Sahana Shetty - Academia.edu (original) (raw)

Papers by Sahana Shetty

Research paper thumbnail of Micronutrients in Adverse Pregnancy Outcomes

F1000Research

About 10 to 20% of reported pregnancies have complications like spontaneous abortion (SA), preecl... more About 10 to 20% of reported pregnancies have complications like spontaneous abortion (SA), preeclampsia (PE), preterm birth (PTB), and fetal growth restriction (FGR); 60% are attributed to maternal nutritional alterations. Multiple micronutrients (MMN) are supplemented in the antenatal period, but no proper validation/guidelines are available regarding dosing/time, the need for initiation, and the duration of supplementation. Studies have reported adverse pregnancy complications related to the overuse/unwanted use of multiple micronutrient supplementations during pregnancy. Identifying the exact population requiring supplementation is necessary to prevent its abuse. This article attempts to review the impacts of micronutrient deficiency/supplementation in cases of SA, FGR, and gestational diabetes mellitus (GDM), preterm delivery and PE. The study used a literature search using PubMed, Google Scholar, Mendeley, and Scopus Databases using search words pregnancy, spontaneous abortio...

Research paper thumbnail of Maternal Serum Zinc, Copper, Magnesium, and Iron in Spontaneous Abortions

Indian Journal of Clinical Biochemistry

Research paper thumbnail of Role and Clinical Significance of Monocarboxylate Transporter 8 (MCT8) During Pregnancy

Reproductive Sciences

The review aims to summarize the available research focusing on the importance of monocarboxylate... more The review aims to summarize the available research focusing on the importance of monocarboxylate transporter (MCT8) in thyroid hormone trafficking across the placenta and fetal development. A systematic search was carried out in PubMed; studies available in English related to “monocarboxylate transporter”, “adverse pregnancy”, “fetal development,” and “thyroid hormone” were identified and assessed. The references within the resulting articles were manually searched. MCT8 is a highly active and selective thyroid hormone transporter that facilitates the cellular uptake of triiodothyronine (T3), thyroxine (T4), reverse triiodothyronine (rT3), and diiodothyronine (T2) in different tissues. MCT8 is expressed in the placenta from the first trimester onwards, allowing the transport of thyroid hormone from mother to fetus. Mutations in MCT8 cause an X-linked disorder known as Allan-Herndon-Dudley syndrome (AHDS), characterized by severe psychomotor impairment and peripheral thyrotoxicosis....

Research paper thumbnail of A narrative review of metabolic monitoring of adult prescribed second-generation antipsychotics for severe mental illness

Clinical Epidemiology and Global Health, 2022

Patients with severe mental illness (SMI) have poor physical wellbeing, leading essentially short... more Patients with severe mental illness (SMI) have poor physical wellbeing, leading essentially shorter lives, compared with the general population. Routine metabolic monitoring is proposed as a strategy for recognizing risk factors for metabolic variations in this population. This narrative review aimed to identify interventions at enhancing uptake of metabolic monitoring parameters in adult prescribed second generation antipsychotics (SGAs) for patients with SMI. Method: A literature search was performed through SCOPUS, PubMed, and CINAHL databases using a combination of keywords. We included primary studies published in the English language until December 2021 that provided evidence on interventions to increase the rate of SGAs related metabolic monitoring in patients with SMI. Results: A total of 21 studies were identified among which in 13 studies frequency of metabolic monitoring ranged between 40% and 80% after implementation of various strategies. These include multi-layer intervention model such as: (A) Reminders (e.g., paper-based prompts, invitation letter); (B) Electronic system of documentation (computer-based intervention, electronic medical records); (C) Healthcare practitioner specific role (Nurse-led intervention, pharmacist-led intervention, barrier focused strategies) and (D) Physical-mental health awareness (Education, quality improvement programme). Conclusion: This review provides evidence that studies involving the reminders such as paper based prompts and education to the patients as well as healthcare professionals could help in enhancing the rate of metabolic monitoring in patients prescribed SGAs.

Research paper thumbnail of A mysterious case of recurrent fracture: Tumour-induced osteomalacia

Journal of Family Medicine and Primary Care, 2022

We report a case of tumour-induced osteomalacia in a 59-year-old man who presented with a long-st... more We report a case of tumour-induced osteomalacia in a 59-year-old man who presented with a long-standing history of myalgia, bone pain and pathological fracture of the bilateral femur at different intervals in the past 4 years. A biochemical evaluation revealed hypophosphatemia secondary to phosphaturia. Localization study by Ga-68 DOTANOC PET-CT for adult-onset hypophosphatemic osteomalacia revealed a tumour in the right femoral head. Resection of the tumour resulted in clinical improvement as well as normalization of biochemical parameters.

Research paper thumbnail of Metabolic Syndrome - A New Paradigm: Need for Capacity Building of Health Care Workers for Early Screening in the Rural Indian Population

Social Science Research Network, 2019

Research paper thumbnail of A rare case report of FSH secreting pituitary adenoma with apoplexy

Endocrine Abstracts, 2021

Research paper thumbnail of Does Baseline PTH Influence Recovery of Bone Mineral Density, Trabecular Bone Score and Bone Turnover Markers? A Prospective Study Following Curative PArathyroidectomy in Primary Hyperparathyroidism

Endocrine Practice, 2020

OBJECTIVE This prospective study was carried out to assess trabecular bone score, bone mineral de... more OBJECTIVE This prospective study was carried out to assess trabecular bone score, bone mineral density (BMD), and bone biochemistry in Indian subjects with symptomatic primary hyperparathyroidism (PHPT), and to study the influence of baseline parathyroid hormone (PTH) on recovery of these parameters following curative surgery. METHODS This was a 2-year prospective study conducted at a tertiary care centre in southern India. Baseline assessment included demographic details, mode of presentation, bone mineral biochemistry, BMD, trabecular bone score (TBS), and bone turnover markers (BTMs). These parameters were reassessed at the end of the first and second years following curative parathyroid surgery. RESULTS Fifty-one subjects (32 men and 19 women) with PHPT who had undergone curative parathyroidectomy were included in this study. The mean (SD) age was 44.6 (13.7) years. The TBS, BTMs, and BMD at lumbar spine and forearm were significantly worse at baseline in subjects with higher baseline PTH (≥250 pg/mL) when compared to the group with lower baseline PTH (<250 pg/mL). At the end of 2 years, the difference between high versus low PTH groups (mean ± SD) persisted only for forearm BMD (0.638±0.093 versus 0.698±0.041 g/cm2; P =.01). However, on follow-up visits in the first and second year after curative parathyroidectomy, there was no significant difference in BTMs, BMD at the femoral neck, lumbar spine, and TBS between the 2 groups stratified by baseline PTH. CONCLUSION The BMD at the forearm remained significantly worse in individuals with high baseline PTH even at 2 years after surgery, while other parameters including TBS improved significantly from baseline. ABBREVIATIONS 25(OH)D = 25-hydroxyvitamin D; BMD = bone mineral density; BMI = body mass index; BTMs = Bone turnover markers; CTX = C-terminal telopeptide of type 1 collagen; DXA = dual energy X-ray absorptiometry; P1NP = N-terminal propeptide of type 1 procollagen; PHPT = primary hyperparathyroidism; PTH = parathyroid hormone; TBS = trabecular bone score.

Research paper thumbnail of Identification of risk factors and metabolic monitoring practices in patients on antipsychotic drugs in South India

Asian Journal of Psychiatry, 2020

The objectives of this study were to identify the risk factors for metabolic syndrome in patients... more The objectives of this study were to identify the risk factors for metabolic syndrome in patients on antipsychotics and to compare the frequency of metabolic monitoring with evidence-based guidelines. We conducted a retrospective cohort study in a tertiary care health institution of South India. The study included patients with schizophrenia, bipolar disorder, and schizoaffective disorders prescribed with antipsychotic drugs. Data was collected from the medical records department. American Diabetic Association/American Psychiatric Association (ADA/APA) guidelines were used as a reference standard to assess the monitoring for metabolic parameters. Diagnosis of metabolic syndrome was done according to the National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATP III) guidelines. Risk factors for metabolic syndrome and frequency of metabolic monitoring were analyzed. A total of 668 patients were included for clinical audit. About 16.5 % of the patients were diagnosed with metabolic syndrome. Age > 50 years (Odds Ratio (OR) 2.00; p value < 0.001) and duration of antipsychotic treatment > 5 years (OR 1.55; p value < 0.05) were recognized as the independent risk factors for metabolic syndrome using multiple logistic regression. Blood pressure (BP) and fasting blood sugar (FBS) levels were documented in 99.7 % and 47 % of cases at baseline respectively, however, subsequent annual data on BP and FBS monitoring was reduced to 72.7 % and 46 % respectively. Weight was documented in 60 % of the cases at baseline, whereas the subsequent data on four times the annual assessment of weight was reduced to 9.8 %. The extent of documentation of metabolic monitoring parameters was inadequate.

Research paper thumbnail of DXA Measured Visceral Adipose Tissue, Total Fat, Anthropometric Indices and its Association With Cardiometabolic Risk Factors in Mother-Daughter Pairs From India

Journal of Clinical Densitometry, 2020

Visceral fat is the pathogenic fat depot associated with diabetes, dyslipidemia, and cardiovascul... more Visceral fat is the pathogenic fat depot associated with diabetes, dyslipidemia, and cardiovascular diseases. Estimation of visceral adipose tissue (VAT) by dual energy-X-ray absorptiometry (DXA) is a newer technique with less radiation exposure, shorter scanning time, and lower cost. In this study, we attempted to look at relationship between cardiometabolic risk factors and VAT, total body fat percent (TBF%) and anthropometry. We also studied the changes in body composition and metabolic parameters with menopause. The familial resemblance of VAT and TBF% in mother-daughter pair was also compared. This was a cross sectional community study of 300 women (150 postmenopausal mothers and 150 premenopausal daughters). Body composition indices by DXA and metabolic parameters were assessed. The association between DXA-VAT, TBF%, anthropometric measures, and cardiometabolic risk factors were studied by correlation, receiver operating characteristics curves, and logistic regression analysis. VAT indices were significantly higher and lean indices lower in postmenopausal women as compared to premenopausal women. One fourth of postmenopausal women were categorized as metabolically obese normal weight. DXA-VAT was a better predictor of cardiometabolic risk factors as compared to waist circumference, body mass index, and TF% in postmenopausal women (AUC:0.68 vs 0.62, 0.60 & 0.5, respectively), whereas body mass index had a better prediction in premenopausal women(AUC:0.68). VAT area >100 cm 2 had a significant association with the presence of 2 cardiometabolic risk factors (p = 0.04, OR: 2.2, CI:1.0À4.7) in the postmenopausal women. Daughters of the mothers with higher TBF% were found to have a higher TBF% compared to daughters of mothers with normal TBF% (36.2 § 4.2 vs 32.2 § 4.4, p = 0.03), similar resemblance was not seen for VAT. The study showed that the VAT increases and lean mass decreases with age and menopause. DXA measured VAT is a better predictor of cardiometabolic risk in postmenopausal women but not in premenopausal women. Total body fat may have a familial resemblance, but not the VAT which is determined by age, menopause, and probable life style factors.

Research paper thumbnail of Association between Dental Health and Osteoporosis: A Study in South Indian Postmenopausal Women

Journal of mid-life health

This study aims to objectively assess the dentition status in South Indian postmenopausal women a... more This study aims to objectively assess the dentition status in South Indian postmenopausal women and compare the dental health of osteoporotic participants with nonosteoporotic individuals. A total of 150 consecutive ambulatory South Indian postmenopausal women (>50 years of age) were assessed for their dental health using an internationally validated scoring system. Bone mineral density (BMD) was assessed using a dual-energy X-ray absorptiometry scanner. About 39% of the participants were found to have osteoporosis and 23% had osteopenia at any site. More than half of them (57%) had poor dental health, and the predominant problems were cavities (43.5%) and loss of teeth (75%). Among 112 women who had tooth loss, the mean tooth loss was 4.8. The mean tooth loss among patients with normal BMD was 1.09 ± 1.2, in osteopenia was 2.1 ± 2, and in osteoporosis was 5.4 ± 2.8 (P < 0.01). The odds of having osteoporosis among the patients with three or more tooth loss were found to be 4....

Research paper thumbnail of Evaluation of Different Screening Tools for Predicting Femoral Neck Osteoporosis in Rural South Indian Postmenopausal Women

Journal of clinical densitometry : the official journal of the International Society for Clinical Densitometry, Jan 25, 2017

The measurement of bone mineral density by dual-energy X-ray absorptiometry scan is the "gol... more The measurement of bone mineral density by dual-energy X-ray absorptiometry scan is the "gold standard" for the diagnosis of osteoporosis, which has limited availability in many parts of India. This study was done to assess the diagnostic performance of 6 internationally validated tools (Simple Calculated Osteoporosis Risk Estimation [SCORE], age, bulk, one or never estrogen [ABONE], Osteoporosis Risk Assessment Instrument [ORAI] and Osteoporosis Self-Assessment Tool for Asians [OSTA], Fracture Risk Assessment Tool [FRAX®], and calcaneal quantitative ultrasound [QUS]) for the diagnosis of osteoporosis at the femoral neck (FN). This was a cross-sectional study conducted in 2108 ambulatory South Indian rural postmenopausal women who were assessed with SCORE, ABONE, ORAI, OSTA, and FRAX® tools. QUS was performed in 850 subjects. Bone mineral density was estimated by dual-energy X-ray absorptiometry scan at the FN, and sensitivity and specificity were calculated for all tools ...

Research paper thumbnail of Clinical case scenarios in the management of diabetes mellitus

Current Medical Issues, 2017

Research paper thumbnail of Practical use of insulin in diabetes mellitus

Current Medical Issues, 2017

Insulin therapy is the cornerstone of treatment in patients with type 1 diabetes mellitus (DM) an... more Insulin therapy is the cornerstone of treatment in patients with type 1 diabetes mellitus (DM) and advanced type 2 DM. Over the years, insulin treatment has advanced from animal insulin to recombinant insulin with more efficiency and fewer side effects and from short-acting conventional insulin to ultrashort and long-acting insulin analogs to mimic various phases of physiological insulin secretion. Various insulin delivery systems from conventional subcutaneous insulin injection using insulin syringe to pen device, subcutaneous insulin infusion pumps, and inhaled insulin to artificial pancreas are now available. Proper insulin injecting techniques and patient education on self-monitoring of blood glucose and insulin dose titration are of utmost importance for effective insulin therapy.

Research paper thumbnail of Diet in a pregnant mother with diabetes mellitus

Current Medical Issues, 2017

Gestational diabetes mellitus (GDM) is a severe threat to maternal and child health. It is associ... more Gestational diabetes mellitus (GDM) is a severe threat to maternal and child health. It is associated complications adversely affect the mother and the child. One in seven births is affected by gestational diabetes. Lifestyle intervention has a positive impact on glycemic control and pregnancy outcomes of GDM. Adequate nutrition during pregnancy ensures good health for the mother and the growing fetus. There is an increased need for calories, proteins and vitamins, and minerals to meet the demands of increased metabolic activity during this period. The composition of each meal is crucial in attaining glycemic control. A low-carbohydrate diet (60%–65%) with adequate proteins (15%) and fats (20%–25%) is beneficial in attaining acceptable postprandial sugars. “My Plate Planner” is a simple method for remembering the type and quantity of food to be consumed with each meal. Regularity of meals with frequent snacking of healthy foods ensures acceptable glucose homeostasis throughout the day.

Research paper thumbnail of Performance of risk assessment tools for predicting osteoporosis in south Indian rural elderly men

Archives of osteoporosis, 2017

Osteoporosis in elderly men is an under-recognized problem. In the current study, we intend to lo... more Osteoporosis in elderly men is an under-recognized problem. In the current study, we intend to look at the performance of two risk assessment tools [OSTA and MORES] for the diagnosis of osteoporosis. Osteoporosis was seen in 1/4th of elderly men at spine and 1/6th of them at femoral neck. Both risk assessment tools were found to have good sensitivity in predicting osteoporosis at spine and femoral neck with good area under curve (AUC). This study attempts to look at the performance of osteoporosis self-assessment tool for Asians (OSTA) and male osteoporosis risk estimation score (MORES) for predicting osteoporosis in south Indian rural elderly men. Five hundred and twelve men above 65 years of age from a south Indian rural community were recruited by cluster random sampling. All subjects underwent detailed clinical, anthropometric, and bone mineral density measurement at lumbar spine and femoral neck using dual-energy X-ray absorptiometry scan. A T score ≤ - 2.5 was diagnostic of os...

Research paper thumbnail of Musculoskeletal oncogenic osteomalacia–An experience from a single centre in South India

Journal of Orthopaedics, 2017

Background: Oncogenic osteomalacia is an acquired form of hypophosphatemic osteomalacia where the... more Background: Oncogenic osteomalacia is an acquired form of hypophosphatemic osteomalacia where the tumour resection may lead to cure of the disease. Tumours originating from the musculoskeletal region form an important subgroup of oncogenic osteomalacia. Methods: This was a retrospective study conducted at a tertiary care centre in south India where we analyzed the hospital records of all the patients with musculoskeletal oncogenic osteomalacia from January 2010-April 2016. Results: A total number of 73 patients were diagnosed to have adult onset hypophosphatemic osteomalacia out of which 13 patients (M: F = 6:7; mean age: 45.38 AE 18.23 years) with musculoskeletal oncogenic osteomalacia were included in the study. Common presenting symptoms were bony pains, proximal myopathy and fractures. Mean duration of symptoms from the initial hospital visit was 58.46 AE 64.48 months. The initial mean fibroblast growth factor (FGF) 23 levels being 828.86 AE 113.22 RU/ ml (Normal range: 22-91). Imaging modalities used for localization of the tumour: DOTATATE PET/CT (8 patients), FDG PET/CT (3 patients), 1 patient (Both DOTATATE PET/CT and FDG PET/CT) and whole body Tc 99 m Red blood cell (RBC) blood pool scintigraphy (2 patients). 9 patients underwent surgery and all achieved remission. 4 patients denied surgical consent. Conclusion: Musculoskeletal oncogenic osteomalacia [ 4 7 _ T D $ D I F F ] is a major subgroup of oncogenic osteomalacia which need more extensive whole body imaging for the localization of the tumour. Surgical excision often leads to remission of the disease.

Research paper thumbnail of Bone turnover markers: Emerging tool in the management of osteoporosis

Indian journal of endocrinology and metabolism

Bone is a dynamic tissue which undergoes constant remodeling throughout the life span. Bone turno... more Bone is a dynamic tissue which undergoes constant remodeling throughout the life span. Bone turnover is balanced with coupling of bone formation and resorption at various rates leading to continuous remodeling of bone. A study of bone turnover markers (BTMs) provides an insight of the dynamics of bone turnover in many metabolic bone disorders. An increase in bone turnover seen with aging and pathological states such as osteoporosis leads to deterioration of bone microarchitecture and thus contributes to an increase in the risk of fracture independent of low bone mineral density (BMD). These microarchitectural alterations affecting the bone quality can be assessed by BTMs and thus may serve as a complementary tool to BMD in the assessment of fracture risk. A systematic search of literature regarding BTMs was carried out using the PubMed database for the purpose of this review. Various reliable, rapid, and cost-effective automated assays of BTMs with good sensitivity are available for...

Research paper thumbnail of The H-syndrome and next generation sequencing for molecular genetic diagnosis

Endocrine Abstracts, 2014

Monogenic auto-inflammatory diseases are a group of hereditary disorders characterized by a clin... more Monogenic auto-inflammatory diseases are a group of hereditary disorders characterized by a clinical and biological inflammatory syndrome without evidence of autoimmunity. The mutated proteins are involved in the altered regulation of inflammation. The 'H' syndrome has been recently described as a monogenic auto-inflammatory autosomalrecessive genodermatosis with several systemic manifestations. It is caused by mutations in the solute carrier family 29 (SLC29A3) gene, which encodes the human equilibrative nucleoside transporter-3 (hENT3). To study the clinical features and establish the genetic diagnosis of a subject with young onset of diabetes. OBJECTIVES Utilizing next generation sequencing we carried out mutational analysis of SLC29A3 gene in the chr.10q22.1 and selectively investigated this patient for various other features of this genodermatosis. SUBJECTS AND METHODS RESULTS OF GENETIC TESTS CONCLUSIONS • H-syndrome must be considered in any subject with young onset of diabetes and the dermatological phenotype of pigmentary hypertrichosis. • Next generation sequencing (NGS) forms a useful platform in genetic testing of monogenic disorders and would aid in the diagnosis and further counseling.

Research paper thumbnail of The impact of the Hologic vs the ICMR database in diagnosis of osteoporosis among South Indian subjects

Clinical Endocrinology, 2014

SummaryBackground and ObjectivesRecently, the Indian Council of Medical Research (ICMR) has publi... more SummaryBackground and ObjectivesRecently, the Indian Council of Medical Research (ICMR) has published normative data for bone mineral density (BMD) measured by dual‐energy X‐ray absorptiometry (DXA) scanning. However, the impact this has had on the diagnosis of osteoporosis when compared to currently used Caucasian databases has not been analysed. Hence, this study was undertaken to look at agreement between the Hologic Database (HD) based on BMD normative data in Caucasians and the ICMR database (ICMRD) in defining osteoporosis in subjects with or without hip fracture.Materials and MethodsIt is a cross ‐sectional study of 2976 subjects (men 341, women 2757) (mean age ± SD = 62·2 ± 7·2 years), including 316 subjects with low impact hip fracture: 2199 were from the hospital database, and 461 were healthy postmenopausal women from the community who underwent (DXA) scanning between January 2010 and March 2013. Recalculated T scores from ICMRD were used for the diagnosis of osteoporosis...

Research paper thumbnail of Micronutrients in Adverse Pregnancy Outcomes

F1000Research

About 10 to 20% of reported pregnancies have complications like spontaneous abortion (SA), preecl... more About 10 to 20% of reported pregnancies have complications like spontaneous abortion (SA), preeclampsia (PE), preterm birth (PTB), and fetal growth restriction (FGR); 60% are attributed to maternal nutritional alterations. Multiple micronutrients (MMN) are supplemented in the antenatal period, but no proper validation/guidelines are available regarding dosing/time, the need for initiation, and the duration of supplementation. Studies have reported adverse pregnancy complications related to the overuse/unwanted use of multiple micronutrient supplementations during pregnancy. Identifying the exact population requiring supplementation is necessary to prevent its abuse. This article attempts to review the impacts of micronutrient deficiency/supplementation in cases of SA, FGR, and gestational diabetes mellitus (GDM), preterm delivery and PE. The study used a literature search using PubMed, Google Scholar, Mendeley, and Scopus Databases using search words pregnancy, spontaneous abortio...

Research paper thumbnail of Maternal Serum Zinc, Copper, Magnesium, and Iron in Spontaneous Abortions

Indian Journal of Clinical Biochemistry

Research paper thumbnail of Role and Clinical Significance of Monocarboxylate Transporter 8 (MCT8) During Pregnancy

Reproductive Sciences

The review aims to summarize the available research focusing on the importance of monocarboxylate... more The review aims to summarize the available research focusing on the importance of monocarboxylate transporter (MCT8) in thyroid hormone trafficking across the placenta and fetal development. A systematic search was carried out in PubMed; studies available in English related to “monocarboxylate transporter”, “adverse pregnancy”, “fetal development,” and “thyroid hormone” were identified and assessed. The references within the resulting articles were manually searched. MCT8 is a highly active and selective thyroid hormone transporter that facilitates the cellular uptake of triiodothyronine (T3), thyroxine (T4), reverse triiodothyronine (rT3), and diiodothyronine (T2) in different tissues. MCT8 is expressed in the placenta from the first trimester onwards, allowing the transport of thyroid hormone from mother to fetus. Mutations in MCT8 cause an X-linked disorder known as Allan-Herndon-Dudley syndrome (AHDS), characterized by severe psychomotor impairment and peripheral thyrotoxicosis....

Research paper thumbnail of A narrative review of metabolic monitoring of adult prescribed second-generation antipsychotics for severe mental illness

Clinical Epidemiology and Global Health, 2022

Patients with severe mental illness (SMI) have poor physical wellbeing, leading essentially short... more Patients with severe mental illness (SMI) have poor physical wellbeing, leading essentially shorter lives, compared with the general population. Routine metabolic monitoring is proposed as a strategy for recognizing risk factors for metabolic variations in this population. This narrative review aimed to identify interventions at enhancing uptake of metabolic monitoring parameters in adult prescribed second generation antipsychotics (SGAs) for patients with SMI. Method: A literature search was performed through SCOPUS, PubMed, and CINAHL databases using a combination of keywords. We included primary studies published in the English language until December 2021 that provided evidence on interventions to increase the rate of SGAs related metabolic monitoring in patients with SMI. Results: A total of 21 studies were identified among which in 13 studies frequency of metabolic monitoring ranged between 40% and 80% after implementation of various strategies. These include multi-layer intervention model such as: (A) Reminders (e.g., paper-based prompts, invitation letter); (B) Electronic system of documentation (computer-based intervention, electronic medical records); (C) Healthcare practitioner specific role (Nurse-led intervention, pharmacist-led intervention, barrier focused strategies) and (D) Physical-mental health awareness (Education, quality improvement programme). Conclusion: This review provides evidence that studies involving the reminders such as paper based prompts and education to the patients as well as healthcare professionals could help in enhancing the rate of metabolic monitoring in patients prescribed SGAs.

Research paper thumbnail of A mysterious case of recurrent fracture: Tumour-induced osteomalacia

Journal of Family Medicine and Primary Care, 2022

We report a case of tumour-induced osteomalacia in a 59-year-old man who presented with a long-st... more We report a case of tumour-induced osteomalacia in a 59-year-old man who presented with a long-standing history of myalgia, bone pain and pathological fracture of the bilateral femur at different intervals in the past 4 years. A biochemical evaluation revealed hypophosphatemia secondary to phosphaturia. Localization study by Ga-68 DOTANOC PET-CT for adult-onset hypophosphatemic osteomalacia revealed a tumour in the right femoral head. Resection of the tumour resulted in clinical improvement as well as normalization of biochemical parameters.

Research paper thumbnail of Metabolic Syndrome - A New Paradigm: Need for Capacity Building of Health Care Workers for Early Screening in the Rural Indian Population

Social Science Research Network, 2019

Research paper thumbnail of A rare case report of FSH secreting pituitary adenoma with apoplexy

Endocrine Abstracts, 2021

Research paper thumbnail of Does Baseline PTH Influence Recovery of Bone Mineral Density, Trabecular Bone Score and Bone Turnover Markers? A Prospective Study Following Curative PArathyroidectomy in Primary Hyperparathyroidism

Endocrine Practice, 2020

OBJECTIVE This prospective study was carried out to assess trabecular bone score, bone mineral de... more OBJECTIVE This prospective study was carried out to assess trabecular bone score, bone mineral density (BMD), and bone biochemistry in Indian subjects with symptomatic primary hyperparathyroidism (PHPT), and to study the influence of baseline parathyroid hormone (PTH) on recovery of these parameters following curative surgery. METHODS This was a 2-year prospective study conducted at a tertiary care centre in southern India. Baseline assessment included demographic details, mode of presentation, bone mineral biochemistry, BMD, trabecular bone score (TBS), and bone turnover markers (BTMs). These parameters were reassessed at the end of the first and second years following curative parathyroid surgery. RESULTS Fifty-one subjects (32 men and 19 women) with PHPT who had undergone curative parathyroidectomy were included in this study. The mean (SD) age was 44.6 (13.7) years. The TBS, BTMs, and BMD at lumbar spine and forearm were significantly worse at baseline in subjects with higher baseline PTH (≥250 pg/mL) when compared to the group with lower baseline PTH (<250 pg/mL). At the end of 2 years, the difference between high versus low PTH groups (mean ± SD) persisted only for forearm BMD (0.638±0.093 versus 0.698±0.041 g/cm2; P =.01). However, on follow-up visits in the first and second year after curative parathyroidectomy, there was no significant difference in BTMs, BMD at the femoral neck, lumbar spine, and TBS between the 2 groups stratified by baseline PTH. CONCLUSION The BMD at the forearm remained significantly worse in individuals with high baseline PTH even at 2 years after surgery, while other parameters including TBS improved significantly from baseline. ABBREVIATIONS 25(OH)D = 25-hydroxyvitamin D; BMD = bone mineral density; BMI = body mass index; BTMs = Bone turnover markers; CTX = C-terminal telopeptide of type 1 collagen; DXA = dual energy X-ray absorptiometry; P1NP = N-terminal propeptide of type 1 procollagen; PHPT = primary hyperparathyroidism; PTH = parathyroid hormone; TBS = trabecular bone score.

Research paper thumbnail of Identification of risk factors and metabolic monitoring practices in patients on antipsychotic drugs in South India

Asian Journal of Psychiatry, 2020

The objectives of this study were to identify the risk factors for metabolic syndrome in patients... more The objectives of this study were to identify the risk factors for metabolic syndrome in patients on antipsychotics and to compare the frequency of metabolic monitoring with evidence-based guidelines. We conducted a retrospective cohort study in a tertiary care health institution of South India. The study included patients with schizophrenia, bipolar disorder, and schizoaffective disorders prescribed with antipsychotic drugs. Data was collected from the medical records department. American Diabetic Association/American Psychiatric Association (ADA/APA) guidelines were used as a reference standard to assess the monitoring for metabolic parameters. Diagnosis of metabolic syndrome was done according to the National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATP III) guidelines. Risk factors for metabolic syndrome and frequency of metabolic monitoring were analyzed. A total of 668 patients were included for clinical audit. About 16.5 % of the patients were diagnosed with metabolic syndrome. Age > 50 years (Odds Ratio (OR) 2.00; p value < 0.001) and duration of antipsychotic treatment > 5 years (OR 1.55; p value < 0.05) were recognized as the independent risk factors for metabolic syndrome using multiple logistic regression. Blood pressure (BP) and fasting blood sugar (FBS) levels were documented in 99.7 % and 47 % of cases at baseline respectively, however, subsequent annual data on BP and FBS monitoring was reduced to 72.7 % and 46 % respectively. Weight was documented in 60 % of the cases at baseline, whereas the subsequent data on four times the annual assessment of weight was reduced to 9.8 %. The extent of documentation of metabolic monitoring parameters was inadequate.

Research paper thumbnail of DXA Measured Visceral Adipose Tissue, Total Fat, Anthropometric Indices and its Association With Cardiometabolic Risk Factors in Mother-Daughter Pairs From India

Journal of Clinical Densitometry, 2020

Visceral fat is the pathogenic fat depot associated with diabetes, dyslipidemia, and cardiovascul... more Visceral fat is the pathogenic fat depot associated with diabetes, dyslipidemia, and cardiovascular diseases. Estimation of visceral adipose tissue (VAT) by dual energy-X-ray absorptiometry (DXA) is a newer technique with less radiation exposure, shorter scanning time, and lower cost. In this study, we attempted to look at relationship between cardiometabolic risk factors and VAT, total body fat percent (TBF%) and anthropometry. We also studied the changes in body composition and metabolic parameters with menopause. The familial resemblance of VAT and TBF% in mother-daughter pair was also compared. This was a cross sectional community study of 300 women (150 postmenopausal mothers and 150 premenopausal daughters). Body composition indices by DXA and metabolic parameters were assessed. The association between DXA-VAT, TBF%, anthropometric measures, and cardiometabolic risk factors were studied by correlation, receiver operating characteristics curves, and logistic regression analysis. VAT indices were significantly higher and lean indices lower in postmenopausal women as compared to premenopausal women. One fourth of postmenopausal women were categorized as metabolically obese normal weight. DXA-VAT was a better predictor of cardiometabolic risk factors as compared to waist circumference, body mass index, and TF% in postmenopausal women (AUC:0.68 vs 0.62, 0.60 & 0.5, respectively), whereas body mass index had a better prediction in premenopausal women(AUC:0.68). VAT area >100 cm 2 had a significant association with the presence of 2 cardiometabolic risk factors (p = 0.04, OR: 2.2, CI:1.0À4.7) in the postmenopausal women. Daughters of the mothers with higher TBF% were found to have a higher TBF% compared to daughters of mothers with normal TBF% (36.2 § 4.2 vs 32.2 § 4.4, p = 0.03), similar resemblance was not seen for VAT. The study showed that the VAT increases and lean mass decreases with age and menopause. DXA measured VAT is a better predictor of cardiometabolic risk in postmenopausal women but not in premenopausal women. Total body fat may have a familial resemblance, but not the VAT which is determined by age, menopause, and probable life style factors.

Research paper thumbnail of Association between Dental Health and Osteoporosis: A Study in South Indian Postmenopausal Women

Journal of mid-life health

This study aims to objectively assess the dentition status in South Indian postmenopausal women a... more This study aims to objectively assess the dentition status in South Indian postmenopausal women and compare the dental health of osteoporotic participants with nonosteoporotic individuals. A total of 150 consecutive ambulatory South Indian postmenopausal women (>50 years of age) were assessed for their dental health using an internationally validated scoring system. Bone mineral density (BMD) was assessed using a dual-energy X-ray absorptiometry scanner. About 39% of the participants were found to have osteoporosis and 23% had osteopenia at any site. More than half of them (57%) had poor dental health, and the predominant problems were cavities (43.5%) and loss of teeth (75%). Among 112 women who had tooth loss, the mean tooth loss was 4.8. The mean tooth loss among patients with normal BMD was 1.09 ± 1.2, in osteopenia was 2.1 ± 2, and in osteoporosis was 5.4 ± 2.8 (P < 0.01). The odds of having osteoporosis among the patients with three or more tooth loss were found to be 4....

Research paper thumbnail of Evaluation of Different Screening Tools for Predicting Femoral Neck Osteoporosis in Rural South Indian Postmenopausal Women

Journal of clinical densitometry : the official journal of the International Society for Clinical Densitometry, Jan 25, 2017

The measurement of bone mineral density by dual-energy X-ray absorptiometry scan is the "gol... more The measurement of bone mineral density by dual-energy X-ray absorptiometry scan is the "gold standard" for the diagnosis of osteoporosis, which has limited availability in many parts of India. This study was done to assess the diagnostic performance of 6 internationally validated tools (Simple Calculated Osteoporosis Risk Estimation [SCORE], age, bulk, one or never estrogen [ABONE], Osteoporosis Risk Assessment Instrument [ORAI] and Osteoporosis Self-Assessment Tool for Asians [OSTA], Fracture Risk Assessment Tool [FRAX®], and calcaneal quantitative ultrasound [QUS]) for the diagnosis of osteoporosis at the femoral neck (FN). This was a cross-sectional study conducted in 2108 ambulatory South Indian rural postmenopausal women who were assessed with SCORE, ABONE, ORAI, OSTA, and FRAX® tools. QUS was performed in 850 subjects. Bone mineral density was estimated by dual-energy X-ray absorptiometry scan at the FN, and sensitivity and specificity were calculated for all tools ...

Research paper thumbnail of Clinical case scenarios in the management of diabetes mellitus

Current Medical Issues, 2017

Research paper thumbnail of Practical use of insulin in diabetes mellitus

Current Medical Issues, 2017

Insulin therapy is the cornerstone of treatment in patients with type 1 diabetes mellitus (DM) an... more Insulin therapy is the cornerstone of treatment in patients with type 1 diabetes mellitus (DM) and advanced type 2 DM. Over the years, insulin treatment has advanced from animal insulin to recombinant insulin with more efficiency and fewer side effects and from short-acting conventional insulin to ultrashort and long-acting insulin analogs to mimic various phases of physiological insulin secretion. Various insulin delivery systems from conventional subcutaneous insulin injection using insulin syringe to pen device, subcutaneous insulin infusion pumps, and inhaled insulin to artificial pancreas are now available. Proper insulin injecting techniques and patient education on self-monitoring of blood glucose and insulin dose titration are of utmost importance for effective insulin therapy.

Research paper thumbnail of Diet in a pregnant mother with diabetes mellitus

Current Medical Issues, 2017

Gestational diabetes mellitus (GDM) is a severe threat to maternal and child health. It is associ... more Gestational diabetes mellitus (GDM) is a severe threat to maternal and child health. It is associated complications adversely affect the mother and the child. One in seven births is affected by gestational diabetes. Lifestyle intervention has a positive impact on glycemic control and pregnancy outcomes of GDM. Adequate nutrition during pregnancy ensures good health for the mother and the growing fetus. There is an increased need for calories, proteins and vitamins, and minerals to meet the demands of increased metabolic activity during this period. The composition of each meal is crucial in attaining glycemic control. A low-carbohydrate diet (60%–65%) with adequate proteins (15%) and fats (20%–25%) is beneficial in attaining acceptable postprandial sugars. “My Plate Planner” is a simple method for remembering the type and quantity of food to be consumed with each meal. Regularity of meals with frequent snacking of healthy foods ensures acceptable glucose homeostasis throughout the day.

Research paper thumbnail of Performance of risk assessment tools for predicting osteoporosis in south Indian rural elderly men

Archives of osteoporosis, 2017

Osteoporosis in elderly men is an under-recognized problem. In the current study, we intend to lo... more Osteoporosis in elderly men is an under-recognized problem. In the current study, we intend to look at the performance of two risk assessment tools [OSTA and MORES] for the diagnosis of osteoporosis. Osteoporosis was seen in 1/4th of elderly men at spine and 1/6th of them at femoral neck. Both risk assessment tools were found to have good sensitivity in predicting osteoporosis at spine and femoral neck with good area under curve (AUC). This study attempts to look at the performance of osteoporosis self-assessment tool for Asians (OSTA) and male osteoporosis risk estimation score (MORES) for predicting osteoporosis in south Indian rural elderly men. Five hundred and twelve men above 65 years of age from a south Indian rural community were recruited by cluster random sampling. All subjects underwent detailed clinical, anthropometric, and bone mineral density measurement at lumbar spine and femoral neck using dual-energy X-ray absorptiometry scan. A T score ≤ - 2.5 was diagnostic of os...

Research paper thumbnail of Musculoskeletal oncogenic osteomalacia–An experience from a single centre in South India

Journal of Orthopaedics, 2017

Background: Oncogenic osteomalacia is an acquired form of hypophosphatemic osteomalacia where the... more Background: Oncogenic osteomalacia is an acquired form of hypophosphatemic osteomalacia where the tumour resection may lead to cure of the disease. Tumours originating from the musculoskeletal region form an important subgroup of oncogenic osteomalacia. Methods: This was a retrospective study conducted at a tertiary care centre in south India where we analyzed the hospital records of all the patients with musculoskeletal oncogenic osteomalacia from January 2010-April 2016. Results: A total number of 73 patients were diagnosed to have adult onset hypophosphatemic osteomalacia out of which 13 patients (M: F = 6:7; mean age: 45.38 AE 18.23 years) with musculoskeletal oncogenic osteomalacia were included in the study. Common presenting symptoms were bony pains, proximal myopathy and fractures. Mean duration of symptoms from the initial hospital visit was 58.46 AE 64.48 months. The initial mean fibroblast growth factor (FGF) 23 levels being 828.86 AE 113.22 RU/ ml (Normal range: 22-91). Imaging modalities used for localization of the tumour: DOTATATE PET/CT (8 patients), FDG PET/CT (3 patients), 1 patient (Both DOTATATE PET/CT and FDG PET/CT) and whole body Tc 99 m Red blood cell (RBC) blood pool scintigraphy (2 patients). 9 patients underwent surgery and all achieved remission. 4 patients denied surgical consent. Conclusion: Musculoskeletal oncogenic osteomalacia [ 4 7 _ T D $ D I F F ] is a major subgroup of oncogenic osteomalacia which need more extensive whole body imaging for the localization of the tumour. Surgical excision often leads to remission of the disease.

Research paper thumbnail of Bone turnover markers: Emerging tool in the management of osteoporosis

Indian journal of endocrinology and metabolism

Bone is a dynamic tissue which undergoes constant remodeling throughout the life span. Bone turno... more Bone is a dynamic tissue which undergoes constant remodeling throughout the life span. Bone turnover is balanced with coupling of bone formation and resorption at various rates leading to continuous remodeling of bone. A study of bone turnover markers (BTMs) provides an insight of the dynamics of bone turnover in many metabolic bone disorders. An increase in bone turnover seen with aging and pathological states such as osteoporosis leads to deterioration of bone microarchitecture and thus contributes to an increase in the risk of fracture independent of low bone mineral density (BMD). These microarchitectural alterations affecting the bone quality can be assessed by BTMs and thus may serve as a complementary tool to BMD in the assessment of fracture risk. A systematic search of literature regarding BTMs was carried out using the PubMed database for the purpose of this review. Various reliable, rapid, and cost-effective automated assays of BTMs with good sensitivity are available for...

Research paper thumbnail of The H-syndrome and next generation sequencing for molecular genetic diagnosis

Endocrine Abstracts, 2014

Monogenic auto-inflammatory diseases are a group of hereditary disorders characterized by a clin... more Monogenic auto-inflammatory diseases are a group of hereditary disorders characterized by a clinical and biological inflammatory syndrome without evidence of autoimmunity. The mutated proteins are involved in the altered regulation of inflammation. The 'H' syndrome has been recently described as a monogenic auto-inflammatory autosomalrecessive genodermatosis with several systemic manifestations. It is caused by mutations in the solute carrier family 29 (SLC29A3) gene, which encodes the human equilibrative nucleoside transporter-3 (hENT3). To study the clinical features and establish the genetic diagnosis of a subject with young onset of diabetes. OBJECTIVES Utilizing next generation sequencing we carried out mutational analysis of SLC29A3 gene in the chr.10q22.1 and selectively investigated this patient for various other features of this genodermatosis. SUBJECTS AND METHODS RESULTS OF GENETIC TESTS CONCLUSIONS • H-syndrome must be considered in any subject with young onset of diabetes and the dermatological phenotype of pigmentary hypertrichosis. • Next generation sequencing (NGS) forms a useful platform in genetic testing of monogenic disorders and would aid in the diagnosis and further counseling.

Research paper thumbnail of The impact of the Hologic vs the ICMR database in diagnosis of osteoporosis among South Indian subjects

Clinical Endocrinology, 2014

SummaryBackground and ObjectivesRecently, the Indian Council of Medical Research (ICMR) has publi... more SummaryBackground and ObjectivesRecently, the Indian Council of Medical Research (ICMR) has published normative data for bone mineral density (BMD) measured by dual‐energy X‐ray absorptiometry (DXA) scanning. However, the impact this has had on the diagnosis of osteoporosis when compared to currently used Caucasian databases has not been analysed. Hence, this study was undertaken to look at agreement between the Hologic Database (HD) based on BMD normative data in Caucasians and the ICMR database (ICMRD) in defining osteoporosis in subjects with or without hip fracture.Materials and MethodsIt is a cross ‐sectional study of 2976 subjects (men 341, women 2757) (mean age ± SD = 62·2 ± 7·2 years), including 316 subjects with low impact hip fracture: 2199 were from the hospital database, and 461 were healthy postmenopausal women from the community who underwent (DXA) scanning between January 2010 and March 2013. Recalculated T scores from ICMRD were used for the diagnosis of osteoporosis...