Sheehan's syndrome presenting as massive pericardial effusion, ventricular tachycardia and diabetes insipidus.

Sheehan's syndrome (SS) is characterised by pituitary necrosis resulting from postpartum haemorrhage. While SS is uncommon in developed nations, it remains a prevalent cause of hypopituitarism in women, particularly in low/middle-income countries. Clinically, SS is characterised by a deficiency in anterior pituitary hormones; involvement of the posterior pituitary is less common. SS presenting as cardiac tamponade is rare, with only a few reported cases in the literature. In this report, we present the case of a patient with SS who arrived at the emergency department with symptoms of light-headedness, palpitations and dyspnoea. Echocardiography revealed a massive pericardial effusion with cardiac tamponade, and during treatment, the patient experienced ventricular tachycardia and circulatory collapse. The collaboration between various medical specialties, including emergency medicine, cardiology, critical care, endocrinology and radiology, played a crucial role in successful patient management. The multidisciplinary approach allowed for comprehensive care addressing acute cardiac complications and underlying hormonal deficiencies.

Association of Sensory Nerve Action Potential Amplitude and Velocity With Type 2 Diabetic Peripheral Neuropathy.

BACKGROUND: There is ongoing controversy regarding the predominant type of nerve injury in diabetic peripheral neuropathy, whether it is demyelination or axonal degeneration. OBJECTIVE: This study aimed to investigate the association between nerve conduction study parameters, specifically nerve conduction velocity and the amplitude of the action potential, with diabetic peripheral neuropathy and determine their potential as early indicators of the condition. METHODS: A cross-sectional study was conducted involving diagnosed type 2 diabetes mellitus patients, who were divided into two groups: Group I (n = 111) with symptomatic diabetic peripheral neuropathy and Group II (n = 109) without clinically detectable peripheral neuropathy. Age and sex-matched healthy controls (n = 100) were also included. Nerve conduction velocity measurements were performed on both upper and lower limbs, with motor nerve conduction study focusing on the dominant side using the median and posterior tibial nerves and sensory nerve conduction study using the median and sural nerves. RESULTS: The nerve conduction studies revealed significantly lower sensory nerve action potential amplitudes and compound muscle action potential amplitudes in the median, posterior tibial, and sural nerves of the diabetic groups compared to the control subjects. Furthermore, these changes were more prominent in patients with peripheral neuropathy. Among the 220 diabetic patients analyzed, 135 (61.36%) exhibited nerve conduction abnormalities. The highest rate of abnormality was observed in the sural nerve, followed by the posterior tibial and median nerves. The most common abnormality detected in diabetic patients was a decrease in sensory nerve action potential, followed by a decrease in sensory nerve conduction velocity. CONCLUSION: The study findings suggest an association between reduced sensory nerve action potential amplitude and diabetic peripheral neuropathy. These results highlight the potential of sensory nerve action potential and velocity as a sensitive indicator of peripheral neuropathy in diabetic patients.

Uncovering Congenital Hypothyroidism in Adulthood: A Case Study Emphasizing the Urgency of Screening and Clinical Awareness.

Congenital hypothyroidism (CH) is an endocrine disorder primarily diagnosed during the neonatal period through routine screening. Screening programs have been established in most developed countries. However, routine neonatal screening is not available in India, and the mainstay for diagnosis is clinical awareness. In this report, we present a case of CH diagnosed for the first time in a 20-year-old male who sought medical attention at our hospital's emergency department due to fever and altered sensorium. This case report elucidates the implications of a delayed diagnosis of CH, shedding light on the pivotal role of neonatal screening and the need for enhanced awareness within the healthcare community and among families.

Emerging therapeutic options in the management of diabetes: recent trends, challenges and future directions.

Diabetes is a serious health issue that causes a progressive dysregulation of carbohydrate metabolism due to insufficient insulin hormone, leading to consistently high blood glucose levels. According to the epidemiological data, the prevalence of diabetes has been increasing globally, affecting millions of individuals. It is a long-term condition that increases the risk of various diseases caused by damage to small and large blood vessels. There are two main subtypes of diabetes: type 1 and type 2, with type 2 being the most prevalent. Genetic and molecular studies have identified several genetic variants and metabolic pathways that contribute to the development and progression of diabetes. Current treatments include gene therapy, stem cell therapy, statin therapy, and other drugs. Moreover, recent advancements in therapeutics have also focused on developing novel drugs targeting these pathways, including incretin mimetics, SGLT2 inhibitors, and GLP-1 receptor agonists, which have shown promising results in improving glycemic control and reducing the risk of complications. However, these treatments are often expensive, inaccessible to patients in underdeveloped countries, and can have severe side effects. Peptides, such as glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1), are being explored as a potential therapy for diabetes. These peptides are postprandial glucose-dependent pancreatic beta-cell insulin secretagogues and have received much attention as a possible treatment option. Despite these advances, diabetes remains a major health challenge, and further research is needed to develop effective treatments and prevent its complications. This review covers various aspects of diabetes, including epidemiology, genetic and molecular basis, and recent advancements in therapeutics including herbal and synthetic peptides.

Engineered Extracellular Vesicles in Treatment of Type 1 Diabetes Mellitus: A Prospective Review.

Insulin replacement is an available treatment for autoimmune type 1 diabetes mellitus (T1DM). There are multiple limitations in the treatment of autoimmune diseases such as T1DM by immunosuppression using drugs and chemicals. The advent of extracellular vesicle (EV)-based therapies for the treatment of various diseases has attracted much attention to the field of bio-nanomedicine. Tolerogenic nanoparticles can induce immune tolerance, especially in autoimmune diseases. EVs can deliver cargo to specific cells without restrictions. Accordingly, EVs can be used to deliver tolerogenic nanoparticles, including iron oxide-peptide-major histocompatibility complex, polyethylene glycol-silver-2-(1'H-indole-3'-carbonyl)-thiazole-4-carboxylic acid methyl ester, and carboxylated poly (lactic-co-glycolic acid) nanoparticles coupled with or encapsulating an antigen, to effectively treat autoimmune T1DM. The present work highlights the advances in exosome-based delivery of tolerogenic nanoparticles for the treatment of autoimmune T1DM.

Mucormycosis and Covid-19 : Risk Factors, Clinical Presentation and Outcome in a Tertiary Care Centre in North India.

A wide range of opportunistic infections have been described in patients with Coronavirus disease 2019 (COVID-19). Aspergillus and Candida have been reported as the main fungal pathogens for co-infection in these patients. Mucormycosis including Rhino-Orbital-Cerebral Mucormycosis (ROCM) has been increasingly described in patients with COVID-19 disease but the risk factors and outcome of such patients are not well described. MATERIAL: This prospective observational study was conducted at a tertiary centre in North India of 50 patients with radiologically and microbiologically proven Mucormycosis. OBSERVATION: The included subjects were evaluated for the risk factors, the clinical presentation, and outcomes. Frequency(t=50) Percentage 1 Age Below 40 10 20 40 and above 40 80 2 Sex F 21 42 M 29 58 3 Covid 19 history positive 39 78 negative 4 8 nr 7 14 4 HTN history Present 21 42 absent 29 58 5 Diabetes history present 42 84 absent 8 16 6 Duration of DM <1 month 8 16 >1 month 26 52 NR 16 32 7 Vaccination Status Vaccinated 2 4 Not vaccinated 48 96 8 HbA1c <6.5 7 14 6.5 to 7 7 14 >7 27 54 9 History of hospital/ home oxygen Present 17 34 absent 33 66 10 SpO2 during admission <90 1 2 90to95 8 16 >95 37 74 No record available 4 8 11 pH at admission <7.35 4 8 7.35 to 7.45 16 32 >7.45 7 14 Data not available 23 46 12 TLC <4400 1 2 4400 to 10900 27 54 >11000 16 32 Data Not available 6 12 Steroid Use in Hospital Stay prednisolone 2 4 Dexamethasone 23 46 13 Hydrocortisone 1 2 Methylprednisolone 1 2 Unavailable 4 8 Not received 19 38 14 Outcome Discharged 41 82 Expired 6 12 Absconded 3 6. CONCLUSION: Out of the 50 patients under study, 78% had Covid-19 disease. The primary risk factor of Mucor in patients of Covid-19 was Diabetes Mellitus (84%) with known diabetics (52%) having uncontrolled hyperglycemia (54%) and those who required oxygen support (home/ hospital) (32%). Mucor was more common in males (58%) of age 40 years and above (80%). About 96% of these patients were not vaccinated against Covid-19, and only 42% had a history of Hypertension. Dexamethasone was used in 46% of the patients admitted and 82% were discharged with satisfactory recovery.

Clinical Features, Biochemical Profile, and Response to Standard Treatment in Lean, Normal-Weight, and Overweight/Obese Indian Type 2 Diabetes Patients.

BACKGROUND: Much evidence is available on the relationship between type 2 diabetes mellitus (T2D) and obesity, but less on T2D in lean individuals. AIM: This study was conducted in 12,069 T2D patients from northern India to find out which clinical and biochemical features are related to lean, normal weight, and overweight/obese T2D patients. METHODS: The study was conducted at two endocrine clinics in northern India as a retrospective cross-sectional study. The records of all patients who attended these clinics from January 2018 to December 2019 were screened. After screening 13,400 patients, 12,069 were labelled as type 2 diabetes mellitus according to the criteria of the American Diabetes Association, 2020, and were included in the study. The patients were subdivided into the three groups by their body mass index (BMI): lean (BMI < 18), normal weight (BMI = 18-22.9), overweight/obese (BMI ≥ 23). The study evaluated how the three subgroups responded to standard diabetes management, including antidiabetic medication and lifestyle interventions. RESULTS: Of a total of 12,069 patients 327 (2.7%) were lean, 1,841 (15.2%) of normal weight, and 9,906 (82.1%) overweight/obese. Lean patients were younger, but had more severe episodes of hyperglycemia. All three subgroups experienced significant improvements in glycemic control during follow-up; HbA1c values were significantly lowered in the overweight/obese group during follow-up compared with baseline. CONCLUSIONS: While overweight/obese patients could benefit from the improvements in glycemic control achieved by lowering HbA1c, lean and normal-weight patients had more severe and difficult-to-control hyperglycemia.

Achievement of guideline targets of glycemic and non-glycemic parameters in North Indian type 2 diabetes mellitus patients: A retrospective analysis.

BACKGROUND AND AIMS: Though, the prevalence of diabetes is increasing in the worldwide, achievement of glycemic and non-glycemic targets remain suboptimal. We conducted this retrospective cross-sectional study at two endocrine clinics of Aligarh (Uttar Pradesh) in north India. MATERIALS AND METHODS: After screening the records of 13800 patients, 12140 patients of type 2 diabetes mellitus who were attending the clinic regularly every three to four months, were included in the final analysis. The data regarding patient's height, weight, body mass index, blood pressure, blood glucose, HbA1c, lipid profile and complications were obtained. RESULTS: Mean age was 49.7 ± 11.3 years; males and females were almost equal in number. 2891 (23.8%) subjects were of age less than 40 years. 9614 (80%) patients had diabetes duration of less than 5 years. 3311 (27.3%) subjects were having an HbA1c of <7%, HbA1c 7-8% in 3711 (30.5%), HbA1c 8-9% in 2653 (21.9%) whereas HbA1c of >9% in 2465 (20.3%) subjects. The microvascular complications; diabetic nephropathy, diabetic neuropathy and diabetic retinopathy were present in 7.5%, 14.9% and 16.2% respectively. Hypertension was present in 25.8% and coronary artery disease was present in 15.5% of patients. Overall 27.3%, 41.7%, 44.1%, 45.3% and 67.7% of patients achieved their HbA1c, triglyceride, HDL, LDL and hypertension targets respectively, as per American Diabetes Association 2020 guidelines. CONCLUSION: Despite availability of multiple drugs and guidelines, the attainment rates of glycemic and non-glycemic targets remain suboptimal. A more aggressive approach in the treatment of type 2 diabetes is required.

Diabetes Care During Hajj.

Diabetes mellitus affects over 463 million individuals worldwide. Religious activities such as the Hajj pilgrimage have a major impact on patients with diabetes mellitus, including increasing the risk of hyperglycaemia and hypoglycaemia. This increased risk is due to dietary changes and intense physical activity during pilgrimage while being on antidiabetic medications. Approximately 20% of the pilgrims with underlying illnesses who visit Mecca are diabetic, and complications, such as diabetic ketoacidosis, nonketotic hyperosmolar state, and fatigue/unconsciousness due to hypoglycaemia, have been observed among these patients. Diabetic patients are also at a high risk for foot complications and infections. To avoid any aggravation of the diabetes, a complete biochemical evaluation of the patient must be conducted before Hajj, and the patients must be provided contextualized educational guidance to avert these potential health challenges. This counselling should include the importance of carrying with them at all time their relevant medical history, summaries of the current treatment regimen and emergency snacks. In addition, to reduce the risk of hypoglycaemia, the dosage of insulin should be reduced in selected patients by 20% and that of sulfonylurea should be reduced as needed. Basal insulin and glucagon-like peptide 1 receptor agonists are associated with fewer complications and can be preferentially prescribed. Those patients with type 1 diabetes can continue with the use of insulin pump with suitable education prior to Hajj. For the prevention of foot problems, the use of padded socks and well-fitting shoes is recommended along with an insistence on not walking barefoot. After Hajj, the patient must be followed up, and necessary investigations must be made along with readjustment of insulin dosage in those patients for whom it was reduced. Until the pandemic situation abates, all diabetic patients should avoid making the Hajj journey.

Fighting pandemics: Inspiration from Islam.

Infectious disease has killed more people than any other cause throughout history. The current pandemic of coronavirus disease (COVID-19) has again revealed how vulnerable we remain. Muslims constitute the world's second-largest religious group, making up about a quarter of the world population. They have distinctive faith and culture, pertaining to their religious beliefs and practices that need special attention, in situations such as current COVID-19 pandemic. Congregational prayers are an indispensable part of Islamic culture. Performance of obligatory prayers in congregation is compulsory and mandatory for every Muslim adult male who has no excuse for not doing so. But, doing so during a pandemic can help in the spread of the COVID-19. Muslims look up to the Holy Qur'an and teachings of Prophet (PBUH) (Hadiths) for guidance under all the circumstances. In this review we will cover how Islamic teaching can guide us to manage pandemics like COVID-19.

The Clinical Spectrum of Fibrocalculous Pancreatic Diabetes in Kashmir Valley and Comparative Study of the Clinical Profile of Fibrocalculous Pancreatic Diabetes and Type 2 Diabetes Mellitus.

BACKGROUND: Fibrocalculous pancreatic diabetes (FCPD) is a secondary form of diabetes, described from several tropical countries, including India. We described the existence of this entity in the subtropical region-the Kashmir valley of the Indian subcontinent and compared the clinical characteristics of these patients with type 2 diabetes mellitus (T2DM) patients. AIM: The present study aimed to compare the clinical characteristics of patients with FCPD and those with T2DM to identify the characteristics distinctive of FCPD. MATERIALS AND METHODS: A total of 124 patients with FCPD were compared with 124 patients with T2DM matched for age and duration of diabetes. Biochemical parameters and microvascular and macrovascular complications were assessed in all patients. Multivariate regression analyses were performed to study the determinants of microvascular complications in both groups. RESULTS: FCPD patients had significantly lower serum cholesterol, serum triglyceride, and serum calcium levels but higher glycosylated hemoglobin levels compared to T2DM patients. FCPD participants were significantly leaner. The prevalence of retinopathy, neuropathy, and nephropathy was similar between the two. Five T2DM patients had documented cardiovascular disease compared to one in FCPD patients (P < 0.05). Multiple logistic regression analysis revealed glycosylated hemoglobin and duration of diabetes to be significantly associated with retinopathy and nephropathy in T2DM. Among FCPD patients, glycosylated hemoglobin showed a strong association with retinopathy as well as nephropathy. BMI showed a significant negative association with nephropathy in FCPD patients. Age and age at onset showed a strong association with neuropathy in FCPD patients while the duration of diabetes showed the association with neuropathy (P = 0.015) in T2DM. CONCLUSION: There are several differences in the phenotype, biochemical parameters, and prevalence of diabetic complications between patients with FCPD and T2DM.

Evaluation of Proinflammatory Cytokines in Obese vs Non-obese Patients with Metabolic Syndrome.

BACKGROUND: Obesity is one of the most common yet neglected public health problems in both the developed and developing countries. Metabolic syndrome (MS) is a multiplex of risk factor for the development of type 2 diabetes (T2D) and cardiovascular disease (CVD) and it reflects the clustering of multiple risk factors resulting from obesity and insulin resistance. Despite its predominance in obese individuals, MS does occur in non-obese individuals. Many individuals characterised as normal weight as per their body mass index (BMI), have increased visceral adiposity thereby leading to an unfavourable inflammatory cytokine profile. There are limited studies from India with respect to inflammatory cytokines in obesity and MS in general and non-obese patients with MS in particular. MATERIALS AND METHODS: An observational cross-sectional study was carried out in patients with MS with or without obesity. Anthropometric parameters such as height, weight and waist girth were measured and BMI was calculated. Serum levels of TNF-α, IL-6 and adiponectin were measured by using the enzyme-linked immunosorbent assay. RESULTS: A significant proportion of individuals categorised as normal weight had an increased waist circumference which correlated with BMI, acanthosis nigricans (AN) and fatty liver. There was no statistically significant difference in the cytokine levels in obese and non-obese patients with MS; similarly among non-obese patients with MS, cytokine levels were comparable in patients with or without abdominal obesity. However, triglycerides inversely correlated with adiponectin levels and there was no significant correlation between the cytokines and other parameters of MS. CONCLUSION: There was no significant difference in various metabolic and inflammatory parameters between obese and non-obese patients with MS. Even in non-obese group, there were no differences in metabolic and inflammatory markers between individuals with or without abdominal obesity. This finding indicates that apart from adipose tissue, other factors are also responsible for the development of MS and its associated proinflammatory profile. There could be a significant contribution of genetic and epigenetic factors which needs to be further explored.

Basic rules of Ramadan: A medico-religious perspective.

Fasting during the month of Ramadan is obligatory for all adult Muslims with few exceptions. The person observing a fast does not eat, drink, and smoke from dawn to dusk. Google and Medline search was undertaken for the articles related to basic rules of fasting-religious and medical perspectives in the previous 24 years using following key words: Islamic fasting, fasting and diabetes, fasting and endocrine system. There are clear cut guidelines regarding fasting in healthy people and exemptions have been emphasized. Some alterations in pulmonary, cardiac, gastrointestinal and neuropsychiatric systems are observed which do not harm a normal person. A risk strategy has been devised for people with diabetes regarding management during Ramadan fasting. Rules regarding adherence to fasting and concessions during the month of Ramadan are clear. Minor alterations in different body systems are observed in normal people during Ramadan.

Impact of lymphadenectomy in management of renal cell carcinoma.

PURPOSE: To evaluate the impact of regional lymphadenectomy as part of a management plan on morbidity, morbidity and survival in renal cell carcinoma (RCC). PATIENTS AND METHODS: A retrospective study reviewing 158 cases diagnosed as RCC at the National Cancer Institute, Cairo university, Egypt, during the time period from 2000 to 2007. Histopathological data and significant operative and postoperative events were retrieved to compare three lymphadenectomy groups; Group A, where more than 5 nodes were dissected, Group B where 5 or less nodes were dissected and Group C where no nodal dissection was done. RESULTS: More positive lymph nodes were seen in group A (37.8%) compared to group B (9.6%) (p=0.002). Lymph node positivity was significantly associated with higher grade (p=0.005), but not with larger tumor size (p=0.221). There was no significant difference in overall survival between the three lymphadenectomy groups (p=0.163). Overall survival was not significantly affected by lymph node status (p=0.585). CONCLUSION: Regional lymphadenectomy in RCC has no impact on the mortality or morbidity.