Subclinical hypothyroidism in the first trimester of pregnancy in North India

Subclinical hypothyroidism based on population and trimester specific cut-offs is reported to complicate 1-2% of all pregnancies. Using the recent Endocrine Society guidelines of 2.5 mIU/L of Thyroid Stimulating Hormone as the upper level of normal in the first trimester the reported prevalence of subclinical hypothyroidism is much higher. Recent publications have also emphasized that there is considerable racial variation in the prevalence of thyroid disorders in pregnancy. Among published literature North Indian women appear to have the highest rates of subclinical hypothyroidism in the first trimester of pregnancy. More widespread use of universal screening and trimester specific ranges in pregnancy for thyroid hormonal assays will lead to a large number of North Indian women requiring treatment for thyroid disorders in pregnancy

Transition Care in Type 1 Diabetes. Five Questions and Five Principles

Management of type 1 diabetes mellitus during the period of adolescence to young adulthood is amongthe most challenging in the field of diabetes care. At around the age of 18 there is a physical transferof care from pediatric physicians to adult physicians. Alongside there is transfer of responsibility ofself-care from parents to the patient over a period of time. Unique medical problems encountered inthis age group include puberty induced increase in insulin requirements, an increase in psychiatriccomorbidities including substance use and abuse, disconnect with health care teams, and problems relatedto reproductive care and contraception. This is reflected in the poorer outcomes seen in this age groupincluding an increase in acute complications, increase in hospitalizations with diabetic emergencies, poorglucose control and an increase in loss to follow. The poor metabolic control during this period leads toestablishment of early chronic macro and microvascular complications. A structured transition care isa planned purposeful process that address these unique medical, psychological, and vocational needsamong these patients that smoothens out the process of transfer to adult care teams. The models thathave been proven to be useful in improving outcomes include the use of separate transition clinics, use oftransition coordinators and enrollment into young patients support groups. Regardless of the model usedthere are five overarching principles that define this process of transition care. They can be summarizedin five Cs which include: appropriate communication, assessment of self-care needs, building competence,using collaborative teams, and finally providing care and counseling for psychological issue

Diabetic distress and work-related stress among individuals with type 2 diabetes mellitus

Background: Work-related diabetes distress was a term introduced in the context of type 1 diabetes mellitus (T1DM). Currently, there are no studies evaluating the contribution of work-related stress to overall diabetes distress among employed persons with type 2 diabetes mellitus (T2DM). Methods: Adult patients over the age of 21 years with T2DM in full-time employment for over a year were interviewed after informed consent. Diabetes distress was identified with the 17-question diabetes distress scale (DDS) and work-related stress was evaluated using the Siegrist effort-reward imbalance (ERI) questionnaire. DDS scores ≥ 3.0 were considered significant diabetes distress and effort-reward ratio > 1.0 was considered indicative of work stress. Results: One hundred and thirteen patients consented. 68/133 (51.2%) had clinically significant diabetes distress. Work-related stress was seen in 67/113 (50.3%) of patients. Prevalence of work stress was higher among those with clinically significant diabetes distress (62%) compared to those without diabetes distress (38%) (p-value = 0.007). Spearman’s Rho correlation between diabetic distress and effort-reward imbalance was found to be moderately positively correlated (rs = 0.27 [2 tailed] p =.002). Conclusions: Increased work stress that manifests as an imbalance between effort and reward is associated with increased diabetes distress among employed persons with T2DM. The measure of diabetes distress needs to include work stress as a component to complete the picture

Plasmacytoma Mimicking Mediastinal Parathyroid Tumour in a Patient with Primary Hyperparathyroidism

The association of monoclonal gammopathies with primary hyperparathyroidism is well documented. Many case reports have documented the coexistence of primary hyperparathyroidism and multiple myeloma. The cause of this relationship is not known. We report the case of a 49-year-old gentleman who was treated for primary hyperparathyroidism. His initial preoperative nuclear scan had shown persistent activity and retention of tracer in the retrosternal region in addition to the discrete hot spot in the region of the lower pole of the left lobe of the thyroid. During surgery, the enlarged left inferior parathyroid gland was removed. In addition, the retrosternal area was also explored and found to be normal. Ten months later, he developed a mass in the region of the manubrium sternii which was proven to be a plasmacytoma. We review the literature for similar cases and suggest hypotheses for a possible association. In conclusion, coexisting plasma cell dyscrasias including plasmacytoma should be considered in patients with primary hyperparathyroidism

Neuro-endocrine regulation of blood pressure

As our understanding of the underlying aetiology of hypertension is far from adequate, over 90% of patients with hypertension receive a diagnosis of essential hypertension. This non-specific diagnosis leads to suboptimal therapeutics and a major problem with non-compliance. Understanding the normal control of blood pressure (BP) is, hence, important for a better understanding of the disease.This review attempts to unravel the present understanding of BP control. The local mechanisms of BP control, the neural mechanisms, renal-endocrine mechanisms, and a variety of other hormones that have a bearing in normal BP control are discussed and the possible role in the pathophysiology is alluded to

Vaccination status, knowledge, and acceptance of adult vaccinations against respiratory illness among patients with Type 2 diabetes mellitus

Patients with diabetes mellitus are more prone to develop infections with influenza virus and pneumococcus. Once they develop respiratory infections, they are twice more likely to die of complication related to the infection. Although there are no Indian guidelines, recent publications have recommended vaccination in patients with diabetes of all ages. Our study was undertaken to find the barriers to the uptake of adult vaccination against respiratory illness among patients with diabetes attending a diabetic clinic in a tertiary care institution. Of the 149 patients interviewed, only 2% and 0.7% had been previously vaccinated against influenza and pneumococcus, respectively. Although 52% of patients agreed that vaccination was safe and effective, only 17.4% got vaccinated during the period of observation after counseling. The primary reasons for refusal were financial (51.7%), while some were not completely convinced of its benefits (9.4%); the other reasons included fear of complications (7.4%) and needles (0.7%)

Newer antidiabetic drugs and calorie restriction mimicry

De-acceleration of aging and delayed development of age-related morbidity accompanies the restriction of calories (without malnutrition) in laboratory mice, nematodes, yeast, fish, and dogs. Recent results from long-term longitudinal studies conducted on primates have suggested longevity benefits of a 30% restriction of calories in rhesus monkeys as well. Among calorie restricted rhesus monkeys one of the mechanisms for the improvement in lifespan was the reduction in the development of glucose intolerance and cardiovascular disease. Although there are no comparable human studies, it is likely that metabolic and longevity benefits will accompany a reduction in calories in humans as well. However, considering the difficulties in getting healthy adults to limit food intake science has focused on understanding the biochemical processes that accompany calorie restriction (CR) to formulate drugs that would mimic the effects of CR without the need to actually restrict calories. Drugs in this emerging therapeutic field are called CR mimetics. Some of the currently used anti-diabetic agents may have some CR mimetic like effects. This review focuses on the CR mimetic properties of the currently available anti-diabetic agents