Suman Kumar Kotwal

High prevalence of vitamin D deficiency among newly diagnosed youth-onset diabetes mellitus in north India

OBJECTIVES Vitamin D deficiency is common at all ages, and low levels of vitamin D have been associated with high incidence of type 1 diabetes. Similar results are not consistent for type 2 diabetes. The aim of the present study was to estimate vitamin D status in newly detected youth-onset diabetes in north India. SUBJECTS AND METHODS This was a prospective case control study at a tertiary care hospital in north India. Seventy two newly detected youth-onset diabetes subjects (age < 25 years), and 41 age- and gender-matched healthy controls were studied. In addition to basic information and management regarding their diabetes, metabolic parameters and serum 25(OH)D were measured in both the groups. RESULTS Vitamin D deficiency was seen in 91.1% of the subjects with diabetes, and 58.5% of the healthy controls. Mean ±SD 25(OH)D was significantly low, 7.88 ± 1.20 ng/mL in subjects with diabetes against 16.64 ± 7.83 ng/mL in controls. Sixty percent of cases had severe Vitamin D deficiency compared with 8.3% in controls. Levels of vitamin D did not correlate with clinical parameters, such as gender, body mass index; or with biochemical parameters, such as serum calcium, phosphorus, alkaline phosphatase, fasting plasma glucose, and HbA1C. CONCLUSION Vitamin D deficiency is common in people with youth-onset diabetes.

Alteration of Lipid Parameters in Patients With Subclinical Hypothyroidism

Background: Overt hypothyroidism is associated with abnormalities of lipid metabolism, but conflicting results regarding the degree of lipid changes in subclinical hypothyroidism (SCH) exist. Objectives: The aim of this study was to assess differences in lipid profile parameters between subjects with and without SCH in a north Indian population. Patients and Methods: Serum lipid parameters of 70 patients with subclinical hypothyroidism and 100 age and sex matched euthyroid controls were evaluated in a cross-sectional study. Results: Mean serum total cholesterol (TC), triglycerides (TG) and very low-density cholesterol (VLDL) were significantly higher in patients with SCH than controls (P < 0.05). Mean TC, TG and low-density cholesterol (LDL) concentrations were higher in patients with serum thyroid stimulating hormone (TSH) greater than 10 mU/L than those with serum TSH equal to or less than 10 mU/L, but this difference was not statistically significant. No association was found between serum high-density cholesterol (HDL-C) concentration and serum TSH level. Conclusions: High TC, TG and VLDL were observed in our patients with SCH.

Pattern of 25 hydroxy vitamin D status in North Indian people with newly detected type 2 diabetes: A prospective case control study.

Background: Vitamin D deficiency (VDD) has been linked to impaired glucose tolerance and type 2 diabetes (T2D) in humans. The aim of the present study was to find the vitamin D status in newly detected T2D patients compared with healthy controls. Materials and Methods: One hundred and two, newly detected T2D patients and similar number of age, body mass index (BMI), and gender matched healthy controls without diabetes were studied. In addition to basic information, metabolic parameters and serum 25 hydroxy vitamin D (25HD) were measured in both the groups. Results: Overall 25HD, was lower (mean ± SD, 18.81 ± 15.18 ng/ml) in patients with T2D as compared to healthy controls (28.46 ± 18.89 ng/ml) (P = 0.00). Taking a cut of 30 ng/ml, 81% of T2D patients had either VDD or insufficiency compared to 67% of healthy control subjects. Severe VDD (25HD of < 5 ng/ml) was seen in 16.2% of patients with diabetes and 2.5% of control subjects. Levels of 25HD had a negative correlation with HbA1c, fasting plasma glucose. Conclusions: VDD is common in people with new onset T2D.

Hydatid lung cyst in a 5-year-old boy presenting with prolonged fever

Cystic echinococcosis is the larval cystic stage (echinococcal cysts) of a small taeniid-type tapeworm (Echinococcus granulosus) that may cause illness in intermediate hosts, generally herbivorous animals and people who are infected accidentally. Pulmonary hydatid cysts are typical, involving one lobe in 72% of cases, usually at the lung base. In the paediatric age group, boys are affected more commonly than girls. We present a case of isolated hydatid cyst of the lung in a 5-year-old boy from a nomadic cattle-rearing tribe.

Cleidocranial dysplasia: a rare cause of disproportionate severe short stature.

Skeletal dysplasia is an uncommon cause of short stature in children. An 11-year-old girl was evaluated for severe short stature in a tertiary care hospital. Clinical examination revealed severe disproportionate short stature and classical triad of multiple supernumerary teeth, and complete absence of clavicles and open sagittal sutures and fontanelles. Skeletal survey confirmed these findings, in addition to other features associated with the syndrome.

Acute renal failure: A rare presentation of Sheehan's syndrome.

Sheehans syndrome occurs as a result of ischemic pituitary necrosis secondary to severe postpartum bleeding. It is one of the most common causes of hypopituitarism, characterized by variable clinical presentation. Acute kidney injury occurs rarely in Sheehans syndrome and most of the cases have been found to be precipitated by rhabdomyolysis. We here present a case of Sheehans syndrome with acute kidney injury where theprecipitating cause was chronic hypocortisolemia. We believe this is the first reported case of Sheehans syndrome in which acute kidney injury was precipitated by adrenal insufficiency.

Leksell Gamma Knife : An Effective Non Invasive Treatment for Rare Case of Nelson’s Syndrome

Nelson’s syndrome nowadays a rare entity results from an adrenocorticotropin (ACTH)–secreting pituitary adenoma in patients with refractory Cushings disease after a therapeutic bilateral adrenal gland removal. We report a case of 25 year old female with cushing’s disease who was initially managed with medical treatment, but in view of severe persistent hyper cortisol state was subjected to bilateral adrenalectomy following which she developed Nelson’s syndrome after a gap of six years, which was difficult to diagnose because of limited investigations available. Patient was managed with stereotactic radiosurgery (gamma knife surgery).

Dynamic Controversies of Pioglitazone

increase risk, but they demonstrated to have different effects on ischemic outcomes.5 Though pioglitazone and rosiglitazone have similar effects on glycemic control, their effects on serum lipid concentrations are different. Pioglitazone produces a more favourable lipid profile.6 It has been demonstrated that LDL cholesterol levels typically remained constant when monotherapy or combination therapy with pioglitazone was used, while 8 to 16 percent increases in LDL cholesterol levels were noted in studies of rosiglitazone.1 HDL cholesterol levels increased by about 10 percent with both drugs. Decrease in triglyceride levels were observed more so with pioglitazone than with rosiglitazone.