Gluconephrotic Syndrome: A Comprehensive Review.

This article provides an overview of the diabetic kidney disease paradigm, explaining important aspects such as prognostic markers, clinical assessments, and therapeutic options. The importance of the term gluconephrotic syndrome (GlucoNS) is emphasized, highlighting its significant influence on clinical evaluations, research procedures, screening techniques, and patient care. This term encapsulates nephrotic syndrome (NS) within the diabetic milieu, shedding light on the intricate relationship between renal complications and diabetes. GlucoNS necessitates a refined approach, considering the unique challenges posed by diabetes in the context of NS. With this review, we want to highlight how important it is to assess diabetes in every case of NS and how important it is to assess albuminuria in every diabetic patient.

The octagon of opportunities in obesity.

The Ominous Octet is a popular construct, which has been used to describe the aetiopathology of diabetes, as well as the endocrine causation of obesity. We utilize this model to create a smart and salutogenic rubric of obesity pathogenesis. Our optimistic Octagon of Opportunities lists eight causative or contributory factors, all of which are associated with the development of obesity. The model gives equal weightage to the biomedical and psychosocial arms of the biopsychosocial model of health. The framework encourages a proactive and comprehensive approach to the prevention and management of obesity.

Headache in diabetes.

Diabetes can present with multiple manifestations and subjective symptoms. One of these is headache. Headache can be a clinical presentation of diabetes per se, its complications or its comorbidities. It can also point towards certain causes of secondary diabetes, as well as iatrogenic issues. This communication lists the various causes of headache in diabetes, so as to help the clinician keep a high index of vigilance.

Ratiocination of ratios in endocrinology.

Endocrinology is an ever-evolving almanac of science. Precise measurement of hormones and associated analytes are necessary to practice endocrine medicine. As the endocrine system depends upon feedback and crosstalk between various glands and hormones, it makes sense to assess ratios or proportions of related hormones. We review the ratiocination, or rationale, of ratios which have diagnostic and therapeutic utility in endocrine praxis.

Longitudinal analysis of glymphatic function in amyotrophic lateral sclerosis and primary lateral sclerosis.

Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disorder of motor neurons in the brain and spinal cord. Accumulation of misfolded proteins is central in the pathogenesis of ALS and the glymphatic system is emerging as a potential therapeutic target to reduce proteinopathy. Using diffusion tensor imaging analysis along the perivascular spaces (DTI-ALPS) to assess glymphatic function, we perform a longitudinal analysis of glymphatic function in ALS and compare it to a disorder in the motor neuron disease spectrum, primary lateral sclerosis (PLS). From a cohort of 45 participants from the Calgary site in the CALSNIC study (Canadian ALS Neuroimaging Consortium), including 18 ALS, 5 PLS and 22 control participants, DTI-ALPS was analyzed and correlated to clinical features (age, sex, disease presentation, disease severity and progression rate), and white matter hyperintensity (WMH) burden. This included longitudinal measurements at three time points, 4 months apart. The DTI-ALPS index was reduced in ALS participants compared to PLS and control participants across all three time points. There was no association with clinical factors, however the index tended to decline with advancing age. Our study suggests heterogeneity in glymphatic dysfunction in motor neuron diseases that may be related to the underlying pathogenesis.

Safety and Efficacy of the Novel RNA Interference Therapies for Hypertriglyceridemia and Mixed Hyperlipidemia Management: A Systematic Review and Meta-analysis.

BACKGROUND: No meta-analysis has holistically analyzed and summarized the safety and therapeutic efficacy of the newer RNA interference (RNAi) therapies, olezarsen, plozasiran, and zodasiran, in managing conditions associated with hypertriglyceridemia (HTG). METHODS: Randomized controlled trials (RCTs) involving patients with HTG or mixed hyperlipidemia (MHL) receiving either olezarsen, plozasiran, or zodasiran in the intervention arm and a placebo in the control arm were searched through electronic databases. The primary outcome was the safety profile of the drugs studied; secondary outcomes included the percent change from baseline (CFB) in the lipid levels, including triglyceride (TG). RESULTS: Six RCTs with 334 participants were evaluated. Olezarsen, plozasiran, and zodasiran were well-tolerated with no higher risk of serious adverse events or injection-site reactions. After 24 weeks, plozasiran increased alanine aminotransferase and HbA1c more than placebo, although the difference was insignificant at 48 weeks. Plozasiran and zodasiran had little effect on hyperglycemia worsening. Olezarsen increased the likelihood of mild platelet count decreases without clinical harm. At their longest clinical trial follow-up, the highest doses of olezarsen, plozasiran, and zodasiran lowered TG by 55.2%, 50.57%, and 51.2% of baseline levels. All three drugs decreased non-HDL-C and remnant cholesterol. Olezarsen and plozasiran lowered ApoC-III and increased HDL-C, whereas zodasiran reduced HDL-C. Zodasiran decreased LDL-C, whereas olezarsen and plozasiran had no effects on LDL-C. Plozasiran and zodasiran lowered apolipoprotein B, but not olezarsen. CONCLUSION: The newer RNA interference (RNAi) therapies appear safe and have excellent TG-lowering efficacy in patients with HTG and MHL.

The Baro-Adrenal Axis.

The adrenal gland is a player in the Ominous Octet of obesity, which lists eight endocrine contributors to the development of obesity. Baro-adrenal axis describes the bidirectional, multifaceted link between weight homoeostasis and adrenal function, in health and disease. This communication lists the various ways in which adrenal function influences, and is impacted by, obesity.

Handling false chronic kidney disease and diabetes treatment information.

While examining the social perspectives of chronic kidney disease (CKD) and its most common cause, diabetes, a common problem is spread of misleading information by unqualified people. This concerning trend makes it more difficult for patients to receive prompt and proper medical advice, which in turn further delays their referral to nephrologists and endocrinologists. In this communication, we highlight the challenges and consequences of this burning issue. We also propose the steps that various stakeholders and policy makers should take to contain this issue at the earliest.

3D Sapiotyping: A Three Dimensional Definition.

Precision medicine and personalized care have been at centre-stage in diabetology, and rightfully so. Various means of classification and clustering have been proposed to help identify clinical features, causative factors and 'curative' strategies for people living with diabetes. Sapiotype describes "the various attitudes that person with diabetes may have towards their disease, their doctor or health care providers, a specific diagnostic procedure, drug, delivery device, and the health care system at large". The sapiotypic spectrum is a wide one, which encapsulates sapiotypic fluidity, or variability in attitudes, as well. In this communication, we further expand the sapiotypic spectrum by creating a 3- dimensional model.

Testomalacia.

In this communication, we introduce the descriptive diagnostic term 'testomalacia'. Testomalacia may suggest softness of the testes, both anatomic and/or functional, or may suggest malaise or illness related to testosterone secretion/function. While the term is not in vogue as of now, we feel that it describes functional androgen deficiency in an apt manner. Unlike other terms used to describe these symptoms, testomalacia can be used at any age, encompasses several etiologies and is just a single term rather than multiple complicated abbreviations.

Glucofriendly couscous usage in diabetes.

Couscous, a staple food of Northern Africa and the Middle East, is consumed across the world. Being carbohydrate - rich, it is often forbidden to persons with diabetes. Its social and cultural connotations, however, do not allow absolute avoidance of this dish in real life. This brief article explores various ways of preparing, serving and eating couscous, in a glucofriendly manner. The authors summarize available literature, and suggest culinary tips to reduce glycaemic index and glycaemic load of this foodstuff.

Quantitative susceptibility mapping in amyotrophic lateral sclerosis: automatic quantification of the magnetic susceptibility in the subcortical nuclei.

Objective: Previous studies have suggested a link between dysregulation of cortical iron levels and neuronal loss in amyotrophic lateral sclerosis (ALS) patients. However, few studies have reported differences in quantitative susceptibility mapping (QSM) values in subcortical nuclei between patients with ALS and healthy controls (HCs). Methods: MRI was performed using a 3 Tesla Prisma scanner (64-channel head coil), including 3D T1-MPRAGE and multi-echo 3D GRE for QSM reconstruction. Automated QSM segmentation was used to measure susceptibility values in the subcortical nuclei, which were compared between the groups. Correlations with clinical scales were analyzed. Group comparisons were performed using independent t-tests, with p < 0.05 considered significant. Correlations were assessed using Pearson's correlation, with p < 0.05 considered significant. Cohen's d was reported to compare the standardized mean difference (SMD) of QSM. Results: Twelve patients with limb-onset ALS (mean age 48.7 years, 75% male) and 13 age-, sex-, and handedness-matched HCs (mean age 44.6 years, 69% male) were included. Compared to HCs, ALS patients demonstrated significantly lower susceptibility in the left caudate nucleus (CN) (SMD = -0.845), right CN (SMD = -0.851), whole CN (SMD = -1.016), and left subthalamic nucleus (STN) (SMD = -1.000). Susceptibility in the left putamen (SMD = -0.857), left thalamus (SMD = -1.081), and whole thalamus (SMD = -0.968) was significantly higher in the patients. The susceptibility of the substantia nigra (SN), CN, and pulvinar was positively correlated with disease duration. Conclusions: QSM detects abnormal iron accumulation patterns in the subcortical gray matter of ALS patients, which correlates with disease characteristics, supporting its potential as a neuroimaging biomarker.

Psychological First Aid.

In this communication, we discuss the concept of psychological first aid, as relevant to diabetes management. Psychological first aid, in the diabetes care context, is defined as "the empathic support, counselling and education to improve coping skills, and optimize selfcare of persons living with diabetes, so that psychological well-being can be optimized." Various models can help provide structured psychological first aid. We feel that each and every health care provider should be able to provide effective first aid, including psychological first aid.

Oneirotherapy in Overweight and Obesity.

Oneirotherapy is a form of psychotherapy that is based on visual imagery and symbolism. In this communication. We discuss the role of oneirotherapy, or using vivid imagery, as adjuvant therapy in obesity care. Oneirotherapy can be used to promote acceptance of, and adherence to, prescribed therapy. It may also help improve quality of life and enhance self-esteem. However, oneirotherapy alone, without following a healthy lifestyle and or taking antiobesity medication, will help manage weight only in one's dreams.

Endocrine Entropy.

This communication defines and describes the novel concept of endocrine entropy. The authors share insights regarding the various facets of entropy in endocrine epidemiology, physiology, clinical presentation and management. The discussion opens up a new way of approaching endocrinology. Recent advances in artificial intelligence, assessment and addressal of entropy may become integral part of endocrine diagnostics and therapeutics.

Endocrine Entropy.

This communication defines and describes the novel concept of endocrine entropy. The authors share insights regarding the various facets of entropy in endocrine epidemiology, physiology, clinical presentation and management. The discussion opens up a new way of approaching endocrinology. Recent advances in artificial intelligence, assessment and addressal of entropy may become integral part of endocrine diagnostics and therapeutics.

Expert Consensus on Dipeptidyl Peptidase-4 Inhibitor-Based Therapies in the Modern Era of Type 2 Diabetes Mellitus Management in India.

India has a high prevalence of type 2 diabetes mellitus (T2DM) with unique clinical characteristics compared to other populations. Despite advancements in diabetes therapy, a significant number of patients in India still experience poor glycemic control and complications. Dipeptidyl peptidase-4 (DPP-4) inhibitors continue to be an important component of T2DM treatment due to their favorable efficacy and tolerability profile. Given the current scenario, there is a need to revisit the role of DPP-4 inhibitors in T2DM management in Indian patients. This consensus paper aims to provide guidance on the utilization of DPP-4 inhibitors in T2DM management from an Indian perspective. A consensus group of 100 experts developed recommendations based on an extensive literature review and discussions. The expert group emphasized the importance of timely glycemic control, combination therapy, and targeting the underlying pathophysiology of T2DM. The combinations of DPP-4 inhibitors with metformin and/or sodium-glucose transport protein-2 inhibitors are rationalized in this paper, considering their complementary mechanisms of action. This paper provides valuable insights for clinicians in optimizing the management of T2DM in the Indian population with the use of DPP-4 inhibitors and proposes an algorithm for selecting DPP-4 inhibitor-based therapies.

Alkaline Phosphatase: The Poor Man's iPTH - An Affordable Approach to Bone Health Assessment.

This review delves into relatively less discussed role of alkaline phosphatase (ALP) as an accessible alternative to intact parathyroid hormone (iPTH) in the context of bone health assessment, particularly focussing on its potential boon for underprivileged individuals with chronic kidney disease (CKD) in South Asia. The financial constraints faced by this demographic often hinder regular monitoring of iPTH levels. ALP emerges as a promising surrogate, offering a cost-effective and practical solution for bone health evaluation in resource-constrained settings.