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Ganie MA, Rashid H, Qadir A, Koul PA. Subacute Thyroiditis in Active COVID-19 Infection: A Report of Two Cases With a Systematic Review of the Literature. Cureus 2024; 16:e52611. [PMID: 38374864 PMCID: PMC10875715 DOI: 10.7759/cureus.52611] [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: 01/20/2024] [Indexed: 02/21/2024] Open
Abstract
Subacute thyroiditis (SAT) is a self-limiting inflammatory condition of the thyroid gland with distinct symptoms and a predictable outcome. During the current COVID-19 pandemic, there have been multiple isolated reports of SAT either during the active viral illness or following recovery. Here, we report two such cases of COVID-19 infection presenting with SAT. A 65-year-old male presented with a two-week history of anterior neck pain, odynophagia, high-grade fever (38.9°C), sweating, palpitations, and tremulousness. At physical examination, the patient presented with a slightly increased heart rate and a tender and enlarged thyroid on palpation. Laboratory examination showed high C-reactive protein levels, with elevated erythrocyte sedimentation rate, and thyroid function tests were suggestive of thyrotoxicosis. Ultrasonography showed a heterogeneous thyroid gland with ill-defined hypoechoic areas, and thyroid scintigraphy showed reduced uptake, confirming the diagnosis of SAT. In another case, a 52-year-old male presented with fever, cough, and myalgias, and was diagnosed with mild COVID-19 pneumonia, and managed conservatively. After two weeks, the patient had a recurrence of high-grade fever, odynophagia, palpitations, and tremors. Examination revealed tachycardia, hyperhidrosis, and a tender and enlarged thyroid on palpation. Thyroid function tests revealed low thyroid-stimulating hormone, with normal total T4 and total T3. Ultrasonography examination showed a heterogeneous thyroid gland with bilateral ill-defined hypoechoic areas. In our systematic review, including 103 SAT cases, it has been suggested that SAT should be recognized as an uncommon extra-pulmonary clinical manifestation of COVID-19 infection and clinicians need to be aware of the association. Pending larger multicentric studies, management of the condition has to be on a case-by-case basis.
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Affiliation(s)
- Mohammad Ashraf Ganie
- Endocrinology and Metabolism, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, IND
| | - Haroon Rashid
- Clinical Research, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, IND
| | - Ajaz Qadir
- Endocrinology and Metabolism, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, IND
| | - Parvaiz A Koul
- Internal Medicine/Pulmonary Medicine, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, IND
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Agrawal S, Ganie MA, Goyal A, Praveen PA, Philip DM, Tandon N. Metabolic syndrome in patients with type 1 diabetes mellitus at a tertiary centre in North India: A five year follow up study. Diabetes Metab Syndr 2023; 17:102781. [PMID: 37216855 DOI: 10.1016/j.dsx.2023.102781] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 12/30/2022] [Accepted: 05/03/2023] [Indexed: 05/24/2023]
Abstract
BACKGROUND AND AIMS Metabolic syndrome (MS) is prevalent in the Indian population and has been traditionally linked to Type 2 diabetes mellitus (T2DM). Its presence is now being increasingly recognized in patients with Type 1 diabetes mellitus (T1DM). Presence of MS may increase the risk of diabetes related complications. This study was designed to determine the prevalence of MS in a cohort of patients with T1DM at baseline and at 5 years of follow up. METHODS Longitudinal cohort study in a tertiary care center in North India. Patients with T1DM attending the Diabetes of the Young (DOY) Clinic from January 2015 to March 2016 included. Microvascular and macrovascular complications assessed. The cohort was followed after a period of 5 years. RESULTS We included 161 patients (males, 49.4%) with a median (IQR) age of 23 (18-34) years and median (IQR) diabetes duration of 12 (7, 17) years. At baseline, 31 (19.2%) patients had MS. Patients with MS were more likely to have microvascular complications: retinopathy (p = 0.003), neuropathy (p = 0.02) and nephropathy (p = 0.04). Independent predictors of MS: insulin sensitivity (IS) (adjusted OR (aOR) 0.02 [95% CI, 0.003-0.118]), body weight (aOR 1.05 [95% CI, 1.007-1.108]), diastolic blood pressure (aOR 1.08 [95% CI, 1.01-1.15]) and duration of diabetes (aOR 1.09 [95% CI, 1.02-1.16]). On follow-up (n = 100), 13 (13%) had MS. CONCLUSIONS One in 5 patients with T1DM suffers from MS, and is therefore predisposed to its attendant risks, calling for early identification and targeted interventions.
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Affiliation(s)
- Sweety Agrawal
- Department of Endocrinology & Metabolism, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Mohammad Ashraf Ganie
- Department of Endocrinology & Metabolism, Sher-I-Kashmir Institute of Medical Sciences (SKIMS), Srinagar, India
| | - Alpesh Goyal
- Department of Endocrinology & Metabolism, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - P A Praveen
- Department of Endocrinology & Metabolism, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Dona Maria Philip
- Department of Endocrinology & Metabolism, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Nikhil Tandon
- Department of Endocrinology & Metabolism, All India Institute of Medical Sciences (AIIMS), New Delhi, India.
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Yousuf SD, Ganie MA, Urwat U, Andrabi SM, Zargar MA, Dar MA, Manzoor-ul-Rehman M, Mudassar S, Rashid F. Oral contraceptive pill (OCP) treatment alters the gene expression of intercellular adhesion molecule-1 (ICAM-1), tumor necrosis factor-α (TNF-α), monocyte chemoattractant protein-1 (MCP-1) and plasminogen activator inhibitor-1 (PAI-1) in polycystic ovary syndrome (PCOS) women compared to drug-naive PCOS women. BMC Womens Health 2023; 23:68. [PMID: 36793022 PMCID: PMC9933286 DOI: 10.1186/s12905-023-02187-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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] [Received: 08/02/2022] [Accepted: 01/20/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND Polycystic ovary syndrome (PCOS) presents clinical symptoms of menstrual abnormalities, excessive hair growth (hirsutism), scalp hair loss, acne and infertility. Metabolic abnormalities such as obesity, insulin resistance, glucose intolerance and cardiovascular problems constitute an essential part of PCOS, all of which can have significant long-term health consequences. Low-grade chronic inflammation demonstrated by persistent moderately elevated serum levels of inflammatory and coagulatory markers plays a critical role in the pathogenesis of PCOS. Oral contraceptive pills (OCPs) constitute the mainstay of pharmacologic therapy for women with PCOS to regularize cyclicity and ameliorate androgen excess. On the other hand, OCP use is associated with various venous thromboembolic and proinflammatory events in the general population. PCOS women always carriers the increased lifetime risk of these events. The studies on the effect of OCPs on inflammatory, coagulation and metabolic parameters in PCOS are less robust. Therefore in this study, we investigated and compared the messenger RNA (mRNA) expression profiles of genes implicated in inflammatory and coagulation pathways between drug-naive and OCP-treated PCOS women. The selected genes include intercellular adhesion molecule-1 (ICAM-1), tumor necrosis factor-α (TNF-α), monocyte chemoattractant protein-1 (MCP-1) and plasminogen activator inhibitor-1 (PAI-1). Furthermore, the correlation between the selected markers and various metabolic indices in the OCP group has also been explored. METHOD The relative amounts of ICAM-1, TNF-α, MCP-1 and PAI-1 mRNA in peripheral blood mononuclear cells from 25 drug-naive PCOS subjects (controls) and 25 PCOS subjects who received OCPs containing 0.03 mg-ethinyl-estradiol and 0.15 mg-levonorgestrel for at least six months (cases) were estimated using real-time qPCR. The statistical interpretation was conducted using SPSS version 20.0 (SPSS, Inc, Chicago, IL), Epi Info version 2002 (Disease Control and Prevention Centres, Atlanta, GA) and GraphPad Prism 5 (GraphPad Software, La Jolla, CA) software. RESULT Six months of OCP therapy enhanced the expression of inflammatory genes viz ICAM-1, TNF-α and MCP-1 mRNA in PCOS women by 2.54, 2.05 and 1.74 folds, respectively, in this study. However, PAI-1 mRNA in the OCP group showed no significant increase. Furthermore, in cases, ICAM-1 mRNA expression positively correlated with body mass index (BMI) (p = 0.01), fasting insulin (p = 0.01), insulin 2 h p = 0.02), glucose 2 h (p = 0.01) and triglycerides (p = 0.01). TNF-α mRNA expression positively correlated with fasting insulin (p = 0.0007). MCP-1 mRNA expression positively correlated with (BMI) (p = 0.002). CONCLUSION OCPs helped reduce clinical hyperandrogenism and regularise menstrual cycles in women with PCOS. However, OCP use was associated with increased fold expression of inflammatory markers which positively correlated with metabolic abnormalities.
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Affiliation(s)
- Syed Douhath Yousuf
- grid.414739.c0000 0001 0174 2901Department of Clinical Biochemistry, Sheri- Kashmir Institute of Medical Sciences, SKIMS, Srinagar, J&K India
| | - Mohammad Ashraf Ganie
- grid.414739.c0000 0001 0174 2901Department of Endocrinology and Metabolism, Sheri- Kashmir Institute of Medical Sciences, SKIMS, Srinagar, J&K India
| | - Uneeb Urwat
- Division of Animal Biotechnology, Sheri- Kashmir Institute of Agricultural Sciences, Shuhama, J&K India
| | - Syed Mudasir Andrabi
- Division of Animal Biotechnology, Sheri- Kashmir Institute of Agricultural Sciences, Shuhama, J&K India
| | | | - Mashooq Ahmad Dar
- Division of Animal Biotechnology, Sheri- Kashmir Institute of Agricultural Sciences, Shuhama, J&K India
| | - Mir Manzoor-ul-Rehman
- Division of Animal Biochemistry, Sheri- Kashmir Institute of Agricultural Sciences, Shuhama, J&K India
| | - Syed Mudassar
- grid.414739.c0000 0001 0174 2901Department of Clinical Biochemistry, Sheri- Kashmir Institute of Medical Sciences, SKIMS, Srinagar, J&K India
| | - Fouzia Rashid
- Clinical Biochemistry, University of Kashmir, Srinagar, J&K, India.
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Sidana S, Ashraf Ganie M, Hussain Bhat M. PSAT173 Weekly Supplementation with Vitamin D3 reduces 1,25(OH)2 vitamin D3 Measured by Mass Spectrometry, and increases Fibroblast-like growth factor 23 (FGF23) in Individuals with and without Primary Hyperparathyroidism (PHPT). J Endocr Soc 2022. [DOI: 10.1210/jendso/bvac150.412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Abstract
Introduction
Vitamin D deficiency is a very common condition, which has been associated with more severe presentations of PHPT. It has been suggested that the Vitamin D replacement improves this prognosis, but there are few data regarding its effect on mineral homeostasis. The aim of this research was to evaluate the effects of weekly Vitamin D supplementation on the mineral metabolism in this population.Material and methods: In this prospective case-control trial, we evaluated the effects of 14,000 IU/week of oral Vitamin D3, for 12 weeks, on albumin-adjusted total Calcium (TCa), Parathormone (PTH), 25 hydroxyvitamin D3 (25OHD), intact FGF23 and 1,25dihydroxyvitamin D3 (1,25(OH)2D), in addition to other biochemical markers. Volunteers with active PHPT (n=55) and paired controls (n=64) collected fasting blood samples before and after 12 weeks of the Vitamin D supplementation. 1,25(OH)2D was measured by liquid chromatography and mass spectrometry, and other hormones by commercial immunometric assays. P<0.05 was considered significant.
Results
At baseline there were no differences between groups regarding 25OHD, FGF23 and clearance of creatinine. As expected, the concentrations of TCa, PTH, 1,25(OH)2D were higher in the PHPT. After supplementation, TCa and PTH did not change despite the significant increase on 25OHD in both groups, more markedly in the controls (from 22.7±6.1 to 31.5±6.8 ng/mL in PHPT; and from 20.4±5.8 to 32.5±6.4 ng/mL in controls). FGF23 levels significantly increased after supplementation in both groups, more markedly in the PHPT. (from 47.9 ± 27.1 to 76.3 ± 33.3 pg/mL in PHPT and from 40.5 ± 13.9 to 59.8±19.8 pg/mL in controls). A significant reduction in the concentrations of 1,25(OH)2D was seen in both groups, (time effect p-value<0.001), with more intensity in the PHPT group (time x group effect p-value=0.015) (from 94.8±34.6 to 68.9±25.3 pg/mL in PHPT and from 68.7±23.5 to 56.4±20.7pg/mL in controls). The delta of 1,25(OH)2D was inversely correlated with the delta of FGF23 in both the PHPT (r=-0.302, p-value=0.028) and control (r=-0.278, p-value=0.027) groups.
Conclusion
In both patient groups (with and without PHPT), weekly administration of 14,000IU of Vitamin D3 reduced 1,25(OH)2D concentrations measured by mass spectrometry, probably due to the inhibition of 1α-hydroxylase induced by the increase in FGF23. This phenomenon could explain the absence of hypercalcemia after supplementation, even in individuals with active PHPT, appearing to be a protective mechanism against Vitamin D excess. Future studies are needed to see if this increase in FGF23 could explain the paradoxical effects observed with the high bolus doses of vitamin D described by others.*This research received public grants from FAPESP (Fundação de Amparo a Pesquisa do Estado de Sao Paulo), with technical support from Laboratorio Fleury
Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.
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Sidana S, Ganie MA, Bhat MH. PSAT173 Evaluation of efficacy and safety of different doses of cholecalciferol supplementation in healthy adults- a single blind randomized control trial. J Endocr Soc 2022. [DOI: 10.1210/jendso/bvac150.411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Abstract
Background
Vitamin-D (VD) has been shown to be associated various skeletal and non-skeletal benefits. Despite synthesis in the body, 70-80% of population has been found to be VD deficient, due to poor sunlight exposure, increasing environmental pollution, indoor habits etc. Institute of medicine recommended daily allowance (RDA) of 600 IU/day, while Endocrine society recommends a daily intake of 1500-2000 IU/day for age group 19-70 years. In the absence of mandatory food fortification with VD, supplementation is an effective alternate strategy to mitigate the issue of VD deficiency. Optimal supplementation dose for achieving and maintaining sufficient VD levels in Indian adults is still not known.
Aim
To evaluate optimal dose of oral cholecalciferol supplementation to achieve and maintain serum hydroxy vitamin D [25(OH)D] sufficiency in Indian adults.
Methodology
In this single center blinded randomized control study, a total of 168 healthy subjects age (18-60 years) were randomized in four groups (A, B, C and D). Subjects were supplemented with 600, 1000, 2000 IU/day and 60,000 IU/month of cholecalciferol to group A, B, C and D in two phases, winter phase and summer phase of three months each with a washout period of three months in between. Serum 25(OH)D, iPTH, calcium, phosphorus, alkaline phosphatase levels and urine calcium/creatinine ratio was assessed at baseline, 12 weeks, 24 weeks and 36 weeks.
Results
The mean increase in serum 25(OH)D following supplementation was 21.67±6.54, 32.50±7.33 and 27.72±5.64 ng/ml after three months, 25.96±7.95, 31.52±8.95, 48.05±9.88 and 40.73±12.96 ng/ml after six months of supplementation in group A, B, C and D respectively, with 9.1%, 16.2%, 50% and 39.5% of subjects achieved levels of >30ng/ml after three months and 27.3%, 59.5%, 93.8% and 76.3% after six month of VD supplementation in group A, B, C and D respectively. Supplementation with VD at various doses raised serum 25(OH)D levels in a dose dependent manner, with an average rate constant of 1.79±0.79 ng/ml/100IU/day. Higher BMI and baseline serum 25(OH)D levels negatively associated with gain in serum VD levels. Overall, secondary hyperparathyroidism decreased from 29.3 to 8·6% post-supplementation. No significant difference in urinary Ca/Cr ratio between baseline and post supplementation was noted.
Conclusion
In accordance with the level of treatment, various oral cholecalciferol regimens improved serum 25(OH)D levels in all the subjects, but the 2000 IU/day achieved the best results while being safe. Daily supplementation with 2000 IU of oral cholecalciferol does meet the RDA requirement of achieving serum 25(OH)D of >30ng/ml in 94% subjects. Whether RDA of 600 IU/day, recommended by IOM is sufficient to combat VD deficiency in our population, is debatable.
Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.
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Abstract
Polycystic ovary syndrome (PCOS) is a common endocrine disorder predominantly affecting women of reproductive age. Clinical manifestations are diverse including hyperandrogenism, anovulation, infertility and increased risk of metabolic diseases besides psychosocial dysfunction. This review provides information on the problem of PCOS in India, its pathophysiology, genetics and an overview of current management options to instigate further research in this field. Prevalence of PCOS in India ranges from 3.7 to 22.5 per cent depending on the population studied and the criteria used for diagnosis. Abnormalities in leptin-adiponectin (adipocyte biology), oxidative stress and autoimmunity are among the mechanisms studied regarding pathogenesis of PCOS. Many candidate gene studies have shown associations with PCOS in various studies. Studies have consistently demonstrated the relationship between the well-known manifestation of hyperandrogenism among Indian PCOS women and the metabolic morbidities including insulin resistance, glucose intolerance and cardiovascular risk. Management of individual components of PCOS can be achieved by medications or surgical methods, though further clarification regarding pathogenesis of PCOS is needed to sharpen our therapeutic armamentarium.
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Affiliation(s)
- Mohammad Ashraf Ganie
- Department of Endocrinology & Metabolism, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Vishnu Vasudevan
- Department of Endocrinology & Metabolism, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Imtiyaz Ahmad Wani
- Department of Endocrinology & Metabolism, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Mohammad Salem Baba
- Department of Endocrinology & Metabolism, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Tasleem Arif
- Department of Endocrinology & Metabolism, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Aafia Rashid
- Department of Endocrinology & Metabolism, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
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Yousuf SD, Ganie MA, Jeelani S, Mudassar S, Shah ZA, Zargar MA, Amin S, Wani IA, Rashid F. Effect of six-month use of oral contraceptive pills on plasminogen activator inhibitor-1 & factor VIII among women with polycystic ovary syndrome: An observational pilot study. Indian J Med Res 2019; 148:S151-S155. [PMID: 30964093 PMCID: PMC6469381 DOI: 10.4103/ijmr.ijmr_1899_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background & objectives: Polycystic ovary syndrome (PCOS) is an endocrinopathy warranting lifelong individualized management by lifestyle and pharmacological agents mainly oral contraceptive pills (OCPs). This study was aimed to report the impact of six-month OCP use on plasminogen activator inhibitor-1 (PAI-1) and factor VIII (FVIII) in women with PCOS. Methods: PCOS women diagnosed on the basis of Rotterdam 2003 criteria, either treated with OCPs (ethinyl estradiol-0.03 mg, levonorgestrel-0.15 mg) for a period of six months (n=40) or drug-naïve (n=42), were enrolled in this study. Blood was drawn to estimate glucose, insulin levels and lipid profile. Chemiluminescence immunoassays were used to measure hormones (LH, FSH, PRL, T4). Plasma levels of PAI-I and FVIII were measured by commercially available kits. Results: Menstrual regularity, Ferriman-Gallwey score and serum total testosterone significantly improved in the OCP group compared to drug-naïve group (P<0.01). No significant difference was observed in PAI-1 levels of the two groups; however, significant decrease in FVIII levels was observed in OCP group as compared to drug-naïve group. PAI-1 levels of OCP group correlated positively with blood glucose two hours, triglycerides and insulin two hours, while FVIII levels of OCP group correlated negatively with fasting insulin and homoeostatic model assessment-insulin resistance. Interpretation & conclusions: OCPs use has differential effect on pro-coagulant markers among women with PCOS. Well-designed, long-term, prospective, large-scale studies are prerequisite to elucidate the efficacy and safety of OCP in the treatment of PCOS.
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Affiliation(s)
- Syed Douhath Yousuf
- Department of Clinical Biochemistry/Biochemistry, University of Kashmir, Srinagar, India
| | - Mohammad Ashraf Ganie
- Department of Endocrinology & Metabolism, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Samoon Jeelani
- Department of Haematology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Syed Mudassar
- Department of Clinical Biochemistry, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Zaffar Amin Shah
- Department of Immunology & Molecular Medicine, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Mohammad Afzal Zargar
- Department of Clinical Biochemistry/Biochemistry, University of Kashmir, Srinagar, India
| | - Shajrul Amin
- Department of Clinical Biochemistry/Biochemistry, University of Kashmir, Srinagar, India
| | - Imtiyaz Ahmad Wani
- Department of Endocrinology & Metabolism, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Fouzia Rashid
- Department of Clinical Biochemistry/Biochemistry, University of Kashmir, Srinagar, India
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Marwaha RK, Mithal A, Bhari N, Sethuraman G, Gupta S, Shukla M, Narang A, Chadda A, Gupta N, Sreenivas V, Ganie MA. Supplementation with Three Different Daily Doses of Vitamin D3 in Healthy Pre-pubertal School Girls: A Cluster Randomized Trial. Indian Pediatr 2018; 55:951-956. [PMID: 30587642] [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: 06/09/2023]
Abstract
OBJECTIVE To compare the adequacy and efficacy of different doses of vitamin D3 in pre-pubertal girls. DESIGN Cluster Randomized controlled trial. SETTING Public school in Delhi, India, between August 2015 and February 2016. PARTICIPANTS 216 healthy pre-pubertal girls, aged 6.1-11.8 years. INTERVENTION Daily supplementation with 600 IU (n=74), 1000 IU (n=67) or 2000 IU (n=75) of vitamin D3 under supervision for 6 months. OUTCOME MEASURES Primary: Rise in serum 25 hydroxy Vitamin D (25(OH)D); Secondary: Change in bone formation and resorption markers. RESULTS Following 6 months of supplementation, the mean (SD) rise in serum 25(OH)D was maximum with 2000 IU (24.09 (8.28) ng/mL), followed by with 1000 IU (17.96 (6.55) ng/mL) and 600 IU (15.48 (7.00) ng/mL). Serum 25(OH)D levels of ≥20 ng/mL were seen in 91% in 600 IU group , 97% in 1000 IU group and 100% in 2000 IU group. The overall mean (SD) rise in urinary calcium creatinine ratio (0.05 (0.28) to 0.13 (0.12) mg/mg), and serum procollagen type I N-terminal propeptide (538.9 (199.78) to 655.5 (218.24) ng/mL), and reduction in serum carboxy-terminal telopeptide (0.745 (0.23) to 0.382 (0.23) ng/mL) was significant (P<0.01). The change in the above parameters was comparable among the three groups after adjustment for age. CONCLUSIONS Daily vitamin D supplementation with 600 IU to 2000 IU for 6 months results in Vitamin D sufficiency in >90% of pre-pubertal girls.
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Affiliation(s)
- Raman Kumar Marwaha
- International Life Sciences Institute, India. Correspondence to: Maj Gen Raman Kumar Marwaha, Scientific Advisor (Projects), International Life Science Institute (India).
| | - A Mithal
- Medanta Hospital Gurgaon, Haryana, India
| | - Neetu Bhari
- Department of Dermatology, AIIMS, New Delhi, India
| | - G Sethuraman
- Department of Dermatology, AIIMS, New Delhi, India
| | | | | | | | - Aditi Chadda
- Dr BR Sur Homeopathic Medical College, New Delhi, India
| | - Nandita Gupta
- Department of Endocrinology, AIIMS, New Delhi, India
| | - V Sreenivas
- Department of Biostatistics, AIIMS, New Delhi, India
| | - M A Ganie
- Department of Endocrinology, AIIMS, New Delhi, India
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Yousuf SD, Ganie MA, Zargar MA, Parvez T, Rashid F. The ICAM-1 Gly241Arg Polymorphism is Not Associated With Polycystic Ovary Syndrome - Results from a Case Control study in Kashmir, India. Asian Pac J Cancer Prev 2017; 17:1583-8. [PMID: 27039809 DOI: 10.7314/apjcp.2016.17.3.1583] [Citation(s) in RCA: 5] [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: 11/10/2022] Open
Abstract
BACKGROUND Polycystic ovary syndrome (PCOS) is considered to be a multifactorial disorder resulting from the interaction of several predisposing and protective genetic variants. PCOS is associated with low-grade chronic inflammation. Elevated levels of inflammatory markers including intercellular adhesion molecule-1 (ICAM-1) are demonstrated in women with PCOS. Recent evidence indicates a significant linkage between a locus on chromosome 19p13 and multifactorial diseases that have an inflammatory component. The aim of the study was to assess the possible association of Gly241Arg polymorphism of ICAM-1 gene located on chromosome 19p13 in determining risk of PCOS in Kashmiri women. MATERIALS AND METHODS Gly241Arg SNP in DNA from peripheral blood leukocytes of 220 PCOS cases and 220 age matched non-PCOS healthy controls was analysed using allel specific PCR. RESULTS The genotype and allele frequency distributions of Gly241Arg SNP showed insignificant difference between the PCOS cases and control women, indicating no role of this SNP in PCOS susceptibility. The odds ratio for Arg/Arg genotype was 0.87 (95% CI=0.32-2.3) [P=0.79], for Gly/Arg genotype was 0.98 (95% CI= 0.66-1.47) [P=1] and for Arg/Arg+Gly/Arg genotype was 0.97 (95% CI=0.65-1.45) [P=0.92]. The genotypic frequencies of ICAM-1codon 241 showed statistically insignificant difference between cases and controls (χ2=0.07; p=0.96) Nor the studied polymorphism was found to affect clinical and laboratory parameters significantly. CONCLUSIONS Although Gly241Arg polymorphism have not shown significant association with PCOS. Further, specifically designed studies on large cohorts are required to conclusively establish any role of ICAM-1 gene polymorphisms in PCOS in our study.
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Yousuf SD, Ganie MA, Zargar MA, Amin SU, Bhat GA, Masood A, Rashid F. The Lys469glu/K469E Polymorphism of the Inflammatory Gene Intercellular Adhesion Molecule-1 Lacks any Apparent Role in the Polycystic Ovary Syndrome in Kashmiri Women: A Case Control Study. Asian Pac J Cancer Prev 2017; 18:2925-2930. [PMID: 29172260 PMCID: PMC5773772 DOI: 10.22034/apjcp.2017.18.11.2925] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background: Polycystic ovary syndrome (PCOS), associated with a state of low grade chronic inflammation,
depends on multiple genetic and environmental factors. Elevated levels of inflammatory markers including intercellular
adhesion molecule-1 (ICAM-1) have been demonstrated in affected women. Recent evidence indicates a significant
linkage between chromosome 19p13 loci and multifactorial diseases that have an inflammatory component. The aim of
this study was to assess the possible association of the lys469glu (K469E) polymorphism of the ICAM-1 gene located
on chromosome 19p13 with risk of PCOS in Kashmiri women. Material and Methods: The K469E single nucleotide
polymorphism (SNP) was analysed with DNA from peripheral blood leukocytes of 220 PCOS cases and 220 age
matched non-PCOS healthy controls using PCR-RFLP. Results: Genotypic frequencies in cases were found to be 32
(14.5%) for EE, 98 (44.5%) for KE, and 90 (40.9%) for KK, with 130 (59.1%) for the KE+EE genotypes compared
to healthy control values of 29 (13.2%) for EE, 113 (51.4%) for KE, 78 (35. 5%) for KK and 142 (64.5%) for KE+EE
combined.The odds ratios for the EE, KE and KE:EE genotypes were 0.95(95% CI= 0.53-1.71)[p= 0.88], 0.75(95%
CI= 0.50-1.12)[p =0.168] and 0.79 (95% CI =0.53-1.16) [p = 0.23], no statistically significant differences being found
between cases and controls (χ2 =2.07; p=0.35). Conclusion: In conclusion, there was no apparent significant influence
of the K469E polymorphism on risk of PCOS, or any clinical or laboratory parameters.
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Affiliation(s)
| | | | | | - Shajr Ul Amin
- Department of Biochemistry, University of Kashmir, Srinagar, J and K, India
| | - Gulzar A Bhat
- Department of Biochemistry, University of Kashmir, Srinagar, J and K, India
| | - Akbar Masood
- Department of Biochemistry, University of Kashmir, Srinagar, J and K, India
| | - Fouzia Rashid
- Department of Biochemistry, University of Kashmir, Srinagar, J and K, India,For Correspondence:
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Kuchay MS, Kudyar RP, Gupta A, Pandita KK, Ganie MA. Gender differences in insulin and C-peptide concentrations at birth using cord blood collection. Arch Endocrinol Metab 2016; 60:264-6. [PMID: 26910627 PMCID: PMC10522301 DOI: 10.1590/2359-3997000000148] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 11/27/2015] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To study gender differences in insulin and C-peptide concentrations at birth using cord blood collection. SUBJECTS AND METHODS This study was conducted in a maternity hospital, in Jammu province of Jammu and Kashmir, India. All women with pregnancy who were hospitalized for delivery were followed. All pregnant ladies who had no medical condition affecting insulin levels, as per history and routine antenatal blood testing, were included in the study. The test for cord plasma insulin and C-peptide was done in 60 (30 males) full-term (≥ 37 completed weeks) normal delivery babies within 4 hours of the collection of samples using the electro-chemiluminescence immunoassay (ECLIA) on Roche elecsys module immunoassay analyzer. Weight of the babies was taken immediately after birth using digital scales. RESULTS Cord plasma insulin and C-peptide measured in EDTA were compared between boys and girls and also related to birth weight. Girls were lighter (2,830 ± 37 vs. 3,236 ± 46 g; p = < 0.001) but had higher cord insulin (16.48 ± 4.88 vs. 10.53 ± 4.04 µU/mL; p = < 0.001), and C-peptide (2.47 ± 0.66 vs. 0.834 ± 0.26 ng/mL; p = < 0.001) concentrations than newborn boys. CONCLUSION Female newborn babies have higher cord plasma insulin and C-peptide concentrations than male newborns, despite being smaller, suggesting intrinsic insulin resistance in girls.
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Affiliation(s)
- Mohammad Shafi Kuchay
- Division of Endocrinology and DiabetesMedanta, The MedicityHaryanaIndiaDivision of Endocrinology and Diabetes, Medanta, The Medicity, Sector-38, Haryana, India
| | - Rattan P. Kudyar
- Postgraduate Department of Internal MedicineAcharya Shri Chander College of Medical Sciences and HospitalJammuJ&KIndiaPostgraduate Department of Internal Medicine, Acharya Shri Chander College of Medical Sciences and Hospital, Jammu, J&K, India
| | - Anil Gupta
- Postgraduate Department of Internal MedicineAcharya Shri Chander College of Medical Sciences and HospitalJammuJ&KIndiaPostgraduate Department of Internal Medicine, Acharya Shri Chander College of Medical Sciences and Hospital, Jammu, J&K, India
| | - Kamal Kishor Pandita
- Postgraduate Department of Internal MedicineAcharya Shri Chander College of Medical Sciences and HospitalJammuJ&KIndiaPostgraduate Department of Internal Medicine, Acharya Shri Chander College of Medical Sciences and Hospital, Jammu, J&K, India
| | - Mohammad Ashraf Ganie
- Department of Endocrinology and MetabolismAll India Institute of Medical SciencesNew DelhiIndiaDepartment of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
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Ganie MA, Laway BA, Nisar S, Wani MM, Khurana ML, Ahmad F, Ahmed S, Gupta P, Ali I, Shabir I, Shadan A, Ahmed A, Tufail S. Presentation and clinical course of Wolfram (DIDMOAD) syndrome from North India. Diabet Med 2011; 28:1337-42. [PMID: 21726277 DOI: 10.1111/j.1464-5491.2011.03377.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [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] [Indexed: 11/26/2022]
Abstract
AIMS Wolfram syndrome, also known as DIDMOAD, is a relatively rare inherited neurodegenerative disorder, first evident in childhood as an association of juvenile-onset diabetes mellitus and optic atrophy, followed by diabetes insipidus and deafness. The aim of the study was to examine the clinical profile of patients with DIDMOAD syndrome presenting to a tertiary care hospital in north India. METHODS Clinical presentation of juvenile-onset diabetes mellitus fulfilling the diagnosis of Wolfram syndrome was studied using a prepared standardized form. RESULTS Subjects with juvenile-onset non-autoimmune diabetes mellitus attending the diabetic clinic at a tertiary care centre in north India were followed for 10 years and a diagnosis of fully developed Wolfram syndrome was confirmed in seven individuals. The series consisted of five male and two female patients with a mean age of 17.5 ±7.34 years. Two subjects had consanguinity and none had any other family member affected. Optic atrophy was present in all, sensorineural hearing loss in 4/7, central diabetes insipidus in 4/7 and nephrogenic diabetes insipidus in 2/7 subjects. The new associations found were: spastic myoclonus, short stature with pancreatic malabsorption, nephrogenic diabetes insipidus, cyanotic heart disease and choledocholithiasis with cholangitis. Genetic analysis revealed mutation in exon 8 of the WFS1 gene in all the cases studied. CONCLUSIONS The present clinical series of Wolfram syndrome reveals a varied clinical presentation of the syndrome and some new associations.
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Affiliation(s)
- M A Ganie
- Department of Endocrinology, Sher-I-Kashmir Institute of Medical Sciences, Soura, India.
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Laway BA, Wani AI, Masoodi SR, Bashir MI, Ganie MA, Zargar AH. Hypercalciuria and nephrolithiasis on long-term follow-up of pseudo-vitamin D deficiency rickets. J PAK MED ASSOC 2010; 60:591-593. [PMID: 20578617] [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: 05/29/2023]
Abstract
A case of pseudovitamin D deficiency (Vitamin D dependent rickets type I) is presented, who initially responded to physiological doses of calcitriol but developed nephrolithiasis and hypercalciuria around puberty. Hypercalciuria was corrected after stopping calcitriol. Pseudo vitamin D deficiency rickets also called vitamin D dependent rickets type I (VDDR 1) is an uncommon cause of rickets. Patients appear normal at birth and manifests with signs between the ages of two months to two years. Muscle weakness is prominent, radiographic features are striking and response to calciferols is complete. Hypercalciuria and nephrolithiasis are uncommon in the untreated disease but can develop due to overtreatment with calcitriol or oral calcium. Here we report a patient who developed hypercalciuria and nephrolithiasis around puberty while on maintenance dose of calcitriol and oral calcium.
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Affiliation(s)
- Bashir Ahmad Laway
- Department of Endocrinology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Kashmir, India
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Zargar AH, Ganie MA, Masoodi SR, Laway BA, Bashir MI, Wani AI, Salahuddin M. Prevalence and pattern of sick euthyroid syndrome in acute and chronic non-thyroidal illness--its relationship with severity and outcome of the disorder. J Assoc Physicians India 2004; 52:27-31. [PMID: 15633715] [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: 05/01/2023]
Abstract
BACKGROUND Non-thyroidal illness is a common cause of alterations in thyroid hormone economy in absence of underlying intrinsic thyroid disorder. OBJECTIVE To study the prevalence and pattern of alterations in thyroid hormone economy in various non-thyroidal illnesses in our region and also to correlate these alterations with the severity and outcome of the non-thyroidal illness. MATERIAL AND METHODS We analyzed circulating T3, T4, TSH in 382 patients with non-thyroidal illness (285 acute and 97 acute on chronic) and correlated the alterations with severity and outcome of the non-thyroidal disorder. The patients had one or more organ failure at the time of enrollment to the study. The hormones were estimated at the onset of sickness, and at 3rd and 24th week. T3, T4 and TSH in 75 age and sex matched euthyroid subjects were taken as controls. RESULTS T3 (mean +/- SEM) was significantly reduced at the onset of illness, in both acute and chronic patient groups (1.61 +/- 0.05 nmol/l) compared to that in the controls (3.17 +/- 0.06 nmol/l). In spite of clinical improvement in most instances, T3 continued to remain low in the 3rd week (1.49 +/- 0.11 nmol/ l) but increased (2.14 +/- 0.09 nmol/l) in 24th week. Low T3 was found in 93 (32.6%) cases with acute illness in 20 (20.6%) cases with chronic illness. A combination of low T3 and T4 was found in 35 (12.3%) of cases with acute and 15 (15.5%) with chronic illness. Although serum TSH showed noticeable fall and rise in some individuals, no significant difference in mean TSH was observed during any period of illness compared to that in the controls. Severity of illness correlated with decrease in T3 (r=0.58) and T4 (r=0.38). A low T3 and T4 with low or undetectable TSH were associated with increased mortality. At the onset of acute illness low T3 was seen in 113 (29.6%, low T3 -low T4 in 50 (13.1%), high T4 in 28 (7.3%) lowT3-lowT4- low TSH in 10 (2.6%) and low T4 alone in 4 (1%) patients. Fifty one 1 (13.4%) of our patients demonstrated alterations in TSH in presence of normal T3 and T4-26 patients had decreased TSH while as 25 had increased TSH. Of 118 patients who followed at 24 weeks, 11 (9.3%) had low T3, 7(5.9%) had low T3- low T4 and 13 (11%) had elevated TSH. CONCLUSION Pattern and prevalence of sick euthyroid syndrome in this part of the world, a recognized iodine deficient region, appears to be similar to that reported elsewhere. Important finding in our study was higher percentage of TSH elevation, which we believe to reflect the underlying iodine deficiency state of our community. Besides a significant number of subjects persisted with alterations in thyroid functions even after 6 months of therapy. Though the severity of thyroid hormone derangement correlated with severity of sickness, the derangement was similar in acute vs. acute on chronic nonthyroidal illnesses.
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Affiliation(s)
- A H Zargar
- Department of Endocrinology and +Immunology, Sher-i-kashmir Institute of Medical Sciences, Soura, Srinagar, Kashmir
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Zargar AH, Bhat MH, Ganie MA, Laway BA, Masoodi SR, Salahuddin M, Kour S. Polyglandular endocrinopathy in myotonic dystrophy: letter to editor. Neurol India 2002; 50:105-6. [PMID: 11960166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
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Zargar AH, Salahuddin M, Laway BA, Masoodi SR, Ganie MA, Bhat MH. Puerperal alactogenesis with normal prolactin dynamics: is prolactin resistance the cause? Fertil Steril 2000; 74:598-600. [PMID: 10973663 DOI: 10.1016/s0015-0282(00)00691-9] [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: 11/15/2022]
Abstract
OBJECTIVE To determine the cause of puerperal alactogenesis in a young woman. DESIGN After proper clinical assessment, a definitive investigative protocol was followed to determine the cause of alactogenesis. SETTING Tertiary care medical center in Kashmir, India. PATIENT(S) A young married woman with three full-term deliveries, all characterized by puerperal alactogenesis. INTERVENTION(S) An investigative protocol to document prolactin reserve and mammography to demonstrate presence of normal breast tissue. MAIN OUTCOME MEASURE(S) Prolactin secretory reserve. RESULT(S) The patient had normal breast development and an adequate pituitary prolactin reserve. CONCLUSION(S) Prolactin resistance may have caused alactogenesis.
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Affiliation(s)
- A H Zargar
- Department of Endocrinology, Sheri-Kashmir Institute of Medical Sciences, Srinagar, Kashmir, India.
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Zargar AH, Bashir MI, Wani AI, Laway BA, Masoodi SR, Ganie MA, Salahuddin M. Clinical and endocrine aspects of thyrotoxicosis and its cardiovascular complications. Ann Saudi Med 2000; 20:485-7. [PMID: 17264659 DOI: 10.5144/0256-4947.2000.485] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- A H Zargar
- Department of Endocrinology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Kashmir, India.
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Zargar AH, Mithal A, Wani AI, Laway BA, Masoodi SR, Bashir MI, Ganie MA. Pseudovitamin D deficiency rickets--a report from the Indian subcontinent. Postgrad Med J 2000; 76:369-72. [PMID: 10824056 PMCID: PMC1741602 DOI: 10.1136/pmj.76.896.369] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [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: 11/04/2022]
Abstract
Pseudovitamin D deficiency rickets (also called vitamin D dependent rickets type I) is one of the types of inherited rickets and is caused by a deficit in renal 25-hydroxyvitamin D 1alpha-hydroxylase. This form of rickets has not been reported from the Indian subcontinent. Three patients with this disorder are presented. These patients were all females aged 3-20 years and presented with growth failure and skeletal deformities. All had florid clinical and radiological rickets. The biochemical abnormalities seen included hypocalcaemia, hypophosphataemia, and hyperphosphatasia. All patients had grossly raised 25-hydroxyvitamin D concentrations and markedly low to undetectable concentrations of 1,25-dihydroxyvitamin D. A disturbing feature of this study was the late referral of the patients.
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Affiliation(s)
- A H Zargar
- Department of Endocrinology, Sheri-Kashmir Institute of Medical Sciences, Srinagar, Kashmir, India.
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