John Punnose - Academia.edu (original) (raw)

Papers by John Punnose

Diabetes research and clinical practice, 2021

AIMS Between 2006 and 2015, the trends in prevalence of Hyperglycemia in pregnancy (HIP);Gestatio... more AIMS Between 2006 and 2015, the trends in prevalence of Hyperglycemia in pregnancy (HIP);Gestational diabetes(GDM),Diabetes in Pregnancy(DIP), Pre existing diabetes (PDM) and GDM risk factors were studied in 30692 pregnancies among Asian Indian women. METHODS GDM (n=4089) and DIP (n=259) diagnoses were by 75 g OGTT, while PDM (n=103) was identified by ICD code O24. Women with DIP and PDM were grouped together as pre-gestational diabetes (PGDM n=362).Crude and age-adjusted prevalence trend analysis by Poisson and Jointpoint regression models respectively, were done in GDM and PGDM groups. RESULTS During study years, the GDM prevalence by WHO 1999 and modified IADPSG criteria, showed decreasing and static trends respectively, while PGDM prevalence remained static. In a subgroup of 2560 women, mean BMI increased from 24.12±4.16 in year 2011 to 25.18±4.7 Kg/m2 in 2015 (p<0.014), but this rise had no impact on GDM prevalence. GDM risk factors; maternal age, gravidity ≥ 3, previous GDM...

Journal of Medical Genetics, 1999

We report two sibs with features overlapping those of orofaciodigital syndrome type VI (Varadi sy... more We report two sibs with features overlapping those of orofaciodigital syndrome type VI (Varadi syndrome). Both presented at birth with oculomotor abnormalities, dysmorphic facial features, and dysgenesis of the cerebellar vermis. There were minimal oral manifestations (high arched palate) in both of them and one had postaxial polydactyly of both hands and one foot. In addition, there was evidence of aplasia of the pituitary gland on MRI scan in both of them with evidence of hypopituitarism. Both responded well to hormone replacement therapy with improvement in their linear growth and mental ability. These cases may represent a new autosomal recessive midline defect syndrome with features overlapping OFDS VI. Alternatively the features in these children could represent variability within OFDS VI.

Australian and New Zealand Journal of Medicine, 1997

Eastern Mediterranean health journal = La revue de santé de la Méditerranée orientale = al-Majallah al-ṣiḥḥīyah li-sharq al-mutawassiṭ, 2005

To characterize the features of type 2 diabetes mellitus among children and adolescents in Al-Ain... more To characterize the features of type 2 diabetes mellitus among children and adolescents in Al-Ain, the records of every child with diabetes attending a teaching hospital in the city from January 1990 to December 2001 were retrospectively examined. Of 96 young people newly diagnosed with diabetes mellitus, 11 were identified as type 2. The clinical characteristics were: pubertal onset, female preponderance, obesity, strong family history of type 2 diabetes mellitus, high plasma glucose at presentation, adequate beta cell reserve and serum pancreatic islet cell antibody negativity. This case series adds to the evidence that type 2 diabetes mellitus is emerging among children in our region.

Postgraduate Medical Journal, 1995

Letters to the Editor 5-Alpha-reductase deficiency in a Saudi 'girl'

Gynecological Endocrinology, 2006

Both gestational diabetes mellitus (GDM) and thyroid dysfunction in pregnancy compromise maternal... more Both gestational diabetes mellitus (GDM) and thyroid dysfunction in pregnancy compromise maternal and fetal health. The aim of the present study was to determine the prevalence of abnormal thyroid function and antithyroid antibodies during early pregnancy in a population at high risk for GDM. Serum free triiodothyronine (FT3), free thyroxine (FT4) and thyroid-stimulating hormone (TSH) were measured in 301 pregnant women who underwent routine &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;universal screening&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; for GDM. The antithyroid peroxidase antibody (antiTPOAb) was also quantified in 255 of these women. GDM was confirmed by a 75-g oral glucose tolerance test using World Health Organization criteria. No statistically significant difference was found between the 80 (26.6%) women with GDM and the 221 (73.4%) women without GDM for any of the thyroid function tests. In the cohort tested for antiTPOAb, the 51 (20.0%) women who were positive for antiTPOAb had higher mean TSH (1.57 +/- 2.49 mIU/l; p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) than the women negative for antiTPOAb. Seventeen (5.6%) women had low FT4 while 12 (4.0%) women had high TSH; 28 (9.3%) women had low serum TSH, among whom three (1.0%) also had high FT4. The significantly higher prevalence of hypothyroxinemia and antiTPOAb titers than generally reported warrants routine screening for thyroid abnormalities. This screening, which can be effectively and easily incorporated into screening practices already in place for GDM, would result in improved obstetric care.

Diabetic Medicine, 2006

Aims To demonstrate the effect of diagnostic criteria, as defined by four international expert pa... more Aims To demonstrate the effect of diagnostic criteria, as defined by four international expert panels, on the usefulness of fasting plasma glucose (FPG) as a screening test for gestational diabetes mellitus (GDM). Methods We tested 4602 pregnant women using a 75-g oral glucose tolerance test (OGTT) for universal GDM screening. The area under the receiver operating characteristic curve (AUC) was used to determine the FPG performance to detect GDM by the criteria of the American Diabetes Association (ADA), the Australasian Diabetes in Pregnancy Society, the European Association for the Study of Diabetes, and the World Health Organization (WHO). Results By applying ADA, Australasian, European and WHO criteria, respectively, the FPG: (i) AUC (95% CI) was 0.882 (0.866-0.897), 0.830 (0.809-0.852), 0.808 (0.791-0.825) and 0.690 (0.670-0.710); (ii) independently could 'rule-in' GDM (with 100% specificity) in 74 (10.9%), 620 (53.5%), 252 (45.3%) and 74 (7.6%) women; (iii) independently could 'rule-out' GDM in an additional 2864 (62.2%), 928 (20.2%), 1510 (32.8%) and 1171 (25.4%) women, at FPG thresholds (with 85% sensitivity); (iv) false-positive rate (FPR) was 29.4, 75.5, 63.8 and 71.2%, at these thresholds. Conclusions The value of the FPG as a screening test for GDM is highly dependent on the diagnostic criteria. The performance is excellent with the ADA criteria. With the other criteria, the high FPR (poor specificity) would limit its utility as a screening test. Regardless of the criteria used, initial testing by FPG can significantly decrease the number of cumbersome OGTTs needed for the diagnosis of GDM.

Diabetes Care, 2012

OBJECTIVE The International Association of the Diabetes and Pregnancy Study Groups (IADPSG) recen... more OBJECTIVE The International Association of the Diabetes and Pregnancy Study Groups (IADPSG) recently recommended new criteria for diagnosing gestational diabetes mellitus (GDM). This study was undertaken to determine whether adopting the IADPSG criteria would be cost-effective, compared with the current standard of care. RESEARCH DESIGN AND METHODS We developed a decision analysis model comparing the cost-utility of three strategies to identify GDM: 1) no screening, 2) current screening practice (1-h 50-g glucose challenge test between 24 and 28 weeks followed by 3-h 100-g glucose tolerance test when indicated), or 3) screening practice proposed by the IADPSG. Assumptions included that 1) women diagnosed with GDM received additional prenatal monitoring, mitigating the risks of preeclampsia, shoulder dystocia, and birth injury; and 2) GDM women had opportunity for intensive postdelivery counseling and behavior modification to reduce future diabetes risks. The primary outcome measure ...

Archives of Gynecology and Obstetrics, 2006

Although debated, most preeminent expert panels recommend routine screening for gestational diabe... more Although debated, most preeminent expert panels recommend routine screening for gestational diabetes mellitus (GDM). Among the many tests that have been used and evaluated for the screening of GDM, the fasting plasma glucose (FPG) remains very appealing. It is easy to administer, well tolerated, inexpensive, reproducible and patient friendly. However attractive, the FPG has given varied results in diVerent populations and its use as a screening test for GDM remains uncertain. This review will objectively assess the available studies to Wnd the real value of FPG as a screening test for GDM.

Journal of Clinical & Translational Endocrinology, 2019

'hyperglycemia first detected in pregnancy' [15]. The women with FPG ≥ 126 mg /dl, 2-h PG ≥ 200 m... more 'hyperglycemia first detected in pregnancy' [15]. The women with FPG ≥ 126 mg /dl, 2-h PG ≥ 200 mg/dl or random plasma glucose ≥ 200 mg/dl are classified as 'diabetes mellitus in pregnancy'. The

Sultan Qaboos University Medical Journal, Mar 16, 2022

Objectives: This study aimed to define trimester-specific hemoglobin A1c (A1c) reference interval... more Objectives: This study aimed to define trimester-specific hemoglobin A1c (A1c) reference intervals among healthy South Asian pregnant women. Methods: In this restrospective study,1357 pregnant women without diabetes, gestational diabetes, gestational hypertension, anemia, β-thalassemia, or systemic diseases were included. They had term delivery of babies having weight appropriate for gestational age. A1c (using high performance liquid chromatography, meeting the National Glycohemoglobin Standardization Program and International Federation of Clinical Chemistry standards), hemoglobin, and RBC indices were estimated at the first antenatal visit. The A1c levels were calculated in terms of nonparametric 2.5 and 97.5 percentiles for women in first (T1), second (T2), and third (T3) trimester groups. The control group included 67 healthy non-pregnant women. Statistical tests were used to obtain the normal the normal reference values for the HbA1c. and the tests were considered significant when p value <0.05. Results: The median HbA1c (2.5 to 97.5 percentiles) was lower among the pregnant women; 4.8 (4-5.5) % or 32 (20-39) mmol/mol than in the non pregnant women; 5.1 (4-5.7) % or 29 (20-37) mmol/mol (p <0.001). These were 4.9 (4.1-5.5) % or 30 (21-37) mmol/mol, 4.8 (4-5.3) % or 29 (20-34) mmol/mol, and 4.8 (3.9-5.6) % or 29 (19-38) mmol/mol for the T1, T2 and T3 groups, respectively; p-values:T1 vs T2=<0.001, T1 vs T3= 0.002, T2 vs T3= 0.111, T1 vs non pregnant group = <0.001. Conclusions: Compared to normal non pregnant women, the A1c was lower in normal pregnant women in South Asian population. These A1c changes were observed despite having significantly higher body max index among women in the T2 and T3 groups than in the T1 and non pregnant groups. To understand the factors determining the A1c decrease in pregnancy and to validate the findings of this study, we recommend further prospective studies among South Asian women

Journal of Diabetes and its Complications

Aims: The aim of this study is to determine the association of elevated HbA1c in the first trimes... more Aims: The aim of this study is to determine the association of elevated HbA1c in the first trimester (HbA1c-FT) with adverse events among pregnant Asian Indian women without gestational diabetes (GDM). Methods: This retrospective cohort study included 1618 pregnant women who delivered at a single urban tertiary care center and had HbA1c-FT estimation between January 2011 and December 2017. Those with GDM according to a 75-g OGTT after 24 gestational weeks were excluded. Multivariable logistic regression models assessed the association between elevated HbA1c-FT and adverse events. Results: At a cutoff of >37 mmol/mol, HbA1c-FT was associated with preterm birth at <37 gestational weeks (adjusted odds ratio (OR) 2.10, 95% CI 1.11-3.98). There was a continuum of risk for primary caesarean delivery with higher HbA1c-FT levels (adjusted OR per 5-mmol/mol increase in HbA1c-FT for primary caesarean delivery: 1.27, 95% CI 1.06-1.52). In the crude analysis, gestational hypertension was associated with HbA1c-FT, but not after adjustment for confounding factors. HbA1c-FT was not associated with other adverse events (macrosomia, large for gestational age babies, or other neonatal complications). Conclusions: Even without GDM, the results suggest an association of HbA1c-FT with preterm birth and primary caesarian delivery among Asian Indian women Statistical analysis A data analysis was performed in the statistical software SPSS version 16.0 (Chicago, SPSS Inc.). The data were summarized with the mean and standard deviation for continuous variables and as numbers with percentages for qualitative variables. The clinical data and other variables in the HbA1c-FT groups were compared using an unpaired student's t-test for continuous variables and a chi-squared test for categorical variables. The adverse pregnancy events were compared among women with HbA1c-FT below 37 mmol/mol and those with levels equal to or above 37 mmol/mol(5.5%). Cohen's d and Cohen's h effect size were determined. Furthermore, crude odds ratios (OR) for eac [...]

Saudi medical journal, 1999

Full text is available as a scanned copy of the original print version.

$Research paper thumbnail of Polyostotic fibrous dysplasia with pseudo-precocious puberty and pathological subtrochanteric fracture of femur$

McCune-Albright Syndrome has orthopedic implications because of the potential for occurrence of p... more McCune-Albright Syndrome has orthopedic implications because of the potential for occurrence of pathological fractures and deformities. The case of a nine year old girl with this condition and recurrent pathological fractures of the femur is reported. We believe this is the first such case reported from the Middle East.

Diabetes Research and Clinical Practice, 2019

To assess the efficacy of first trimester glycated hemoglobin (HbA1c-FT) in diagnosing or predict... more To assess the efficacy of first trimester glycated hemoglobin (HbA1c-FT) in diagnosing or predicting gestational diabetes mellitus (GDM) in Asian Indian women. Methods: This retrospective cohort study involved 2275 women who underwent both HbA1c-FT estimation and GDM screening with a one-step 75 g oral glucose tolerance test. Receiver Operating Characteristic (ROC) curve statistics were applied to assess the discriminative ability of HbA1c-FT in GDM diagnosis. A multivariable logistic regression analysis after adjusting for plausible confounders was used to evaluate the independent effect of HbA1c-FT on GDM diagnosis. Results: The mean HbA1c-FT of GDM (n = 578) and non-GDM women (n = 1697) were 5.04 + 0.04% and 4.9 + 0.37%, respectively (p < 0.001). Compared to women with a HbA1c-FT < 5.2%, the adjusted odds ratio to develop GDM of women with an HbA1c-FT range of 5.2-5.5% and those >5.6% to develop GDM were 1.627 (p < 0.004) and 2.6 (p < 0.001), respectively. The area under the ROC curve to detect GDM was 0.606 (95% CI: 0.519-0.633 p < 0.001), but the sensitivity and specificity of the HbA1c-FT were not sufficient to diagnose, rule in or rule out GDM. Conclusions: HbA1c-FT is an independent GDM predictor in Asian Indian women but lacks sufficient sensitivity or specificity for use as a diagnostic test.

Journal of Clinical & Translational Endocrinology, 2018

Canadian journal of diabetes, Jan 15, 2017

To evaluate the value of the fasting plasma glucose (FPG) level for simplifying the International... more To evaluate the value of the fasting plasma glucose (FPG) level for simplifying the International Association of Diabetes and Pregnancy Study Groups (IADPSG) diagnostic algorithm of gestational diabetes mellitus (GDM) in a South Asian population. In 6,520 pregnant women undergoing universal screening with the 75 g oral glucose tolerance test (OGTT), the area under receiver operating characteristic curve was used to determine the overall FPG performance to detect GDM (IADPSG criteria). Specifically, 2 different FPG thresholds of the OGTT were used to rule in and rule out GDM so as to decrease the need for the cumbersome OGTT. GDM was present in 1,193 (18.3%) women. The FPG 1) area under receiver operating characteristic curve (95% CI) was 0.909 (0.898 to 0.920); 2) threshold of ≥5.1 mmol/L independently could rule in GDM in 708 (10.9%) women (100% specificity); 3) threshold of <4.3 mmol/L independently could rule out GDM in an additional 2,389 (36.6%) women (95.6% sensitivity). By...

Recent Advances in Pediatrics (Special Vol. 13): Pediatric Endocrinology, 2004