63 cells/mm3. Hypogonadism was seen in 20 (23.3%) and majority (85.7%) had secondary hypogonadism. There was significant association between hypogonadism and CD4 count, but no association was found with BMI and duration of ART. CONCLUSIONS: Hypogonadism is seen in 23.3% of HIV-infected males. Majority (85.7%) had secondary hypogonadism. There was significant association of hypogonadism with lower CD4 count.

Reference intervals in evaluation of maternal thyroid function of Manipuri women.

CONTEXT: The population of Manipur is of different ethnic background from the rest of the country. Several authors have suggested population/ethnic and laboratory specific reference range of maternal thyroid profile of different trimesters. AIMS: To find the reference range of thyroid stimulating hormone (TSH), total thyroxine (TT4) and total tri-iodothyronine (TT3) levels for normal pregnant women of native Manipur descendants. SETTINGS AND DESIGN: The cross-sectional study was conducted at a teaching Institute after ethical clearance was obtained. SUBJECTS AND METHODS: A reference populations of 375 normal pregnant women were established after screening about 600 pregnant women. The study excluded patients with hyperemesis gravid arum, past history or family history of thyroid disorders as well as the connective tissue disorders, WHO grade 1 or 2 goiter, or any medications that alter thyroid functions. The serum levels of TSH, TT4, and TT3 were measured using chemiluminescence assay. STATISTICAL ANALYSIS USED: Data for TT3 and TT4 were expressed as mean ± standard deviation, median and 5-95(th) percentiles. RESULTS: The mean TSH in the three trimesters was 1.06 + 0.45, 1.23 + 0.30, and 1.25 + 0.36, respectively. The normal reference range thus was different from that of the kit reference range. On comparing to the Indian normative reference for the pregnant women, our results were not similar. However, the values were near similar to that of the American Thyroid Association guidelines. CONCLUSIONS: We conclude our study results with a new reference range for the pregnant population in Manipur and also emphasis the use of trimester-specific reference range of thyroid hormone.

Prevalence of lean type 2 diabetes mellitus in recently diagnosed type 2 diabetes mellitus patients.

INTRODUCTION: Obesity has always been thought to be a risk factor for diabetes; however, some studies in India have reported that even lean people are prone to diabetes. We conducted this study to see if this holds true for this part of the country. OBJECTIVES: To determine the prevalence of lean type 2 diabetes mellitus (DM) in recently diagnosed type 2 DM in Manipur. MATERIALS AND METHODS: All recently diagnosed type 2 DM patients, within a period of 24 weeks, who attended the endocrine clinic of RIMS from Jan to Dec 2012 are included in the study. Exclusion criteria are patients with chronic diseases. RESULTS: Out of the 181 recently diagnosed diabetics 3.9% had a BMI of <19 kg/m(2) of which five are females (5.4% of female patients) and two are males (2.2% of male patients). Mean age of Lean diabetics is 54.86 ± 15.32, mean fasting glucose is 212 ± 105.5 mg% and mean postprandial glucose is 351.57 ± 167.79 mg%. DM complications were observed in 28.6% of the Lean diabetics. CONCLUSION: Our study shows a low prevalence rate of Lean DM in recently diagnosed type 2 DM.

Testosterone and metabolic syndrome: The link.

Metabolic syndrome (MetS) or "Syndrome X" which is a constellation of insulin resistance, hyperglycemia, hypertension, low high-density lipoprotein cholesterol (HDL-C), and increased very-low-density lipoprotein (VLDL) and triglyceride (TG) levels. It is one of the main threats for public health in the 21st century with its associated risk of cardiovascular disease. This condition affects a major chunk of mankind. International Diabetes Federation (IDF) estimated that around 20-25% of the adult population of the world has MetS. Several definitions have been put forward by different expert bodies leading to confusion. To overcome this, joint new statement of many expert group have been issued. Serum testosterone (T) has been shown to be associated with MetS. Several studies have shown a higher prevalence of MetS in subjects with low testosterone. There are also several studies showing a significant difference in serum T between those with MetS and those without. Serum T has also been shown to be associated with components of MetS and testosterone replacement therapy (TRT) improves various metabolic and anthropometric parameters in MetS. Patients with androgen deprivation for treatment of various cancers have also been reported to have higher prevalence of MetS. But the evidence of association is not sufficient evidence for the causation of MetS by low testosterone and long-term studies are needed to confirm whether T deficiency is the cause or is a feature of MetS.