Ambika Ashraf - Academia.edu (original) (raw)

Papers by Ambika Ashraf

PLOS ONE, 2014

Legend: General linear models using backward stepwise regression used to obtain β estima... more Legend: General linear models using backward stepwise regression used to obtain β estimates and P-values. Bolded values represent those that are statistically significant (P ≤0.05). Abbreviations: PTH, parathyroid hormone; 25(OH)D, 25-hydroxyvitamin D; VDBP, vitamin D binding protein.Multiple linear regression analyses of variables modifying VDBP concentrations.</p

The Endocrine Society's 93rd Annual Meeting & Expo, June 4–7, 2011 - Boston, 2011

Journal of Clinical Lipidology, 2015

Springer eBooks, Sep 26, 2013

Hormone Research in Paediatrics

Introduction: There are two major categories of peroxisomal disorders (PDs): peroxisomal biogenes... more Introduction: There are two major categories of peroxisomal disorders (PDs): peroxisomal biogenesis disorders (PBDs) due to defects in peroxisomal (PEX) genes and deficiency of other peroxisomal enzymes (such as D-bifunctional enzyme deficiency due to HSD17B4). PDs are characterized by abnormal elevations of very-long-chain fatty acids (VLCFA). We aimed to evaluate the clinical phenotype of adrenal insufficiency in patients with PD and to assess any genotype-phenotype correlations with adrenal insufficiency. Case Presentation: We performed a retrospective electronic medical record review at a single university medical center, of data over 12 years and identified 7 patients with PD. Of the 7 patients identified, 6 patients had a diagnosis of PBD and one had a single peroxisomal enzyme deficiency, HSD17B4. The average age of the patients at diagnosis were 0.61 ± 0.66 years. Four patients (66.7%) had primary adrenal insufficiency: 3, out of the 4, patients had elevated baseline ACTH. T...

The Journal of Clinical Endocrinology & Metabolism

Context Pediatric obesity is a serious health problem in the United States. While lifestyle modif... more Context Pediatric obesity is a serious health problem in the United States. While lifestyle modification therapy with dietary changes and increased physical activity are integral for the prevention and treatment of mild to moderate obesity in youth, only a modest effect on sustained weight reduction is observed in children and young adults with severe obesity. This underscores the need for additional evidence-based interventions for children and adolescents with severe obesity, including pharmacotherapy, before considering invasive procedures such as bariatric surgery. Evidence Acquisition This publication focuses on recent advances in pharmacotherapy of obesity with an emphasis on medications approved for common and rarer monogenic forms of pediatric obesity. Evidence Synthesis We review medications currently available in the United States, both those approved for weight reduction in children and “off-label” medications that have a broad safety margin. Conclusion It is intended tha...

Endocrinology

Objective: To examine the accuracy of urine c-peptide creatinine ratio (UCPCR) for identifying th... more Objective: To examine the accuracy of urine c-peptide creatinine ratio (UCPCR) for identifying the type of diabetes in appropriate clinical settings. Design: Systematic review of test accuracy studies on patients with different forms of diabetes. Data sources: Medline, Embase and Cochrane library databases from 1 January 2000 to 15 November 2020. Eligibility criteria: Studies reporting the use of UCPCR for diagnosing patients with type 1 diabetes mellitus (T1DM), type 2 diabetes mellitus (T2DM) and monogenic forms of diabetes (categorized as maturity-onset diabetes of the young [MODY]). Study selection and data synthesis: Two reviewers independently assessed articles for inclusion and assessed the methodological quality of the studies using the Quality Assessment of Diagnostic Accuracy Studies-2 tool, with input from a third reviewer to reach consensus when there was a dispute. Meta-analysis was performed with the studies reporting complete data to derive the pooled sensitivity, spe...

Newborn

Hypocalcemia in neonates is defined as total serum calcium concentration less than 7.5-8 mg/dL an... more Hypocalcemia in neonates is defined as total serum calcium concentration less than 7.5-8 mg/dL and/or ionized calcium less than 4.4 mg/dL in neonates (>1500 g) and total serum calcium concentration less than 7 mg/dL or ionized calcium less than 3.6 mg/dL in low-birth-weight neonates (<1500 g). About 80% of the calcium transfer across the placenta occurs in the last trimester. Parathyroid hormone-related peptide (PTHrP) regulates the positive calcium balance in the placenta. Postpartum serum calcium level in neonates depends on an intricate relationship between PTH and renal and skeletal factors. Based on the timing of the presentation, hypocalcemia can be early onset (develops in the first 72 hours of life) and late onset (occurs after 72 hours of life). Causes of early-onset hypocalcemia include prematurity, SGA, IUGR, birth asphyxia, diabetes mellitus, or toxemia in the mother. Late-onset neonatal hypocalcemia may be caused by increased dietary phosphate content, neonatal vitamin D deficiency, hypomagnesemia, hypoparathyroidism, or parathyroid hormone resistance. We present a neonate with hypocalcemia due to transient hypoparathyroidism secondary to maternal adenoma. A thorough history and physical examination are essential to identify at-risk asymptomatic infants who need screening for hypocalcemia. Neonatal hypocalcemia can be a serious event and can cause serious morbidity and mortality. Majority of the early as well as transient late neonatal hypocalcemia resolves completely, while lifelong treatment may be required in some cases depending on the etiology.

Therapeutic Advances in Endocrinology and Metabolism

Landmark studies have convincingly demonstrated that atherosclerosis begins in youth. While gener... more Landmark studies have convincingly demonstrated that atherosclerosis begins in youth. While generally asymptomatic, an increasing number of youth with disorders of lipid and lipoprotein metabolism, such as familial hypercholesterolemia, are being identified through selective and universal screening. While a heart healthy lifestyle is the foundation of treatment for all youth with dyslipidemia, lipid-lowering therapy may be required by some to prevent morbidity and premature mortality, especially when initiated at a young age. When appropriate, use of statins has become standard of care for reducing low-density lipoprotein cholesterol, while fibrates may be beneficial in helping to lower triglycerides. Many therapeutic options commonly used in adults are not yet approved for use in youth less than 18 years of age. Although currently available lipid-lowering therapy is well tolerated and safe when administered to youth, response to treatment may vary and some conditions lack an effici...

Dietary Sugar, Salt and Fat in Human Health, 2020

Abstract There has been a significant rise in the prevalence of pediatric obesity and metabolic s... more Abstract There has been a significant rise in the prevalence of pediatric obesity and metabolic syndrome (MetS) in both developed and developing countries over the past few decades. At the center of any intervention directed toward improving weight and cardiometabolic risk profile of MetS is dietary management. With limited access to medical nutritional therapy at a primary care setting, it often falls upon the physician to understand and assimilate basic principles of nutrition as part of obesity prevention and management. Eating habits and dietary preferences are formed during childhood, and it is important to make a positive impact on food choices early in life. This chapter discusses macronutrient components of standard meals, some popular meal plans, and the state of the current literature on their effects on the components of MetS.

Cardiovascular disease is the world’s leading cause of death. This chapter provides a brief overv... more Cardiovascular disease is the world’s leading cause of death. This chapter provides a brief overview of cholesterol metabolism and focuses on the genetic disorders of dyslipidemia. It explains the common causes and mechanisms of acquired dyslipidemia, addressing the impact of obesity, type 2 diabetes, and metabolic syndrome. Current dietary recommendations and pharmacological options are reviewed. Primary prevention strategies are of utmost importance because abnormalities of lipid metabolism are associated with premature atherosclerotic changes in childhood that can track into adulthood.

Archives of pediatrics, 2019

Treatment of Type 2 Diabetes (T2DM) in adolescents is challenging due to limited pharmacological ... more Treatment of Type 2 Diabetes (T2DM) in adolescents is challenging due to limited pharmacological options and inadequate therapy adherence. Objective: This study aimed to evaluate differences in glucose handling and endogenous insulin secretion during a Mixed Meal Tolerance Test (MMTT) in adolescents with T2DM who were treated with metformin alone versus insulin + metformin. Design/Methods: Cross-sectional study of 15 adolescents with T2DM who were on treatment with metformin alone or insulin + metformin. Results: There were 10 participants on metformin alone and 5 participants on insulin + metformin. The mean hemoglobin A1C (HbA1C) was higher in the insulin-treated group (7.7 ± 0.85 % for insulin + metformin-treated versus 6.3 ± 1.03 % for metformin-treated groups, p=0.02). The first phase and the overall Area Under the Curve (AUC) glycemic response was significantly higher in the insulin + metformin-treated versus metformin-treated group (6179.50 ± 1394.17 mg/dl/30 min versus 4578....

Endocrine Practice, 2021

OBJECTIVES To examine main factors that influence the decision to choose pediatric endocrinology ... more OBJECTIVES To examine main factors that influence the decision to choose pediatric endocrinology as a career among pediatric endocrinologists and assess their work satisfaction or stress level and suggested strategies to increase interest in subspecialty training in pediatric endocrinology. METHODS A workforce survey was distributed among 1470 members of the Pediatric Endocrine Society. RESULTS The response rate was 37.4%, with 550 members responding. The most common reasons for the respondents choosing pediatric endocrinology were intellectual stimulation (79%), exposure to endocrinology during residency (57%) or medical school (43%), and ability to establish relationships with patients with chronic disorders (54%). Of the respondents, 97% considered intellectual stimulation as the most favorable aspect of the specialty, and 84% considered financial compensation as the most unfavorable aspect of pediatric endocrinology. Majority (77%) were satisfied or very satisfied with their work environment. The mean work-related stress score (0 [none] to 10 [worst]) was 5.7, standard deviation was 2.1, and median was 6 (Q1, Q3: 4, 7). Increased financial compensation for the services and loan payment or forgiveness option were the top strategies suggested to enhance interest among residents for training in the subspecialty. One third (37%) felt that reducing the duration of the fellowship to 2 years would increase interest in training in pediatric endocrinology. CONCLUSION The pediatric endocrinologists reported overall excellent career satisfaction, indicating the potential to attract high-quality doctors to the specialty. Improving reimbursement and loan forgiveness were the top strategies suggested for increasing interest in subspecialty training in pediatric endocrinology.

The Journal of Clinical Endocrinology & Metabolism, 2021

Context Identification of modifiable risk factors, including genetic and acquired disorders of li... more Context Identification of modifiable risk factors, including genetic and acquired disorders of lipid and lipoprotein metabolism, is increasingly recognized as an opportunity to prevent premature cardiovascular disease (CVD) in at-risk youth. Pediatric endocrinologists are at the forefront of this emerging public health concern and can be instrumental in beginning early interventions to prevent premature CVD-related events during adulthood. Aim In this article, we use informative case presentations to provide practical approaches to the management of pediatric dyslipidemia. Cases We present 3 scenarios that are commonly encountered in clinical practice: isolated elevation of low-density lipoprotein cholesterol (LDL-C), combined dyslipidemia, and severe hypertriglyceridemia. Treatment with statin is indicated when the LDL-C is ≥190 mg/dL (4.9 mmol/L) in children ≥10 years of age. For LDL-C levels between 130 and 189 mg/dL (3.4-4.89 mmol/L) despite dietary and lifestyle changes, the pr...

The Journal of Pediatrics, 2021

Endocrinology, Diabetes & Metabolism, 2020

BackgroundType 2 diabetes (T2DM) in children is considered rare before puberty.ObjectiveDescribe ... more BackgroundType 2 diabetes (T2DM) in children is considered rare before puberty.ObjectiveDescribe the characteristics and outcomes of children with T2DM diagnosed at or before 10 years of age.MethodsRetrospective electronic medical record review of children diagnosed with T2DM at a University Children's Hospital over 12 years was conducted. Patient characteristics at diagnosis, 2‐3‐year follow‐up, and 4‐5‐year follow‐up were analysed as a whole and by age groups, 5‐8 and 9‐10 years.ResultsThere were 42 children ≤ 10 years with T2DM (5‐8‐year age group, n = 8 and 9‐10‐year age group, n = 34). There were 88.1% African American, 11.9% Caucasian, and 88.1% females. Body mass index (BMI) was ≥95th percentile in 95.2%. Average BMI z score was 2.5 ± 0.4 and higher in the 5‐8‐year age group (2.7 ± 0.5 vs 2.4 ± 0.4, P = .02). Average haemoglobin A1C at diagnosis was 10.5 ± 2.4%, and improvement was seen at 2‐3 years, but subsequent worsening was noted at 4‐5 years in both age groups. At 4...

Journal of the Endocrine Society, 2020

Osteopetrosis is a rare group of bone disorders characterized by defective osteoclast bone resorp... more Osteopetrosis is a rare group of bone disorders characterized by defective osteoclast bone resorption causing high bone mineral density. A high bone mineral density in combination with defective skeletal mineralization results in a phenotype of osteopetrorickets. We present a rare presentation of infantile osteopetrorickets in an 8-week-old female who presented with failure to thrive, hypophosphatemia, anemia, and thrombocytopenia. A skeletal survey showed increased bone density with rachitic changes. She was found to have a homozygous T-cell immune regulator 1 (TCIRG1) pathogenic mutation consistent with osteopetrosis. This highlights the importance of a clinical suspicion of osteopetrosis with this symptom constellation.