Arshad Iqbal Wani

Copper, zinc, and magnesium levels in non-insulin dependent diabetes mellitus.

A relationship has been reported between trace elements and diabetes mellitus. This study evaluated the role of such a relationship in 83 patients with non-insulin dependent diabetes mellitus (40 men and 43 women), with a mean duration of diabetes of 3.9 +/- 3.6 years. Patients with nephropathy were excluded. Thirty healthy non-diabetic subjects were studied for comparative analysis. Subjects were subdivided into obese and non-obese. Diabetic subjects were also subdivided into controlled and uncontrolled groups; control was based on fasting blood glucose and serum fructosamine levels. Plasma copper, zinc and magnesium levels were analysed using a GBC 902 double beam atomic absorption spectrophotometer. Plasma zinc and magnesium levels were comparable between diabetic and non-diabetic subjects, while copper levels were significantly elevated (p < 0.01) in diabetic patients. Age, sex, duration and control of diabetes did not influence copper, zinc, or magnesium concentrations. We conclude that zinc and magnesium levels are not altered in diabetes mellitus, but the increased copper levels found in diabetics in our study may merit further investigation of the relationship between copper and non-insulin dependent diabetes mellitus.

Prevalence of Type 2 diabetes mellitus and impaired glucose tolerance in the Kashmir Valley of the Indian subcontinent

This cross-sectional population survey was undertaken to determine the prevalence of type 2 diabetes and impaired glucose tolerance in subjects aged 40 years or more in Kashmir Valley, India. The study was carried out in two phases. In phase one, 6091 randomly selected subjects, 40 years or older, from all six districts of the valley were surveyed for prevalence of known diabetes mellitus. In phase two, 5083 subjects, 40 years or older, were screened with oral glucose tolerance test for prevalence of undiagnosed (asymptomatic) diabetes mellitus and impaired glucose tolerance. Abnormalities of carbohydrate intolerance were determined as recommended by WHO. Of 6091 subjects interviewed, 115 were known cases of diabetes mellitus with an overall prevalence of 1.89% (1.98% in males and 1.77% in females). Results of glucose tolerance test revealed that mean fasting as well as mean 2 h blood glucose was significantly more in females as compared to males (4.68+/-0.91 and 6.40+/-2.12 vs. 4.49+/-0.96 and 5.94+/-2.03 mmol/l, respectively, P < 0.0001). Of 5083 subjects who were subjected to glucose tolerance test (GTT), 627 (12.34%) had an abnormal test; with 411 (8.09%) having impaired glucose tolerance (IGT) and 216 (4.25%) having diabetes mellitus. The prevalence of IGT as well as of diabetes was significantly more in females as compared to males (P < 0.001). Subjects who had family history of diabetes had a significantly higher prevalence of abnormal GTT. Prevalence of known diabetes as well as that of abnormal GTT steadily increased with age, with a highest prevalence in the age group of > or = 70 years (P < 0.001). Obese subjects had a significantly higher basal as well as 2 h blood glucose in males as well as in females. Subjects with diabetes on GTT had a higher waist/hip ratio. Overall the prevalence of diabetes as well as IGT was significantly higher in the urban population. We conclude that 1.89% of the general population have known diabetes, 4.25% have undiagnosed diabetes and 8.09% have impaired glucose tolerance test; making the total load of abnormal glucose tolerance 14.23% in Kashmir Valley. In subjects greater than 40 years of age having a family history of diabetes, obesity, higher age (50 years or above), female sex, and urban origin have more chance (odds ratio: 4.65, 2.30, 1.87, 1.49 and 1.16, respectively) of developing abnormal glucose tolerance.

Vitamin D status in apparently healthy adults in Kashmir Valley of Indian subcontinent

Background: The worldwide prevalence of vitamin D deficiency is reported to be high. Objectives: To assess the vitamin D status in apparently healthy adults in Kashmir valley by measuring serum 25-hydroxyvitamin D 25 OH D. Methods: 92 healthy natives 64 men and 28 non-pregnant/non-lactating women, aged 1840 years, residing in Kashmir for at least last 5 years and not having any suggestion of systemic disease, were selected for this study. The samples were collected throughout the year in both summer and winter months. Vitamin D deficiency was defined as a serum 25 OH D concentration of <50 nmol/l and graded as mild 2550 nmol/l, moderate 12.525 nmol/l and severe <12.5 nmol/l. Results: Body mass index, total energy intake, and other nutritional parameters were comparable among subjects in different groups. Overall 76 83 of the subjects studied had vitamin D deficiency25, 33, and 25 had mild, moderate, and severe deficiency, respectively. 49 of the 64 males and all but 1 of the 28 females were vitamin D deficient. The prevalence of vitamin D deficiency ranged from 69.6 in the employed group to 100 in the household group. Vitamin D deficiency was equally prevalent in subjects from rural and urban areas. Serum calcium and phosphorus values were comparable in subjects with and without vitamin D deficiency, while daily intake and urinary excretion of calcium were significantly lower in the former. Vitamin D deficient subjects had a significantly lower mean weekly exposure to sunlight. Conclusions: In spite of abundant sunlight, healthy individuals in Kashmir valley are vitamin D deficient, particularly women. Serum 25 OH D concentrations are significantly related to sun exposure.

Mortality in diabetes mellitus—data from a developing region of the world

This retrospective study presents the mortality trends in diabetic patients in a developing region of the world. The data were collected by screening the hospital records of all diabetic patients who died over a period of a decade at Institute of Medical Sciences, a tertiary care medical centre in Kashmir Valley of India. Of 133,374 patients admitted to the centre from January 1987 to December 1996, 9627 died, of whom 269 (151 males and 118 females) were recorded to have diabetes mellitus. The mean+/-S.D. age at the time of death was 51.61+/-13.77 years for males and 51.50+/-15.50 years for females. The common causes contributing to death were infections (33.83%), chronic renal failure (30.85%), coronary artery disease (16.36%), cerebrovascular disease (13.75%), hypoglycaemia (7.81%), diabetic ketoacidosis (6.69%) and hyperosmolar coma (2.23%). In 7.43% patients the cause of death could not be ascertained. Death was attributed to single cause in 60.22%, to two causes in 26.39% and to three or more causes in 5.95%. Most (59.11%) of these diabetic patients died within a week of hospitalisation. We conclude that mortality trends in diabetes mellitus differ in developing regions as compared to developed regions reflecting poor healthcare in general and diabetic care in particular. Unlike in west, where the major killers in diabetic patients are coronary artery disease and cerebrovascular disease, infections and chronic renal failure continue to be leading causes of death in patients with diabetes mellitus in developing regions like ours.

Epidemiologic and etiologic aspects of primary infertility in the Kashmir region of India

OBJECTIVE To assess the magnitude of primary infertility and to study its etiologic aspects in India. DESIGN After proper randomization, 10,063 married couples were interviewed to ascertain the prevalence of primary infertility. A definitive protocol was followed to determine the etiology of primary infertility in 250 consecutive couples. SETTING Tertiary care medical center in the Kashmir valley of India. PATIENT(S) Couples married for > or = 1 year; 250 consecutive couples attending an endocrine clinic for primary infertility. INTERVENTION(S) A logical investigative protocol was followed to identify the etiology of infertility. MAIN OUTCOME MEASURE(S) Magnitude of primary infertility in the community as well as the male, female, or combined etiology of infertility. RESULT(S) Fifteen percent of the couples interviewed had primary infertility, among whom 4.66% had unresolved infertility at the time of the survey. The etiology of infertility in 250 consecutive couples revealed a female factor in 57.6%, a male factor in 22.4%, combined factors in 5.2%, and an undetermined cause in 14.8%. CONCLUSION(S) Primary infertility is as common and distressing a problem in India as in other parts of the world. Semen abnormalities (22.4%), anovulation (17.2%), ovarian failure (8.8%), hyperprolactinemia (8.4%) and tubal disease (7.2%) are common causes of infertility. The pattern of infertility in India is the same as in other parts of the world, except that infertile couples report late for evaluation.

Prevalence of diabetes mellitus and other abnormalities of glucose tolerance in young adults aged 20-40 years in North India (Kashmir Valley).

AIMS To assess the burden of type 2 diabetes mellitus (T2DM) and other abnormalities of glucose tolerance in young-adult (20-40 years) men and non-pregnant women. METHODS Prevalence of diagnosed T2DM, undiagnosed T2DM and other abnormalities of glucose tolerance studied in 3032 subjects from Kashmir Valley of India. The study included a questionnaire, anthropological measurements, blood sampling, and a standard OGTT. RESULTS Eight (0.3%) of surveyed subjects were previously diagnosed to have diabetes. Of 3024 subjects screened, prevalence of diabetes, impaired glucose tolerance (IGT), and impaired fasting glycemia [IFG, World Health Organization, Definition, Diagnosis, and Classification of Diabetes Mellitus and its Complications. Part 1. Diagnosis and Classification of Diabetes Mellitus, World Health Organization, Geneva, 1999], IFG [American Diabetes Association, Diagnosis and classification of diabetes mellitus, Diabetes Care 27 (Suppl. 1) (2004) S5-S10] was 2.5%, 2.0%, 11.9% and 26.7%, respectively. Overall, age-adjusted prevalence of T2DM (known plus unknown), IGT, IFG (WHO) and IFG (ADA) was 2.4% (95% CI: 1.9-3.0), 1.6% (95% CI: 1.3-2.2), 11.1% (95% CI: 10.0-12.3), and 25.2% (95% CI: 23.7-26.8), respectively. The difference in diabetes prevalence was significant by age, habitat, family history of diabetes and BMI. The ratio of known-to-unknown diabetes was 1:10. CONCLUSIONS This is the first large scale study from North India on prevalence of type 2 diabetes in the younger age group of 20-40 years. Abnormal glucose tolerance including undiagnosed T2DM is common in young adults.

Causes of mortality in diabetes mellitus: data from a tertiary teaching hospital in India.

Background: Mortality studies can show the relative contribution of diabetes to mortality in the total population, and they can provide important descriptions of the changes in causes and frequency of diabetes mortality over time. Objective: To find the mortality pattern in people with diabetes admitted to a tertiary care hospital in a developing country, using underlying/contributory causes of death. Methods: In this retrospective study, mortality trends among people with diabetes admitted to Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Kashmir, India were reviewed by screening the hospital records of all people with diabetes who died over the last 9 years, carrying forward earlier observations from the same centre. Results: Of 234 776 people admitted to the centre during the review period, 16 690 (7.11%) died; 741 (383 men) of these had diabetes mellitus mentioned on the death certificate. The mean (SD) age at death for people with diabetes was 60.07 (13.62) years in men and 57.36 (13.40) years in women. The leading contributory causes of death were infections (40.9%), chronic renal failure (33.6%), coronary artery disease (16.9%), cerebrovascular disease (13.2%), chronic obstructive pulmonary disease (6.9%), acute renal failure (6.2%), malignancy (4.2%), hypoglycaemia (3.5%) and diabetic ketoacidosis (3.4%). The cause of death could not be ascertained in 2.8% of cases; in 52.9%, 36.3% and 8.0% cases one, two and three or more causes, respectively, were recorded as the cause of death. Conclusions: The aetiological spectrum of mortality in people with diabetes at this Indian centre continues to be dominated by infections and renal failure, which is different from that in the developed world, where coronary artery disease and cerebrovascular disease are the principal causes of death in people with diabetes.

Epidemiologic and etiologic aspects of hirsutism in Kashmiri women in the Indian subcontinent

OBJECTIVE To assess the prevalence of hirsutism and study its etiology in the Kashmir Valley of the Indian subcontinent. DESIGN Prospective random sample of the general population attending outpatient medical clinics and prospective evaluation of hirsute patients referred to our endocrinology clinic. SETTING A tertiary care hospital and district-level primary care hospitals. PATIENT(S) Five thousand women attending various hospitals for reasons unrelated to hirsutism and 150 consecutive women referred for hirsutism. INTERVENTION(S) Assessment of body hair as per the Ferriman and Gallwey scoring system and an investigative protocol including detailed clinical assessment with endocrinologic workup including estimations of gonadotropins, PRL, T, and 17-hydroxyprogesterone and abdominopelvic ultrasound. MAIN OUTCOME MEASURE(S) Presence and cause of hirsutism. RESULT(S) Of 4,780 adult women for whom adequate data were available, 504 (10.5%) had hirsutism, among whom 484 (10.1%) had mild (score of 6-9) and 20 (0.4%) had moderate hirsutism (score of 10-14). The etiology of hirsutism revealed idiopathic hirsutism in 38.7%, polycystic ovary syndrome (PCOS) in 37.3%, postmenopausal state in 9.2%, adrenal tumors in 2.1%, congenital adrenal hyperplasia in 1.4%, and drug-induced hirsutism in 0.7%. The cause remained undetermined in 10.6% of patients for whom the available information was not adequate. CONCLUSION(S) Hirsutism is as common a problem in the Kashmir Valley (India) as elsewhere in the world. Idiopathic hirsutism (38.7%), PCOS (37.3%), and postmenopausal state (9.2%) are common causes of hirsutism. Late-onset congenital adrenal hyperplasia is a relatively uncommon cause of hirsutism in the Kashmir Valley.

Prevalence of ultrasonography proved polycystic ovaries in North Indian women with type 2 diabetes mellitus.

BackgroundPolycystic ovaries (PCO) and their clinical expression (the polycystic ovary syndrome [PCOS]) as well as type 2 diabetes mellitus (T2DM) are common medical conditions linked through insulin resistance. We studied the prevalence of PCO and PCOS in women with diet and/or oral hypoglycemic treated T2DM and non-diabetic control women.DesignProspective study.MethodsOne hundred and five reproductive age group women with diet and /or oral hypoglycemic treated T2DM were the subjects of the study. Sixty age-matched non-diabetic women served as controls. Transabdominal ultrasonographic assessment of the ovaries was used to diagnose PCO. Clinical, biochemical and hormonal parameters were also noted.ResultsUltrasonographic prevalence of PCO was higher in women with diabetes than in non-diabetic subjects (61.0% vs. 36.7%, P < 0.003) whereas that of PCOS was 37.1% in diabetic subjects and 25% in non-diabetic controls (P > 0.1). Diabetic women with PCO had diabetes of significantly longer duration than those without PCO (4.19±2.0 versus 2.9±1.6 yrs; p < 0.05). Among both diabetic and non-diabetic women, those with PCO had significantly higher plasma LH, LH/FSH ratio, total testosterone and androstenedione levels.ConclusionThis study demonstrates a higher prevalence of PCO in women with T2DM as compared to non-diabetic subjects.

Seroprevalence of toxoplasmosis in women with repeated abortions in Kashmir.

Toxoplasmosis caused by an obligate intracellular protozoan parasite Toxoplasma gondii is a very common infection among young adults in diVerent parts of the world. 1 Most of the toxoplasma infections are asymptomatic, the diagnosis relies mainly on the results of serological tests. The clinical implications of toxoplasma infection in pregnant patients are manifold. Such patients may have spontaneous abortions, still births or premature delivery in addition to various fetal anomalies. 2 Ideally every woman should know her toxoplasma status before conception.Toxoplasma antibodies may persist in the serum of an asymptomatic people for years at higher titres. 3 In this study we screened women with repeated abortions for prevalence of toxoplasma antibodies (IgM) to determine any possible aetiological relation between abortions and toxoplasma infection. Methods Two hundred and eighty five consecutive women who attended our endocrine clinic at Institute of Medical Sciences, Soura, Srinagar, for repeated abortions (two or more) were studied for serological evidence of toxoplasmosis in the form of IgM antibodies.Abortion was defined as the termination of pregnancy before 20 weeks of gestation or below a fetal weight of 500 grams. 4 One hundred and sixty nine, age matched, multiparous controls were also studied simultaneously. To ensure a uniform socioeconomic group, all the controls were selected randomly from subjects attending the associated Maternity Hospital of the Institute for routine antenatal and postnatal visits. In 62 controls, blood samples for IgM toxoplasma were taken in immediate postpartum period while in the 107 controls samples were taken during pregnancy. These 107 subjects subsequently had normal deliveries. The serum samples were separated and stored in aliquots at ˛10°C till assayed. Samples were tested for toxoplasma IgM by ELISA kits, commercially available from Diagnostic Automation Inc, Calabasas, California, USA. Samples were tested strictly according to the manufacturer’s instruction.The results are read by a microwell reader compared in a parallel manner with calibrator and controls. INTERPRETATION Toxo M index of less than 0.80 is taken as negative, between 0.80 to 1.00 is equivocal, and 1.00 or greater is positive for IgM antibody toToxoplasma gondiiand indicates the probability of current or recent toxoplasmosis.