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Kalra S, Zargar AH, Sridhar GR, Das AK, Ahmed J, Mohan JC, Vijayakumar G, Kumar A, Sahay RK, Ayer V, Pandit K, Bantwal G, Srinivas A, Unnikrishnan AG, Jindal S, Ray S, Baruah MP, Ganguly K, Mittal S, Joshi A, George J, HK G, Kapoor N, Ramakrishnan S, Shah C, Dhingra A, Sharma B. Expert eValuation of Efficacy and Rationality of Vildagliptin "EVER-Vilda": An Indian Perspective. Clin Med Insights Endocrinol Diabetes 2024; 17:11795514231203911. [PMID: 38405679 PMCID: PMC10893842 DOI: 10.1177/11795514231203911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 09/04/2023] [Indexed: 02/27/2024] Open
Abstract
Vildagliptin, a dipeptidyl peptidase-4 (DPP-4) inhibitor is effective in reducing HbA1c levels in patients with type 2 diabetes (T2DM) when administered as monotherapy, dual or triple combination therapy. In India, Vildagliptin is commonly prescribed in T2DM patients because it reduces mean amplitude of glycemic excursion (MAGE), has lower risk of hypoglycemia and is weight neutral. Early combination therapy with vildagliptin and metformin is effective and well-tolerated in patients with T2DM, regardless of age or ethnicity. In view of already existing data on vildagliptin and the latest emerging clinical evidence, a group of endocrinologists, diabetologists and cardiologists convened for an expert group meeting to discuss the role and various combinations of vildagliptin in T2DM management. This practical document aims to guide Physicians and Specialists regarding the different available strengths and formulations of vildagliptin for the initiation and intensification of T2DM therapy.
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Affiliation(s)
| | - Abdul Hamid Zargar
- Centre for Diabetes and Endocrine Care, Srinagar, Jammu and Kashmir, India
| | - GR Sridhar
- Endocrine and Diabetes Centre, Visakhapatnam, Andhra Pradesh, India
| | - Ashok Kumar Das
- Pondicherry Institute of Medical Sciences, Pondicherry, India
| | - Jamal Ahmed
- Diabetes & Endocrinology Super Specialty Center, Aligarh, Uttar Pradesh, India
| | | | - G Vijayakumar
- Diabetes Medicare Centre, Apollo Specialty Hospital, Chennai, Tamil Nadu, India
| | - Ajay Kumar
- Diabetes Care and Research Centre, Patna, Bihar, India
| | - Rakesh Kumar Sahay
- Department of Endocrinology, Osmania Medical College, Hyderabad, Telangana, India
| | - Vageesh Ayer
- Department of Endocrinology, St. John’s Hospital, Bengaluru, Karnataka, India
| | - Kaushik Pandit
- Department of Endocrinology, Institute of Post Graduate Medical Education & Research, Kolkata, West Bengal, India
| | - Ganapathi Bantwal
- Department of Endocrinology, St John’s Medical College, Bengaluru, Karnataka, India
| | - Arun Srinivas
- Department of Cardiology, Apollo Hospital, Mysore, Karnataka, India
| | | | - Sushil Jindal
- Department of Endocrinology, People’s College of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Saumitra Ray
- Vivekananda Institute of Medical Sciences, Kolkata, West Bengal, India
| | - Manash P Baruah
- Department of Endocrinology, Apollo Excel Hospital, Guwahati, Assam, India
| | - Kajal Ganguly
- Department of Cardiology, N.R.S. Medical College, Kolkata, West Bengal, India
| | - Sachin Mittal
- Department of Endocrinology, Fortis Hospital, Mohali, Chandigarh, India
| | - Ameya Joshi
- Department of Endocrinology, Endocrine and Diabetes Clinic, Mumbai, Maharashtra, India
| | - Joe George
- Department of Endocrinology, Endodiab Clinic, Calicut, Kerala, India
| | - Ganesh HK
- Mangalore Endodiab Clinic; Department of Endocrinology, Diabetes & Metabolism A J Institute of Medical Sciences, Mangalore, Karnataka, India
| | - Nitin Kapoor
- Department of Endocrinology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Santosh Ramakrishnan
- Magna Centre for Obesity, Diabetes and Endocrinology, Hyderabad, Telangana. India
| | - Chetan Shah
- Heart Rhythm Clinic, Mumbai, Maharashtra, India
| | - Atul Dhingra
- Department of Endocrinology, Gangaram Bansal Hospital, Sri Ganganagar, Rajasthan, India
| | - Balram Sharma
- Department of Endocrinology, S.M.S. Medical College and Hospital, Jaipur, Rajasthan, India
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Sridhar GR, Lakshmi G. Editorial: Diabetes and depression. Front Clin Diabetes Healthc 2023; 4:1221640. [PMID: 37435572 PMCID: PMC10332312 DOI: 10.3389/fcdhc.2023.1221640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 06/05/2023] [Indexed: 07/13/2023]
Affiliation(s)
- G. R. Sridhar
- Department of Endocrinology, Endocrine and Diabetes Centre, Visakhapatnam, India
| | - G. Lakshmi
- Department of Medicine, Gayatri Vidya Parishad Institute of Health Care and Medical Technology, Visakhapatnam, India
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Sridhar GR, Pandit K, Warrier S, Birla A. Sustained-Release Vildagliptin 100 mg in Type 2 Diabetes Mellitus: A Review. Cureus 2023; 15:e39204. [PMID: 37378205 PMCID: PMC10291938 DOI: 10.7759/cureus.39204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2023] [Indexed: 06/29/2023] Open
Abstract
Dipeptidyl peptidase-4 inhibitors (DPP4Is) were introduced into the management of type 2 diabetes mellitus (T2DM) as they are insulinotropic and have no inherent risk of hypoglycemia and no effect on body weight. Currently, 11 drugs in this class are available for the management of diabetes. Although they have a similar mechanism of action, they differ from one other in their binding mechanisms, which influences their therapeutic and pharmacological profiles. Vildagliptin's overall safety and tolerability profile was comparable to placebo throughout clinical studies, and real-world data in a large group of T2DM patients corroborated this finding. Therefore, DPP4Is like vildagliptin is a secure alternative for treating patients with T2DM. Vildagliptin treatment given as a once-daily (QD) 100 mg sustained release (SR) formulation fits the criteria of adherence and compliance. This SR formulation, given once daily has the potential to provide glycemic control like the vildagliptin 50 mg twice-daily (BD) formulation. This comprehensive review discusses the journey of vildagliptin as 50 mg BD therapy as well as 100 mg SR QD therapy.
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Affiliation(s)
- G R Sridhar
- Endocrinology, Endocrine and Diabetes Centre, Visakhapatnam, IND
| | - Kaushik Pandit
- Endocrinology, Diabetes and Metabolism, Belle Vue Clinic, Kolkata, IND
- Endocrinology, Diabetes and Metabolism, Institute of Post Graduate Medical Education & Research, Kolkata, IND
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Das AK, Saboo B, Chawla R, Aravind SR, Rajput R, Singh AK, Mukherjee JJ, Jhingan A, Shah P, Deshmukh V, Kale S, Jaggi S, Sridhar GR, Dhediya R, Gaurav K. Time to reposition sulfonylureas in type 2 diabetes management in Indian context: A pragmatic practical approach. Int J Diabetes Dev Ctries 2023:1-19. [PMID: 37360324 PMCID: PMC10113130 DOI: 10.1007/s13410-023-01192-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 03/20/2023] [Indexed: 06/28/2023] Open
Abstract
Sulfonylureas (SU) continue to be a vital therapeutic category of oral hypoglycemic agents (OHAs) for the management of type 2 diabetes mellitus (T2DM). Physicians consider modern SU (gliclazide and glimepiride) as "safe and smart" choices for T2DM management. The presence of multiple international guidelines and scarcity of a national guideline may contribute to the challenges faced by few physicians in choosing the right therapeutic strategy. The role of SU in diabetes management is explicit, and the present consensus aims to emphasize the benefits and reposition SU in India. This pragmatic, practical approach aims to define expert recommendations for the physicians to improve caregivers' knowledge of the management of T2DM, leading to superior patient outcomes.
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Affiliation(s)
- Ashok Kumar Das
- Department of Endocrinology and Medicine, Pondicherry Institute of Medical Sciences, Puducherry, India
| | - Banshi Saboo
- Department of Diabetology, DIA-CARE, Ahmedabad, India
| | | | - S. R. Aravind
- Department of Medicine, Diacon Hospital, Bengaluru, India
| | - Rajesh Rajput
- Department of Endocrinology, PGIMS, Rohtak, Haryana India
| | | | - J. J. Mukherjee
- Department of Endocrinology and Diabetes, Apollo Gleneagles Hospital, Kolkata, India
| | - Ashok Jhingan
- Department of Diabetology, Delhi Diabetes Education and Research Foundation, New Delhi, India
| | - Parag Shah
- Department of Endocrinology and Diabetes, Gujarat Endocrine Centre, Ahmedabad, India
| | - Vaishali Deshmukh
- Department of Endocrinology, Deshmukh Clinic and Deenanath Mangeshkar Hospital and Research Centre, Pune, India
| | - Shailaja Kale
- Dr Shailaja Kale’s Diabetes & Speciality Clinic, Pune, India
| | | | | | - Rajnish Dhediya
- Department of Medical Affairs, Dr Reddy’s Laboratories Ltd, Hyderabad, Telangana India
| | - Kumar Gaurav
- Department of Medical Affairs, Dr Reddy’s Laboratories Ltd, Hyderabad, Telangana India
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Kowalski AJ, Poongothai S, Chwastiak L, Hutcheson M, Tandon N, Khadgawat R, Sridhar GR, Aravind SR, Sosale B, Anjana RM, Rao D, Sagar R, Mehta N, Narayan KMV, Unutzer J, Katon W, Mohan V, Ali MK. The INtegrating DEPrEssioN and Diabetes treatmENT (INDEPENDENT) study: Design and methods to address mental healthcare gaps in India. Contemp Clin Trials 2017. [PMID: 28642211 DOI: 10.1016/j.cct.2017.06.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Depression and diabetes are highly prevalent worldwide and often co-exist, worsening outcomes for each condition. Barriers to diagnosis and treatment are exacerbated in low and middle-income countries with limited health infrastructure and access to mental health treatment. The INtegrating DEPrEssioN and Diabetes treatmENT (INDEPENDENT) study tests the sustained effectiveness and cost-effectiveness of a multi-component care model for individuals with poorly-controlled diabetes and depression in diabetes clinics in India. MATERIALS AND METHODS Adults with diabetes, depressive symptoms (Patient Health Questionnaire-9 score≥10), and ≥1 poorly-controlled cardiometabolic indicator (either HbA1c≥8.0%, SBP≥140mmHg, and/or LDL≥130mg/dl) were enrolled and randomized to the intervention or usual care. The intervention combined collaborative care, decision-support, and population health management. The primary outcome is the between-arm difference in the proportion of participants achieving combined depression response (≥50% reduction in Symptom Checklist score from baseline) AND one or more of: ≥0.5% reduction in HbA1c, ≥5mmHg reduction in SBP, or ≥10mg/dl reduction in LDL-c at 24months (12-month intervention; 12-month observational follow-up). Other outcomes include control of individual parameters, patient-centered measures (i.e. treatment satisfaction), and cost-effectiveness. RESULTS The study trained seven care coordinators. Participant recruitment is complete - 940 adults were screened, with 483 eligible, and 404 randomized (196 to intervention; 208 to usual care). Randomization was balanced across clinic sites. CONCLUSIONS The INDEPENDENT model aims to increase access to mental health care and improve depression and cardiometabolic disease outcomes among complex patients with diabetes by leveraging the care provided in diabetes clinics in India (clinicaltrials.gov number: NCT02022111).
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Affiliation(s)
- A J Kowalski
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322, United States
| | - S Poongothai
- Madras Diabetes Research Foundation, Dr. Mohan's Diabetes Specialities Centre, 4, Conran Smith Road, Gopalapuram, Chennai 600 086, Tamil Nadu, India
| | - L Chwastiak
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - M Hutcheson
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322, United States
| | - N Tandon
- All India Institute of Medical Sciences, Department of Endocrinology & Metabolism, Biotechnology Block, 3rd Floor, Rm #312, Ansari Nagar, New Delhi 110 029, India
| | - R Khadgawat
- All India Institute of Medical Sciences, Department of Endocrinology & Metabolism, Biotechnology Block, 3rd Floor, Rm #312, Ansari Nagar, New Delhi 110 029, India
| | - G R Sridhar
- Endocrine and Diabetes Centre, Visakhapatnam, Andhra Pradesh, India
| | - S R Aravind
- Diacon Hospital, Diabetes Care and Research Center, Rajajinagar, Bangalore 560 010, Karantaka, India
| | - B Sosale
- Diacon Hospital, Diabetes Care and Research Center, Rajajinagar, Bangalore 560 010, Karantaka, India
| | - R M Anjana
- Madras Diabetes Research Foundation, Dr. Mohan's Diabetes Specialities Centre, 4, Conran Smith Road, Gopalapuram, Chennai 600 086, Tamil Nadu, India
| | - D Rao
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States; Department of Global Health, University of Washington, Seattle, WA, United States
| | - R Sagar
- All India Institute of Medical Sciences, Department of Psychiatry, Ansari Nagar, New Delhi 110 029, India
| | - N Mehta
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322, United States
| | - K M V Narayan
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322, United States
| | - J Unutzer
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - W Katon
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - V Mohan
- Madras Diabetes Research Foundation, Dr. Mohan's Diabetes Specialities Centre, 4, Conran Smith Road, Gopalapuram, Chennai 600 086, Tamil Nadu, India
| | - M K Ali
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322, United States.
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Sridhar GR. Erratum to: Diabetes and data in many forms. Int J Diabetes Dev Ctries 2017. [DOI: 10.1007/s13410-016-0546-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Rao D, Lipira L, Kumar S, Mohanraj R, Poongothai S, Tandon N, Sridhar GR, Katon W, Narayan KV, Chwastiak L, Mohan V, Ali MK. Input of stakeholders on reducing depressive symptoms and improving diabetes outcomes in India: Formative work for the INDEPENDENT Study. Int J Noncommun Dis 2016; 1:65-75. [PMID: 29075675 DOI: 10.4103/2468-8827.191979] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
AIMS Depression and diabetes are highly comorbid, adversely affecting treatment adherence and resulting in poor outcomes. To improve treatment and outcomes for people dually-affected by diabetes and depression in India, we aimed to develop and test an integrated care model. In the formative phase of this INtegrated DEPrEssioN and Diabetes TreatmENT (INDEPENDENT) study, we sought stakeholder perspectives to inform culturally-sensitive adaptations of the intervention. METHODS At our Delhi, Chennai, and Vishakhapatnam sites, we conducted focus groups for patients with diabetes and depression and interviewed healthcare workers, family members, and patients. These key informants were asked about experiences with diabetes and depression and for feedback on intervention materials. Data were analyzed using a grounded theory approach. RESULTS Three major themes emerged that have bearing on adaptation of the proposed intervention: importance of family assistance, concerns regarding patient/family understanding of diabetes, and feedback regarding the proposed intervention (e.g. adequate time needed for implementation; training program and intervention should address stigma). CONCLUSIONS Based on our findings, the following components would add value when incorporated into the intervention: 1) engaging families in the treatment process, 2) clear/simple written information, 3) clear non-jargon verbal explanations, and 4) coaching to help patients cope with stigma.
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Affiliation(s)
- Deepa Rao
- Department of Global Health; Department of Psychiatry and Behavioral Sciences, Health Services University of Washington, Seattle, USA
| | - Lauren Lipira
- Department of Health Services, University of Washington, Seattle, USA
| | - Shuba Kumar
- Samarth, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | - Rani Mohanraj
- Samarth, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | - Subramani Poongothai
- Department of Clinical Trials, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | - Nikhil Tandon
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - G R Sridhar
- Endocrine and Diabetes Centre, Visakhapatnam, Andhra Pradesh, India
| | - Wayne Katon
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, USA
| | - Km Venkat Narayan
- Department of Global Health and Epidemiology; Department of Medicine, Emory University, Atlanta, GA, USA
| | - Lydia Chwastiak
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, USA
| | - Viswanathan Mohan
- Department of Diabetology, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | - Mohammed K Ali
- Department of Medicine, Emory University, Atlanta, GA, USA
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Sridhar GR. Malignant hyperthermia in a young adolescent in Singapore. Natl Med J India 2015; 28:106-107. [PMID: 26612166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- G R Sridhar
- Department of Endocrine and Diabetes Centre 15-12-15 Krishnanaar Visakhapatnam Andhra Pradesh
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Abstract
This consensus based national guideline addresses the need for psychological, psychiatric and social assessment, as well as management, in antenatal women with diabetes. It builds upon the earlier Indian guidelines on psychological management of diabetes, and should be considered as an addendum to the parent guideline.
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Affiliation(s)
- Bharti Kalra
- Department of Endocrinology, Bharti Hospital, Karnal, India
| | - G. R. Sridhar
- Endocrine and Diabetes Centre, Andhra University, Vishakhapatnam, India
| | - K. Madhu
- Department of Psychology, Andhra University, Vishakhapatnam, India
| | - Yatan Pal Singh Balhara
- Department of Psychiatry, National Drug Dependence Treatment Centre, AIIMS, New Delhi,, India
| | | | - Sanjay Kalra
- Department of Endocrinology, Bharti Hospital, Karnal, India
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Kalra S, Sridhar GR, Balhara YPS, Sahay RK, Bantwal G, Baruah MP, John M, Unnikrishnan AG, Madhu K, Verma K, Sreedevi A, Shukla R, Prasanna Kumar KM. National recommendations: Psychosocial management of diabetes in India. Indian J Endocrinol Metab 2013; 17:376-95. [PMID: 23869293 PMCID: PMC3712367 DOI: 10.4103/2230-8210.111608] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Although several evidence-based guidelines for managing diabetes are available, few, if any, focus on the psychosocial aspects of this challenging condition. It is increasingly evident that psychosocial treatment is integral to a holistic approach of managing diabetes; it forms the key to realizing appropriate biomedical outcomes. Dearth of attention is as much due to lack of awareness as due to lack of guidelines. This lacuna results in diversity among the standards of clinical practice, which, in India, is also due to the size and complexity of psychosocial care itself. This article aims to highlight evidence- and experience-based Indian guidelines for the psychosocial management of diabetes. A systemic literature was conducted for peer-reviewed studies and publications covering psychosocial aspects in diabetes. Recommendations are classified into three domains: General, psychological and social, and graded by the weight they should have in clinical practice and by the degree of support from the literature. Ninety-four recommendations of varying strength are made to help professionals identify the psychosocial interventions needed to support patients and their families and explore their role in devising support strategies. They also aid in developing core skills needed for effective diabetes management. These recommendations provide practical guidelines to fulfill unmet needs in diabetes management, and help achieve a qualitative improvement in the way physicians manage patients. The guidelines, while maintaining an India-specific character, have global relevance, which is bound to grow as the diabetes pandemic throws up new challenges.
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Affiliation(s)
- Sanjay Kalra
- Department of Endocrinology, Bharti Hospital, Karnal, India
| | - G. R. Sridhar
- Department of Endocrine and Diabetes Centre, Visakhapatnam, India
| | - Yatan Pal Singh Balhara
- Department of Psychiatry, National Drug Dependence Treatment Centre (NDDTC), AIIMS, New Delhi, India
| | | | - Ganapathy Bantwal
- Department of Endocrinology, St. John's Medical College, Bengaluru, India
| | - Manash P. Baruah
- Department of Endocrinology, Excel Centre Hospitals, Guwahati, India
| | - Mathew John
- Department of Endocrinology, Providence Endocrine and Diabetes Specialty Centre, Trivandrum, India
| | | | - K. Madhu
- Department of Psychology, Andhra University, Vishakhapatnam, India
| | - Komal Verma
- Department of Psychology, Consultant Psychologist, Noida, India
| | - Aswathy Sreedevi
- Department of Community Medicine, Amrita Institute of Medical Sciences, Kochi, India
| | - Rishi Shukla
- Department of Endocrinology, Center For Diabetes, Kanpur, Uttar Pradesh, India
| | - K. M. Prasanna Kumar
- Department of Endocrinology, CDEC and Bangalore Diabetes Hospital, Bengaluru, Karnataka, India
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Abstract
This chapter presents an extension of the authors’ earlier work, where they showed that nucleotide/amino acid sequences related to insulin occurred in the plant kingdom. It was believed that plants did not have, nor did they need insulin, a protein hormone considered to be restricted to the animal kingdom. In the current study, the human insulin sequence was initially obtained from UniProt/SwissProt (accession no. P01308). Plant genome sequences were obtained from NCBI PubMed (Bauhinia purpurea [Gi|229412], Vigna unguiculata [P83770], and Canavalia ensiformis [Gi|7438602]. Scores were obtained from ProtFun 2.2 [http://www.cbs.dtu.dk/services/ProtFun/]. At the next stage, functions of insulin and glucokinin (insulin like proteins in plants) were predicted by the Protein Function Prediction database (http://dragon.bio.purdue.edu/pfp/index.html), followed by functional site prediction from the ELM database (http://elm.eu.org/). ProtFun predicted the following functions: human insulin (Cell envelope), Jack bean (Energy metabolism), Bauhinia purpurea(Translation). The amino acid Glycine at 32 positions was most highly conserved. Present predictions advocate the use of these sequences (QHLCGS motif) as targets for probing the other plants with lesser homology. In summary our in silico studies have suggested that Bauhinia purpurea (Purple orchid tree-BP), Vigna unguiculata (Cow pea-CP) and Canavalia ensiformis (Jack bean-JB) have conserved the important regions of the human insulin protein.
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Sundararaman PG, Manomani R, Sridhar GR, Sridhar V, Sundaravalli A, Umachander M. Risk of atherosclerosis in women with polycystic ovary syndrome: a study from South India. Metab Syndr Relat Disord 2012; 1:271-5. [PMID: 18370651 DOI: 10.1089/1540419031361435] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Women with polycystic ovary syndrome (PCOS) often present for cosmetic and or reproductive symptoms; attention is generally not paid to the future risk of atherosclerosis for these women. Given that Asian Indians are insulin resistant and prone to metabolic syndrome at an earlier age, we assessed glucose/insulin ratio and intimal medial thickness (IMT) in young women with PCOS from south India. In this cross-sectional case control study, we assessed insulin resistance and carotid IMT in 40 women presenting with hyperandrogenic features of PCOS. Insulin resistance was assessed by fasting glucose/insulin ratio and IMT by the Doppler system with electrical linear transducer midfrequency of 12 MHz. Women with PCOS had higher fasting insulin levels (36.58 +/- 17.81 muU/mL, vs. 16.60 +/- 3.22 muU/mL in controls; p < 0.001), higher insulin resistance (glucose/insulin ratio 2.81 +/- 1.47 vs. 5.47 +/- 1.46 in controls; p < 0.001), and greater IMT (0.53 +/- 0.14 mm vs. 0.39 +/- 0.06 mm in controls; p < 0.001). Women with PCOS had a higher body mass index (BMI) (26.46 +/- 5.24 vs. 23.24 +/- 3.05 in controls; p < 0.001), and the differences between PCOS and controls persisted, even among those who had a BMI of less than 25. We concluded that South Indian women with the reproductive abnormalities of PCOS have greater insulin resistance and IMT, and therefore they must be advised about lowering the risk of future vascular disease.
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Abstract
OBJECTIVE To measure serum chromium level in women with gestational diabetes mellitus (GDM) from Chennai, South India. MATERIALS AND METHODS Thirty women with gestational diabetes, 60 age matched controls. INCLUSION CRITERIA Gestational age 22-28 weeks, age group 20-35 years. EXCLUSION CRITERIA Gestational age beyond 28 weeks, malnutrition or presence of infection. Serum chromium was measured using inductive couple plasma emission spectrometer. RESULTS Serum chromium levels of women with GDM, 1.59+/-0.02 ng/ml (range: 0.16-4.0 ng/ml) were lower than in controls (4.58+/-0.62 ng/ml; range 0.82-5.33 ng/ml) (P < 0.001). However, there were no significant differences among cases and controls when subdivided by parity. CONCLUSIONS Women with GDM from a South Indian city had lower levels of serum chromium compared to pregnant women without GDM. Studies may be done whether chromium supplementation is useful in this group of women.
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Affiliation(s)
- P. G. Sundararaman
- Department of Endocrinology, Apollo Hospitals, Gream's lane, Off Gream's Road, Chennai, India
| | - G. R. Sridhar
- Endocrine and Diabetes Centre, 15-12-15 Krishnanagar, Visakhapatnam, India
| | - V. Sujatha
- Institute of Obstetrics and Gynecology, Chennai, India
| | - V. Anita
- Institute of Obstetrics and Gynecology, Chennai, India
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Affiliation(s)
- G. R. Sridhar
- Department of Endocrinology, Endocrine and Diabetes Centre, Krishnanagar, Visakhapatnam, Andhra Pradesh, India
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Guttula SV, Rao AA, Sridhar GR, Chakravarthy MS, Nageshwararo K, Rao PV. Cluster analysis and phylogenetic relationship in biomarker identification of type 2 diabetes and nephropathy. Int J Diabetes Dev Ctries 2011; 30:52-6. [PMID: 20431808 PMCID: PMC2859286 DOI: 10.4103/0973-3930.60003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2008] [Accepted: 12/23/2009] [Indexed: 12/14/2022] Open
Abstract
Cluster analysis of DNA microarray data that uses statistical algorithms to arrange the genes according to similarity in patterns of gene expression and the output displayed graphically is described in this article. Hierarchical clustering is a multivariate tool often used in phylogenetics, comparative genomics to relate the evolution of species. The patterns seen in microarray expression data can be interpreted as indications of the status of the genes responsible for nephropathy in peripheral blow cells of type 2 diabetes (T2DN). Out of 415 genes totally expressed in the 3 DNA chips it was concluded that only 116 genes expressed in T2DN and in that only 50 are functional genes. These 50 functional genes are responsible for diabetic nephropathy; of these 50, some of the genes which are more expressed and responsible are AGXT: Alanine-glyoxylate aminotransferase, RHOD: Ras homolog gene family, CAPN6: Calpain 6, EFNB2: Ephrin-B2, ANXA7: Annexin A7, PEG10: Paternally expressed 10, DPP4: Dipeptidyl-peptidase 4 (CD26, adenosine deaminase complexing protein 2), ENSA: Endosulfine alpha, IGFBP2: Insulin-like growth factor binding protein 2, 36kDa, CENPB: Centromere protein B, 80kDa, MLL3: Myeloid/lymphoid or mixed-lineage leukemia 3, BDNF: Brain-derived neurotrophic factor, EIF4A2: Eukaryotic translation initiation factor 4A, isoform 2, PPP2R1A: Protein phosphatase 2 (formerly 2A), regulatory subunit A, alpha isoform. Fifty genes and their nucleotide sequences are taken from NCBI and a phylogenetic tree is constructed using CLUSTAL W and the distances are closer to each other concluding that based on the sequence similarity and evolution the genes are expressed similarly. Literature survey is done for each gene in OMIM and the genes responsible for diabetic nephropathy are listed.
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Abstract
Development of type 2 diabetes mellitus is influenced by built environment, which is, 'the environments that are modified by humans, including homes, schools, workplaces, highways, urban sprawls, accessibility to amenities, leisure, and pollution.' Built environment contributes to diabetes through access to physical activity and through stress, by affecting the sleep cycle. With globalization, there is a possibility that western environmental models may be replicated in developing countries such as India, where the underlying genetic predisposition makes them particularly susceptible to diabetes. Here we review published information on the relationship between built environment and diabetes, so that appropriate modifications can be incorporated to reduce the risk of developing diabetes mellitus.
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Affiliation(s)
- Sudhir Kumar Pasala
- Department of Architecture, Andhra University College of Engineering (Autonomous), Visakhapatnam, India
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Abstract
OBJECTIVE Pattern of sleep in hyperthyroid state / thyrotoxicosis has not been systematically studied. It is being characterized as poor without further elaboration. We analyzed the pattern of sleep in a large sample of individuals with thyrotoxicosis who came to our endocrine center in southern India. MATERIALS AND METHODS We identified individuals with the diagnosis of 'thyrotoxicosis' from our electronic medical record database, and evaluated clinical parameters and pattern of their sleep: difficulty in falling asleep (DFA), difficulty in maintaining sleep (DMS), excess daytime sleepiness). In the first phase, univariate analysis with logistic regression was performed. Multivariate logistic regression was performed in the next phase on variables with a P-value < 0.1: these were considered as potential categories/ variables. RESULTS In model response variable with DFA, multivariate logistic regression predicted that subjects with abnormal appetite (more 1.7 or less 2.2), change in bowel motion (loose 1.5 or constipation 2.8), in mood (easy loss of temper 3.4), change of voice -- hoarse 7.4 or moderately hoarse 3.1), tended to have higher chances of difficulty in falling asleep (DFA). Patients with tremor (yes = 5.4) had greater likelihood of difficulty in maintaining sleep (DMS). CONCLUSIONS Individuals with hyperthyroidism/thyrotoxicosis principally had difficulty in falling asleep DFA, which was related to hyperkinetic features.
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Affiliation(s)
- G. R. Sridhar
- Endocrine and Diabetes Centre, 15-12-15 Krishnanagar, Visakhapatnam-530 002, India
| | - Venkata Putcha
- Accostats Solution UK Ltd, 53 Charlwood Road, Luton LU4 0BT, UK
| | - G. Lakshmi
- Kasturba Medical College, Manipal, India
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Reddy BVR, Sridhar GR, Anuradha CH, Chandrasekhar P, Lingamaneni KP. Malignant melanoma of the mandibular gingiva: a rare occurrence. Indian J Dent Res 2010; 21:302-5. [PMID: 20657106 DOI: 10.4103/0970-9290.66644] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Primary mucosal malignant melanoma of the oral cavity is a rare tumor. It accounts for only 0.2-8% of all malignant melanomas. This malignancy commonly affects male subjects and is more frequently seen on the hard palate and maxillary gingiva. The peak age for diagnosis of oral melanoma is between 55 and 65 years. A biopsy is required to establish a diagnosis. Ablative surgery with tumor-free margins remains the treatment of choice. It has a much poorer prognosis than its counterpart on the skin. Here, we present a case of malignant melanoma of the mandibular lingual gingiva in a 55-year-old male patient. Immunohistochemistry and special stains were conducted for confirmatory diagnosis.
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Affiliation(s)
- B V R Reddy
- Department of Oral Pathology, Sibar Institute of Dental Sciences, Takkellapadu, Guntur, Andhra Pradesh, India
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Dharmiah D, Narasinga Rao M, Ravikiran, Sandeep N, Gopal VDS, Appa Rao A, Sridhar GR. Genomic patient information management system. Genome Biol 2010. [PMCID: PMC3026275 DOI: 10.1186/gb-2010-11-s1-p44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
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Sridhar GR, Putcha V, Lakshmi G. Time trends in the prevalence of diabetes mellitus: ten year analysis from southern India (1994-2004) on 19,072 subjects with diabetes. J Assoc Physicians India 2010; 58:290-294. [PMID: 21117347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To assess the time trends in the prevalence of diabetes at our Centre from 1994-2004 (N: 19,072 individuals) on the following parameters: age group, sex, rural or urban area and individuals with freshly diagnosed diabetes versus known diabetes. STUDY DESIGN AND SETTING Analysis of data from electronic medical records at a referral Endocrine and Diabetes Centre in Southern India. METHODS We have employed the period prevalence method and person-time risk to express the results. The concept of person-time risk can be estimated as the actual time-at-risk in years that all persons contributed to a study. The person-time can be estimated for each patient when a patient changed from diabetic free to diabetic patient. This can be captured for each patient from the variable onset of first diagnoses as a diabetic patient. Thus person-time is employed to derive information on the rate at which people acquire the disease. RESULTS Between 1994 and 2004 however there is an increasing trend in the number of individuals in the young, particularly the 18-34 year group. Similarly there is a steadily increasing pattern in both urban and rural areas; the number from rural areas tended to increase compared to urban areas. The number of women with diabetes tended to increase over the 10-year period. CONCLUSION Between 1994 and 2004 among persons with diabetes who presented at our Centre, there was a trend toward more number of younger persons, particularly women from rural areas.
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Affiliation(s)
- G R Sridhar
- Endocrine and Diabetes Centre, 15-12-16 Krishnanagar, Visakhapatnam 530 002, India
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Gedela S, Guruju VPB, Sulakshana M, Maheswari IL, Prabhakar T, GirijaSankar, Rao AA, Sridhar GR. Quantitative Analysis of Cytokines in Diabetic Nephropathy. ACTA ACUST UNITED AC 2009. [DOI: 10.4172/jpb.1000079] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Narasingarao MR, Manda R, Sridhar GR, Madhu K, Rao AA. A clinical decision support system using multilayer perceptron neural network to assess well being in diabetes. J Assoc Physicians India 2009; 57:127-133. [PMID: 19582980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND Diabetes mellitus is an increasingly common life-style disorder whose management outcomes are measured in symptomatic, biochemical as well as psychological areas. Well being as an outcome of treatment is being increasingly recognized as a crucial component of treatment. There is little published literature on psychosocial outcomes and the factors influencing them. Therefore we have developed a neural network system which is trained to predict the well being in diabetes, using data generated in real life. MATERIAL AND METHODS We developed a Multi Layer Perceptron Neural Network model, which had been trained by back propagation algorithm. Data was used from a cohort of 241 individuals with diabetes. We used age, gender, weight, fasting plasma glucose as a set of inputs and predicted measures of well-being (depression, anxiety, energy and positive well-being). RESULTS It was observed that female patients report significantly higher levels of depression than their male counter parts. Some slight high or no significant differences are observed between males and female patients with regard to the number of persons with whom they share their anxieties and fears regarding diabetes. There is not much difference has been observed in energy levels of both males and females. Also, Males have higher pwb value when compared with the female counterparts. Also, this may be due to women tend to react more emotionally to disease and hence experience more difficulty in coping with it. The present sample of women being predominantly house wives may be worrying more about their health and its problems. Also, it is observed that, gender differences are significant with regard to total general well-being. With five inputs (age, sex, weight, fasting plasma glucose, bias), four outputs are four (depression, anxiety, energy and positive well-being) the momentum rate was 0.9, the learning rate 0.7, using a sample of 50. the maximum individual error is 0.001 when the number of iterations were 500, number of hidden layers is 1 and the number of units in the hidden layer are 6, the normalized system error was 470.57. With input samples of 100, 150 and 200, keeping the other variables constant, the normalized system error was 419.61, 359.67 and 332.32 respectively. Similar values are found for the normalized system error when the number of units in the hidden layer have been increased to 7, 8 and 9 respectively. With two hidden layers, and with each hidden layer containing 6,7 ,8, 9, 10, 11 units for the samples 50, 100, 150, and 200, the same values of normalized system error was found. Women having weight between 40 kgs and 85kgs had higher levels of depression than men who had weight between 39kgs and 102 kgs. CONCLUSION We have developed a prototype neural network model to predict the psychosocial well-being in diabetes, when biological or biographical variables are given as inputs. When greater data was fed to the system, the normalized system error can be reduced.
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Affiliation(s)
- M R Narasingarao
- Department of Computer Science and Engineering, Vignan Institute of Information Technology, Duvvada, Visakhapatnam
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Sundararaman PG, Sridhar GR. Psychosocial aspects of women with polycystic ovary syndrome from south India. J Assoc Physicians India 2008; 56:945-948. [PMID: 19322973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND Polycystic ovary syndrome (PCOS), though initially manifesting with reproductive and cosmetic symptoms is a harbinger of insulin resistance syndrome. It is associated with psychological distress in both management as well as in its etiology. There are no Indian studies on psychological stress in women with PCOS. METHODS Ninety nine women who presented with PCOS to the Endocrinology clinic were administered Goldberg's GHQ 28 (General Health Questionnaire) to assess psychological status, along with clinical, hormonal and ultrasound evaluation. RESULTS Fifty four percent had a GHQ28 score >8. Among them 38% had a family size <4, 72% had obesity, 70% had hirsutism, 72% had a waist circumference >88 cm and 69% had a F/G score >4 . All these variables were statistically significant; p < 0.05 using Chi-square test. CONCLUSION Women presenting with PCOS had increased psychological distress, which was related to smaller size of family, and more severe physical manifestations of the condition.
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Abstract
A 20-year-old woman with epilepsy had resolution of features of polycystic ovary syndrome on discontinuing valproic acid; they reappeared with the newer antiepileptic divalproex sodium.
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Affiliation(s)
- G R Sridhar
- Endocrine and Diabetes Centre, Visakhapatnam, India
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Sridhar GR. Psychiatric co-morbidity & diabetes. Indian J Med Res 2007; 125:311-20. [PMID: 17496358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023] Open
Abstract
Diabetes mellitus as well as psychiatric disorders are common. These may occur with one another and/or one may worsen the other. Psychological stress may follow screening for diabetes, as well as when diabetes is first identified. Acting through the hypothalamo-pituitary-adrenal axis, stress may initiate or worsen hyperglycaemia. Depression may be a risk factor for the development of diabetes; it also commonly occurs in subjects with diabetes. Identification and management are both important in preventing the disability. A variety of antipsychotic medications, especially the newer agents can induce weight gain, dyslipidaemia, insulin resistance and diabetes. Therefore in choosing a drug, one must consider the risk factors and screen for metabolic syndrome. Subjects with type 1 diabetes can have cognitive dysfunction, eating disorders and developmental disturbances. Physicians caring for people with diabetes must be trained to recognize and manage co-morbid psychiatric conditions that commonly occur. A biopsychosocial disease model for both conditions can leverage the social strengths and medical knowledge in developing countries.
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Affiliation(s)
- G R Sridhar
- Endocrine & Diabetes Centre, Visakhapatnam, India.
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Sridhar GR, Putcha V. Sleep and body weight in diabetes mellitus: a large retrospective analysis from South India. Diabetes Res Clin Pract 2006; 72:209-11. [PMID: 16288816 DOI: 10.1016/j.diabres.2005.10.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2005] [Revised: 09/27/2005] [Accepted: 10/02/2005] [Indexed: 11/23/2022]
Abstract
AIM To analyze the pattern of sleep disorders among 4624 individuals with type 2 diabetes mellitus who complained of disturbed sleep at our centre in South India. METHODS Retrospective analysis of data from electronic medical records. RESULTS Body mass index or body weight was not related to the prevalence of sleep disturbances. They were more in sedentary individuals, who consumed alcoholic beverages, and those with known hypertension or with a family history of diabetes. Body mass index was not a risk factor even after excluding known factors disturbing sleep (viz. nocturia, body pains, burning soles). CONCLUSION Body weight in type 2 diabetes mellitus was not related to the prevalence of sleep disorders in our sample.
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Affiliation(s)
- G R Sridhar
- Endocrine and Diabetes Centre, 15-12-16 Krishnanagar, Visakhapatnam 530 002, India.
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Sridhar GR, Lakshmi PV, Rao AA. Phylogenetic tree construction of butyrylcholinesterase sequences in life forms. J Assoc Physicians India 2006; 54:122-3. [PMID: 16715615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Butyrylcholinesterase is an enzyme with few known physiological functions. It is related to acetylcholine that was shown to be expressed in a variety of life forms. We performed a search using the human butyrylcholinesterase gene (HGNC:983;MIM:177400), and found the sequence in a broad spectrum including plants, bacteria and animals. Therefore butyrylcholinesterase appears to have evolved early in evolution, and to have been conserved.
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Affiliation(s)
- G R Sridhar
- Endocrine and Diabetes Centre, 15-12-16 Krishnanagar, Visakhapatnam 530 002, India
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Sridhar GR, Nirmala G, Apparao A, Madhavi AS, Sreelatha S, Rani JS, Vijayalakshmi P. Serum butyrylcholinesterase in type 2 diabetes mellitus: a biochemical and bioinformatics approach. Lipids Health Dis 2005; 4:18. [PMID: 16150144 PMCID: PMC1242349 DOI: 10.1186/1476-511x-4-18] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2005] [Accepted: 09/08/2005] [Indexed: 11/29/2022] Open
Abstract
Background Butyrylcholinesterase is an enzyme that may serve as a marker of metabolic syndrome. We (a) measured its level in persons with diabetes mellitus, (b) constructed a family tree of the enzyme using nucleotide sequences downloaded from NCBI. Butyrylcholinesterase was estimated colorimetrically using a commercially available kit (Randox Lab, UK). Phylogenetic trees were constructed by distance method (Fitch and Margoliash method) and by maximum parsimony method. Results There was a negative correlation between serum total cholesterol and butyrylcholinesterase (-0.407; p < 0.05) and between serum LDL cholesterol and butyrylcholinesterase (-0.435; p < 0.05). There was no statistically significant correlation among the other biochemical parameters. In the evolutionary tree construction both methods gave similar trees, except for an inversion in the position of Sus scrofa (M62778) and Oryctolagus cuniculus (M62779) between Fitch and Margoliash, and maximum parsimony methods. Conclusion The level of butyrylcholinesterase enzyme was inversely related to serum cholesterol; dendrogram showed that the structures from evolutionarily close species were placed near each other.
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Affiliation(s)
- GR Sridhar
- Endocrine and Diabetes Centre, 15-12-16 Krishnanagar, Visakhapatnam 530 002, India
| | - G Nirmala
- Endocrine and Diabetes Centre, 15-12-16 Krishnanagar, Visakhapatnam 530 002, India
| | - Allam Apparao
- Department of Computer Science and Systems Engineering, Andhra University, Visakhapatnam, India
| | - AS Madhavi
- Department of Computer Science and Systems Engineering, Andhra University, Visakhapatnam, India
| | - S Sreelatha
- Department of Computer Science and Systems Engineering, Andhra University, Visakhapatnam, India
| | - J Sudha Rani
- Department of Computer Science and Systems Engineering, Andhra University, Visakhapatnam, India
| | - P Vijayalakshmi
- Department of Computer Science and Systems Engineering, Andhra University, Visakhapatnam, India
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Sridhar GR. What works: Insulin or the needle? Int J Diabetes Dev Ctries 2005. [DOI: 10.4103/0973-3930.27010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Sridhar GR, Madhu K. Quality of life in type 2 diabetes. J Assoc Physicians India 2003; 51:1124-5; author reply 1125. [PMID: 15260409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
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Sridhar GR. Sleep in type 2 diabetes. J Assoc Physicians India 2003; 51:739; author reply 739. [PMID: 14621057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
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Sridhar GR. Containing the diabetes epidemic. Natl Med J India 2003; 16:57-60. [PMID: 12816181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
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Sridhar GR. Peroxisome proliferator-activated receptors as molecular targets for drug therapy. J Assoc Physicians India 2003; 51:49-52. [PMID: 12693455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
Peroxisome proliferator-activated receptors (PPAR) are a family of nuclear receptors that regulate lipid and carbohydrate metabolism in response to extracellular fatty acids and their metabolites. They are crucial in the regulation of fat storage, besides having a potential role in insulin resistance syndrome. They have clinical relevance in understanding the cause and in development of drugs in common clinical conditions such as type 2 diabetes mellitus, cellular growth and neoplasia. Three types of receptors were identified: PPAR alpha, gamma and delta. Fibrate group of lipid lowering agents bind to the alpha isoform and glitazone group of insulin sensitizers to gamma isoform. Further advances can result in new drugs for atherosclerosis, malignancies and diabetes mellitus.
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Affiliation(s)
- G R Sridhar
- Endocrine and Diabetes Centre, 15-12-16 Krishnanagar, Visakhapatnam, 530 002
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Abstract
The adult form of polyglandular autoimmune syndrome (type 2) is associated with disorders of the thyroid, adrenal, and pancreas (type 1 diabetes mellitus). We profile the clinical association of autoimmune diseases among patients from our center in southern India: autoimmune diseases were diagnosed in 1.68% of persons with diabetes mellitus (147/15,523). Diabetes mellitus was diagnosed in 2.3% of persons with hypothyroidism (33/1435) and in 4.35% with thyrotoxicosis (15/345).
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Affiliation(s)
- G R Sridhar
- Endocrine and Diabetes Center, Visakhapatnam 530 002, India.
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Bhat VB, Sridhar GR, Madyastha KM. Efficient scavenging of hydroxyl radicals and inhibition of lipid peroxidation by novel analogues of 1,3,7-trimethyluric acid. Life Sci 2001; 70:381-93. [PMID: 11798008 DOI: 10.1016/s0024-3205(01)01484-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
New water-soluble analogues of 1,3,7-trimethyluric acid with N-1 methyl replaced by various groups were prepared and evaluated for their ability to scavenge hydroxyl radicals as well as their protective potential against lipid peroxidation in erythrocyte membranes. The deoxyribose degradation method indicates that all the analogues tested effectively scavenge hydroxyl radicals and some of them show better activity than uric acid and methyluric acids. These effects are shown to be concentration dependent and are more potent at low concentrations (10-50 microM). Among the analogues tested, 1-butenyl-, 1-propargyl- and 1-benzyl-3,7-dimethyluric acids show high hydroxyl radical scavenging property with a reaction rate constant (Ks) of 3.2-6.7 x 10(10) M(-1) S(-1), 2.3-3.7 x 10(10) M(-1) S(-1) and 2.4-3.7 x 10(10) M(-1) S(-1), respectively. The effectiveness of these analogues as hydroxyl radical scavengers appears to be better than mannitol (Ks, 1.9-2.5 x 10(9) M(-1) S(-1)). With the exception of 1-pentyl- and 1-(2'-oxopropyl)-3,7-dimethyluric acids, all other analogues tested are effective inhibitors of tert-butylhydroperoxide-induced lipid peroxidation in human erythrocyte membranes. All the analogues tested are susceptible to peroxidation in the presence of hemoprotein and hydrogen peroxide. The present study has pointed out that it is possible to significantly enhance the antioxidant property of 1,3,7-trimethyluric acid by structural modification at N-1 position. Such compounds may be useful as antioxidants in vivo.
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Affiliation(s)
- V B Bhat
- Department of Organic Chemistry, Indian Institute of Science, Bangalore
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Sridhar GR. Impact of human genome project on medical practice. J Assoc Physicians India 2001; 49:995-8. [PMID: 11848333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
The sequence of bases on all 23 pairs of human chromosomes has been nearly unravelled. Nearly 3.1 billion nucleotide bases were sequenced using the clone based approach of Human Genome Project Consortium and the shotgun approach of Celera. There appear to be about 30,000 genes, which are however more complex. Human genes seem to have been transferred over evolution from bacteria. Further progress is likely in identifying genes and their function, in development of DNA chips or arrays to identify genes, expanded field of protomics or the study of detailed structure and function of proteins. Pharmacogenomics is possible to develop designer drugs depending on the individuals genetic make-up. Projected drawbacks from availability of genetic data of individuals include loss of privacy, genetic determinism and the risk of high insurance premia, conflict about patenting and ownership.
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Affiliation(s)
- G R Sridhar
- Endocrine and Diabetes Centre, Visakhapatnam
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Burczynski ME, Sridhar GR, Palackal NT, Penning TM. The reactive oxygen species--and Michael acceptor-inducible human aldo-keto reductase AKR1C1 reduces the alpha,beta-unsaturated aldehyde 4-hydroxy-2-nonenal to 1,4-dihydroxy-2-nonene. J Biol Chem 2001; 276:2890-7. [PMID: 11060293 DOI: 10.1074/jbc.m006655200] [Citation(s) in RCA: 142] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The human aldo-keto reductase AKR1C1 (20alpha(3alpha)-hydroxysteroid dehydrogenase) is induced by electrophilic Michael acceptors and reactive oxygen species (ROS) via a presumptive antioxidant response element (Burczynski, M. E., Lin, H. K., and Penning, T. M. (1999) Cancer Res. 59, 607-614). Physiologically, AKR1C1 regulates progesterone action by converting the hormone into its inactive metabolite 20alpha-hydroxyprogesterone, and toxicologically this enzyme activates polycyclic aromatic hydrocarbon trans-dihydrodiols to redox-cycling o-quinones. However, the significance of its potent induction by Michael acceptors and oxidative stress is unknown. 4-Hydroxy-2-nonenal (HNE) and other alpha,beta-unsaturated aldehydes produced during lipid peroxidation were reduced by AKR1C1 with high catalytic efficiency. Kinetic studies revealed that AKR1C1 reduced HNE (K(m) = 34 microm, k(cat) = 8.8 min(-1)) with a k(cat)/K(m) similar to that for 20alpha-hydroxysteroids. Six other homogeneous recombinant AKRs were examined for their ability to reduce HNE. Of these, AKR1C1 possessed one of the highest specific activities and was the only isoform induced by oxidative stress and by agents that deplete glutathione (ethacrynic acid). Several hydroxysteroid dehydrogenases of the AKR1C subfamily catalyzed the reduction of HNE with higher activity than aldehyde reductase (AKR1A1). NMR spectroscopy identified the product of the NADPH-dependent reduction of HNE as 1,4-dihydroxy-2-nonene. The K(m) of recombinant AKR1C1 for nicotinamide cofactors (K(m) NADPH approximately 6 microm, K(m)(app) NADH >6 mm) suggested that it is primed for reductive metabolism of HNE. Isoform-specific reverse transcription-polymerase chain reaction showed that exposure of HepG2 cells to HNE resulted in elevated levels of AKR1C1 mRNA. Thus, HNE induces its own metabolism via AKR1C1, and this enzyme may play a hitherto unrecognized role in a response mounted to counter oxidative stress. AKRs represent alternative GSH-independent/NADPH-dependent routes for the reductive elimination of HNE. Of these, AKR1C1 provides an inducible cytosolic barrier to HNE following ROS exposure.
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Affiliation(s)
- M E Burczynski
- Department of Pharmacology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104-6084, USA
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Sridhar GR. Socio-psychological aspects of artificial sex change. J Assoc Physicians India 1999; 47:1217-8. [PMID: 11225236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
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Madyastha KM, Sridhar GR, Vadiraja BB, Madhavi YS. Purification and partial characterization of caffeine oxidase--A novel enzyme from a mixed culture consortium. Biochem Biophys Res Commun 1999; 263:460-4. [PMID: 10491316 DOI: 10.1006/bbrc.1999.1401] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Cell-free extract prepared from a mixed culture consisting of strains belonging to the genera Klebsiella and Rhodococcus grown in the presence of caffeine contains a novel enzyme, caffeine (1,3, 7-trimethylxanthine) oxidase which catalyzes the oxidation of caffeine at the C-8 position to produce 1,3,7-trimethyluric acid. The enzyme was purified to homogeneity by a combination of ion-exchange and hydrophobic column chromatographies. Both native and SDS/PAGE of the purified enzyme showed a single protein band and the subunit molecular mass of the protein was determined to be 85 kDa. Dichlorophenol indophenol and cytochrome c served as good electron acceptors but NAD and NADP did not. Caffeine served as the best substrate with an apparent K(m) of 11.4 microM. various analogues of theobromine were also effective substrates for caffeine oxidase. The activity was inhibited by o-phenanthroline, H(2)O(2), and methanol, but salicylate, thiol-group blocking reagents, and sodium arsenite, the known xanthine oxidase inhibitors, did not inhibit the reaction. The spectral characteristics of the purified enzyme suggest that it is a flavoprotein containing non-heme iron.
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Affiliation(s)
- K M Madyastha
- Department of Organic Chemistry, Indian Institute of Science, Bangalore, 560 012, India.
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Madyastha KM, Sridhar GR. Highly efficient C-8 oxidation of substituted xanthines with substitution at the 1-, 3-, and 7- positions using biocatalysts. ACTA ACUST UNITED AC 1999. [DOI: 10.1039/a900089e] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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