Alankar Tiwari | King George's Medical University (original) (raw)

Papers by Alankar Tiwari

Turkish Journal of Endocrinology and Metabolism, 2020

International Journal of Medical and Health Research, 2020

Journal of medical case reports and reviews, Jan 20, 2020

Mucopolysaccharidoses (MPS) are rare genetic diseases lysosomal storage disorders, in which there... more Mucopolysaccharidoses (MPS) are rare genetic diseases lysosomal storage disorders, in which there is deficiency of certain specific lysosomal enzymes involved in the glycosaminoglycan (GAG) breakdown pathway. Hunter syndrome is type 2 MPS caused by a deficiency of the lysosomal enzyme iduronate-2-sulfatase. It is a rare genetic syndrome of x linked recessive inheritance with a prevalence of 1:100,000 births. It is a hetrogenous disease with multisystem involvement including skeletal, joint, airway, cardiac, and hearing and vision impairment with mild to severe mental retardation. Treatment option includes haematopoietic stem cell transplantation and recombinant i.v. enzyme replacement therapy, here we discussed a case of hunter syndrome that presented in our hospital with typical features of hunter syndrome, and was diagnosed with specific enzyme assay.

International Journal of Advances in Medicine, Jan 23, 2020

Tumoral calcinosis is a rare condition characterized by solitary or multiple, periarticular masse... more Tumoral calcinosis is a rare condition characterized by solitary or multiple, periarticular masses. Surgical excision of the tumoral calcinosis lesion is a well-documented treatment, but recurrences are not uncommon. A case of 42 year old male patient of tumoral calcinosis presented to us with history of repeated surgical excision twice in past 8 years for recurrent swellings. He was started on IV zoledronic acid and the patient has shown improvement after two years with no recurrence in follow up.

Journal of medical case reports and reviews, Jan 20, 2020

This is a short report based on personal experience of clinicians and senior residents working in... more This is a short report based on personal experience of clinicians and senior residents working in a superspeciality department at a tertiary care center in Western Uttar Pradesh. It highlights the issues and hindrances faced by them during managing the patients of diabetes attending the superspecialty OPD.

International Journal of Research in Medical Sciences, Oct 24, 2019

Background: EZSCAN is a new, non-invasive technique to detect sudomotor dysfunction and thus neur... more Background: EZSCAN is a new, non-invasive technique to detect sudomotor dysfunction and thus neuropathy in diabetes patients at an early stage. It further predicts chances of development of other microvascular complications. In this study we evaluated EZSCAN for detection of microvascular complications in Type 2 diabetes patients and assessed their correlation with various metabolic parameters. Methods: 104 known diabetes patients, 56 males and 48 females, were studied. All cases underwent the EZSCAN test, Body mass index measurement, fasting and postprandial blood glucose, HbA1c tests. Diabetes related complications were thereafter correlated with various metabolic indices. Results: Strong correlation was found between HbA1c, body mass index (BMI), fasting blood glucose (FBG) and post-prandial blood glucose (PPBG) with diabetes related microvascular complications assessed by EZSCAN, strongest being with FBG (r=0.755) and weakest with BMI(r=0.232). Conclusions: Microvascular complications of diabetes as detected by EZSCAN method correlate strongly with metbolic indices of the patient and thus EZSCAN can be used as a simple, non-invasive and quick method to detect microvascular complications of diabetes.

Journal of Evidence Based Medicine and Healthcare, Aug 18, 2016

BACKGROUND EZSCAN is a new, noninvasive technique to detect sudomotor dysfunction and thus neurop... more BACKGROUND EZSCAN is a new, noninvasive technique to detect sudomotor dysfunction and thus neuropathy in diabetes patients at an early stage. It further predicts chances of development of other microvascular complications. In this study, we evaluated EZSCAN for detection of microvascular complications in Type 2 diabetes patients and compared accuracy of EZSCAN with standard screening methods. MATERIALS AND METHODS 104 known diabetes patients, 56 males and 48 females, were studied. All cases underwent the EZSCAN test, Nerve Conduction Study (NCS) test, Vibration perception threshold test (VPT), Monofilament test, Fundus examination and Urine micral test. The results of EZSCAN were compared with standard screening methods. The data has been analysed and assessed by applying appropriate statistical tests within different groups. RESULTS Mean age of the subjects was 53.5 ± 11.4 years. For detection of diabetic neuropathy, sensitivity and specificity of EZSCAN was found to be 77.0 % and 95.3%, respectively. Odd's ratio (OR) was 68.82 with p < 0.0001. AUC in ROC curve was 0.930. Sensitivity and specificity of EZSCAN for detection of nephropathy were 67.1% and 94.1%, respectively. OR = 32.69 with p < 0.0001. AUC was 0.926. Sensitivity of EZSCAN for detection of retinopathy was 90% while specificity is 70.3%. OR = 21.27; p< 0.0001). AUC came out to be 0.920. CONCLUSION Results of EZSCAN test compared significantly to the standard screening methods for the detection of microvascular complications of diabetes and can be used as a simple, noninvasive and quick method to detect microvascular complications of diabetes.

Journal of Evidence Based Medicine and Healthcare, Oct 21, 2016

BACKGROUND Role of testosterone in the pathogenesis of metabolic syndrome and diabetes mellitus h... more BACKGROUND Role of testosterone in the pathogenesis of metabolic syndrome and diabetes mellitus has been studied in recent years and an inverse relationship has been subsequently elicited. Low testosterone levels have been associated with insulin resistance and an increased risk of Type 2 diabetes (T2DM). However, limited data are available regarding association of testosterone with metabolic indices like Body Mass Index (BMI), waist circumference and lipid profile. This study was undertaken with the objective of evaluating levels of serum testosterone in newly diagnosed male T2DM and to correlate testosterone levels with the glycemic status and other metabolic indices. MATERIALS AND METHODS A single point cross sectional case control study was conducted at MLN Medical College, Allahabad and its associated SRN Hospital, Allahabad during a period from March 2013 to July 2014 on 168 males between 18-60 years of age of whom 83 were diagnosed with T2DM within the past three months were taken as cases and remaining 85 patients without diabetes were taken as controls. Detailed history was obtained and clinical examination was done. Low testosterone was defined as total testosterone <241 ng/dl and its prevalence was calculated. The values of serum testosterone were correlated with Fasting Blood Sugar (FBS), Post-prandial Blood Sugar (PPBS), Glycosylated Hemoglobin (HbA1c), BMI, Waist circumference and Lipid profile of the patients. RESULTS Out of the 83 patients of T2DM, low serum testosterone was found in 37 (44.58%) while it was present in only 10 (11.8%) of 85 controls, which was found to be statistically significant (p value=<0.0001). The mean HbA1c in T2DM with low testosterone was 6.81±0.44% compared to 6.5±0.47% in normal testosterone group and the difference was statistically significant (p value=0.0029). Among cases there was statistical difference between low and normal testosterone values when BMI was compared (p=0.0162). It was significant among controls as well (p=0.0229). CONCLUSIONS Prevalence of hypogonadism was significantly higher in T2DM as compared to controls. Testosterone levels had significant negative correlation with HbA1c levels and BMI of the subjects.

International journal of advanced research, Jul 31, 2016

Background-Hypertension is one of the leading risk factor for Chronic Kidney Disease and non-dipp... more Background-Hypertension is one of the leading risk factor for Chronic Kidney Disease and non-dipper pattern of blood pressure is very common in chronic kidney disease patients and affects the renal outcome in these patients.Ambulatory blood pressure monitoring assists in targeting this population. Methods-Total 160 non diabetic hypertensive patients were enrolled between 10/04/14 to 15/05/15 at M.L.N. Medical College and SRN Hospital, Allahabad. Out of them 80 were CKD patients who were taken as cases and remaining 80 patients were non CKD and taken as controls. Ambulatory blood pressure monitoring, clinic BP, eGFR, and other clinical data were collected for 1 year duration. Statistical analysis was done by using unpaired t-test for independent variables. Results-out of 160 non diabetic hypertensive patients, 48(60%) cases and 28(35%) controls were found nondippers, while remaining 32(40%) cases and 52(65%) controls were have dipper BP pattern. Patients with non-dipping BP pattern had the worst renal function (P <0.05). The eGFR shown significant relationship with the nocturnal BP. Conclusion-Ambulatory blood pressure measurement allows a better risk stratification compared to clinic blood pressure measurement. Non-dipping status is closely related to severe renal damage in CKD patients. Hence 24-hr ABPM can be used as prognostic markers in non diabetic CKD patients, and Lowering of nocturnal BP will reduce the risk of renal damge in these patients.

Journal of medical science and clinical research, Jul 16, 2020

Sri Lanka Journal of Diabetes Endocrinology and Metabolism, 2016

Background: The role of testosterone in the pathogenesis of metabolic syndrome and diabetes melli... more Background: The role of testosterone in the pathogenesis of metabolic syndrome and diabetes mellitus has been well documented. Low testosterone levels have been associated with an increased risk of insulin resistance and type 2 diabetes mellitus (T2DM) and testosterone supplementation has been found to reduce insulin resistance and blood glucose levels. However, there is limited data available regarding the influence of testosterone levels on microvascular complications in patients with diabetes. This study was undertaken with the objective of evaluating levels of serum testosterone in newly diagnosed male patients with T2DM and to correlate serum testosterone levels with microvascular complications. Materials and Methods: A single point cross sectional case-control study was conducted at MLN Medical College, Allahabad and its associated SRN Hospital, Allahabad from March 2013 to July 2014. 168 males between 18-60 years of age were recruited for the study. From these patients, 83 patients who were diagnosed with T2DM during the last 3 months were considered as cases and remaining 85 patients without diabetes were taken as controls. Detailed history was obtained and clinical examination was performed. Serum low testosterone was defined as total testosterone<241 ng/dl and the prevalence of its deficiency was calculated. The values of serum testosterone were correlated with microvascular complications of diabetes viz. neuropathy, retinopathy and nephropathy. Results: Out of the 83 patients of T2DM, low serum testosterone was found in 37(44.58%) while it was present in only 10(11.8%) of 85 controls, which was statistically significant (χ2 = 20.84, df =1, p <0.0001). Microvascular complications were seen in 25(67.56%) patients with low testosterone while only 4(8.7%) patients had microvascular complications with normal testosterone level which was statistically significant (p<0.0001). Conclusions: Prevalence of hypogonadism was significantly (P<0.0001) higher in T2DM patients compared to controls. Subjective evidence of hypogonadism and microvascular complications were observed more frequently in patients with low testosterone compared to normal testosterone.

International Journal of Advances in Medicine, Dec 23, 2019

Normal thyroid function is important to maintain normal reproduction, via its interaction in seve... more Normal thyroid function is important to maintain normal reproduction, via its interaction in several pathways. 1 dysfunction has also been linked to reduced fertility and pregnancy complications. Previously several studies were done on animal models and in humans with overt hypothyroidism to evaluate hypothalamo-pituitarygonadal axis. It was shown that in overt hypothyroidism basal gonadotropin levels were normal as in healthy subjects but there was a sluggish response to stimulation with gonadotropin releasing hormone when compared to healthy subjects. SHBG is decreased resulting in low Total E2 and T, but free hormone is normal when compared with euthyroid healthy individuals. But there are very few studies in patients with subclinical hypothyroidism. Subclinical hypothyroidism is a condition of mild to moderate thyroid failure defined biochemically by normal levels of thyroid hormones with mildly elevated TSH concentrations. 2 It has variety of designations, including mild thyroid failure, as well as compensated, early latent, mild, minimally symptomatic, ABSTRACT Background: In females, hypothyroidism can cause menstrual disturbances mainly oligomenorrhea. Thyroid dysfunction has also been linked to reduced fertility and pregnancy complications. Several studies have been done to evaluate gonadal dysfunctions in overt hypothyroidism but very few studies are there regarding subclinical hypothyroidism. Present study evaluates the gonadal functions of women with subclinical hypothyroidism. Methods: Total 20 females of age 18 to 35 years with newly diagnosed subclinical hypothyroidism were taken as cases and 20 age and body mass index (BMI) matched healthy females were taken as controls. Both in cases and controls, basal FSH, LH, estradiol were measured on 3 rd or 4 th day of menstrual cycle at 8 AM on fasting. Thereafter Leuprolide 20 mcg/kg was given subcutaneously on the same day. One hour after injection, LH and estradiol were measured. Basal and stimulated values were compared between both groups. Results: Basal LH was significantly higher in controls (6.63±2.38 m IU/ml) when compared to cases (6.06±2.10 m IU) with a p value 0.01 (<0.05). No significant differences were found between stimulated LH and estradiol in both the groups. Conclusions: In mild thyroidal failure the response of pituitary gonadotrophs to leuprolide is normal in contrast to overt hypothyroidism where the response is sluggish. This is the first study to be done in subclinical hypothyroid subjects to asses both basal and stimulated gonadotropin levels. Further studies are required in large samples to confirm these findings.

Internet Journal of …, 2012

ABSTRACT: The aim of this study was to observe whether levothyroxine replacement therapy has an e... more ABSTRACT: The aim of this study was to observe whether levothyroxine replacement therapy has an effect on hypertension in patients of hypothyroidism. This prospective study included all newly diagnosed cases of hypothyroidism (overt or subclinical) with ...

International Journal of Medical and Health Research, 2020

International Journal of Advanced Research, 2016

Background-Hypertension is one of the leading risk factor for Chronic Kidney Disease and non-dipp... more Background-Hypertension is one of the leading risk factor for Chronic Kidney Disease and non-dipper pattern of blood pressure is very common in chronic kidney disease patients and affects the renal outcome in these patients.Ambulatory blood pressure monitoring assists in targeting this population. Methods-Total 160 non diabetic hypertensive patients were enrolled between 10/04/14 to 15/05/15 at M.L.N. Medical College and SRN Hospital, Allahabad. Out of them 80 were CKD patients who were taken as cases and remaining 80 patients were non CKD and taken as controls. Ambulatory blood pressure monitoring, clinic BP, eGFR, and other clinical data were collected for 1 year duration. Statistical analysis was done by using unpaired t-test for independent variables. Results-out of 160 non diabetic hypertensive patients, 48(60%) cases and 28(35%) controls were found nondippers, while remaining 32(40%) cases and 52(65%) controls were have dipper BP pattern. Patients with non-dipping BP pattern had the worst renal function (P <0.05). The eGFR shown significant relationship with the nocturnal BP. Conclusion-Ambulatory blood pressure measurement allows a better risk stratification compared to clinic blood pressure measurement. Non-dipping status is closely related to severe renal damage in CKD patients. Hence 24-hr ABPM can be used as prognostic markers in non diabetic CKD patients, and Lowering of nocturnal BP will reduce the risk of renal damge in these patients.

International Journal of Research in Medical Sciences, 2019

Background: Hypothyroidism can cause menstrual disturbances mainly oligoanovualtory cycles and so... more Background: Hypothyroidism can cause menstrual disturbances mainly oligoanovualtory cycles and sometimes menorrhagia. It has also been seen to cause subfertility and pregnancy related complications. Various studies have been done to evaluate gonadal dysfunctions in overt hypothyroidism but very few studies are there which have done using a gonadotrophin response in that subset of patients. Present study evaluates the response of leuprolide on gonadal functions of women with overt hypothyroidism in a tertiary care centre at Meerut.Methods: In this study 50 females of age 20 to 40 years with newly diagnosed overt hypothyroidism were taken as cases and age and Body Mass Index (BMI) matched healthy females were taken as controls. Both in cases and controls, basal FSH, LH, estradiol was measured on 2nd day to 5th day of menstrual cycle. Thereafter Leuprolide 20 mcg/kg was given subcutaneously on the same day. Post leuprolide test, stimulated LH, FSH and estradiol were measured. Basal and...

journal of medical science and clinical research, 2020

This is a short report based on personal experience of clinicians and senior residents working in... more This is a short report based on personal experience of clinicians and senior residents working in a superspeciality department at a tertiary care center in Western Uttar Pradesh. It highlights the issues and hindrances faced by them during managing the patients of diabetes attending the superspecialty OPD.

Turkish Journal of Endocrinology and Metabolism, 2020

International Journal of Medical and Health Research, 2020

Journal of medical case reports and reviews, Jan 20, 2020

Mucopolysaccharidoses (MPS) are rare genetic diseases lysosomal storage disorders, in which there... more Mucopolysaccharidoses (MPS) are rare genetic diseases lysosomal storage disorders, in which there is deficiency of certain specific lysosomal enzymes involved in the glycosaminoglycan (GAG) breakdown pathway. Hunter syndrome is type 2 MPS caused by a deficiency of the lysosomal enzyme iduronate-2-sulfatase. It is a rare genetic syndrome of x linked recessive inheritance with a prevalence of 1:100,000 births. It is a hetrogenous disease with multisystem involvement including skeletal, joint, airway, cardiac, and hearing and vision impairment with mild to severe mental retardation. Treatment option includes haematopoietic stem cell transplantation and recombinant i.v. enzyme replacement therapy, here we discussed a case of hunter syndrome that presented in our hospital with typical features of hunter syndrome, and was diagnosed with specific enzyme assay.

International Journal of Advances in Medicine, Jan 23, 2020

Tumoral calcinosis is a rare condition characterized by solitary or multiple, periarticular masse... more Tumoral calcinosis is a rare condition characterized by solitary or multiple, periarticular masses. Surgical excision of the tumoral calcinosis lesion is a well-documented treatment, but recurrences are not uncommon. A case of 42 year old male patient of tumoral calcinosis presented to us with history of repeated surgical excision twice in past 8 years for recurrent swellings. He was started on IV zoledronic acid and the patient has shown improvement after two years with no recurrence in follow up.

Journal of medical case reports and reviews, Jan 20, 2020

This is a short report based on personal experience of clinicians and senior residents working in... more This is a short report based on personal experience of clinicians and senior residents working in a superspeciality department at a tertiary care center in Western Uttar Pradesh. It highlights the issues and hindrances faced by them during managing the patients of diabetes attending the superspecialty OPD.

International Journal of Research in Medical Sciences, Oct 24, 2019

Background: EZSCAN is a new, non-invasive technique to detect sudomotor dysfunction and thus neur... more Background: EZSCAN is a new, non-invasive technique to detect sudomotor dysfunction and thus neuropathy in diabetes patients at an early stage. It further predicts chances of development of other microvascular complications. In this study we evaluated EZSCAN for detection of microvascular complications in Type 2 diabetes patients and assessed their correlation with various metabolic parameters. Methods: 104 known diabetes patients, 56 males and 48 females, were studied. All cases underwent the EZSCAN test, Body mass index measurement, fasting and postprandial blood glucose, HbA1c tests. Diabetes related complications were thereafter correlated with various metabolic indices. Results: Strong correlation was found between HbA1c, body mass index (BMI), fasting blood glucose (FBG) and post-prandial blood glucose (PPBG) with diabetes related microvascular complications assessed by EZSCAN, strongest being with FBG (r=0.755) and weakest with BMI(r=0.232). Conclusions: Microvascular complications of diabetes as detected by EZSCAN method correlate strongly with metbolic indices of the patient and thus EZSCAN can be used as a simple, non-invasive and quick method to detect microvascular complications of diabetes.

Journal of Evidence Based Medicine and Healthcare, Aug 18, 2016

BACKGROUND EZSCAN is a new, noninvasive technique to detect sudomotor dysfunction and thus neurop... more BACKGROUND EZSCAN is a new, noninvasive technique to detect sudomotor dysfunction and thus neuropathy in diabetes patients at an early stage. It further predicts chances of development of other microvascular complications. In this study, we evaluated EZSCAN for detection of microvascular complications in Type 2 diabetes patients and compared accuracy of EZSCAN with standard screening methods. MATERIALS AND METHODS 104 known diabetes patients, 56 males and 48 females, were studied. All cases underwent the EZSCAN test, Nerve Conduction Study (NCS) test, Vibration perception threshold test (VPT), Monofilament test, Fundus examination and Urine micral test. The results of EZSCAN were compared with standard screening methods. The data has been analysed and assessed by applying appropriate statistical tests within different groups. RESULTS Mean age of the subjects was 53.5 ± 11.4 years. For detection of diabetic neuropathy, sensitivity and specificity of EZSCAN was found to be 77.0 % and 95.3%, respectively. Odd's ratio (OR) was 68.82 with p < 0.0001. AUC in ROC curve was 0.930. Sensitivity and specificity of EZSCAN for detection of nephropathy were 67.1% and 94.1%, respectively. OR = 32.69 with p < 0.0001. AUC was 0.926. Sensitivity of EZSCAN for detection of retinopathy was 90% while specificity is 70.3%. OR = 21.27; p< 0.0001). AUC came out to be 0.920. CONCLUSION Results of EZSCAN test compared significantly to the standard screening methods for the detection of microvascular complications of diabetes and can be used as a simple, noninvasive and quick method to detect microvascular complications of diabetes.

Journal of Evidence Based Medicine and Healthcare, Oct 21, 2016

BACKGROUND Role of testosterone in the pathogenesis of metabolic syndrome and diabetes mellitus h... more BACKGROUND Role of testosterone in the pathogenesis of metabolic syndrome and diabetes mellitus has been studied in recent years and an inverse relationship has been subsequently elicited. Low testosterone levels have been associated with insulin resistance and an increased risk of Type 2 diabetes (T2DM). However, limited data are available regarding association of testosterone with metabolic indices like Body Mass Index (BMI), waist circumference and lipid profile. This study was undertaken with the objective of evaluating levels of serum testosterone in newly diagnosed male T2DM and to correlate testosterone levels with the glycemic status and other metabolic indices. MATERIALS AND METHODS A single point cross sectional case control study was conducted at MLN Medical College, Allahabad and its associated SRN Hospital, Allahabad during a period from March 2013 to July 2014 on 168 males between 18-60 years of age of whom 83 were diagnosed with T2DM within the past three months were taken as cases and remaining 85 patients without diabetes were taken as controls. Detailed history was obtained and clinical examination was done. Low testosterone was defined as total testosterone <241 ng/dl and its prevalence was calculated. The values of serum testosterone were correlated with Fasting Blood Sugar (FBS), Post-prandial Blood Sugar (PPBS), Glycosylated Hemoglobin (HbA1c), BMI, Waist circumference and Lipid profile of the patients. RESULTS Out of the 83 patients of T2DM, low serum testosterone was found in 37 (44.58%) while it was present in only 10 (11.8%) of 85 controls, which was found to be statistically significant (p value=<0.0001). The mean HbA1c in T2DM with low testosterone was 6.81±0.44% compared to 6.5±0.47% in normal testosterone group and the difference was statistically significant (p value=0.0029). Among cases there was statistical difference between low and normal testosterone values when BMI was compared (p=0.0162). It was significant among controls as well (p=0.0229). CONCLUSIONS Prevalence of hypogonadism was significantly higher in T2DM as compared to controls. Testosterone levels had significant negative correlation with HbA1c levels and BMI of the subjects.

International journal of advanced research, Jul 31, 2016

Background-Hypertension is one of the leading risk factor for Chronic Kidney Disease and non-dipp... more Background-Hypertension is one of the leading risk factor for Chronic Kidney Disease and non-dipper pattern of blood pressure is very common in chronic kidney disease patients and affects the renal outcome in these patients.Ambulatory blood pressure monitoring assists in targeting this population. Methods-Total 160 non diabetic hypertensive patients were enrolled between 10/04/14 to 15/05/15 at M.L.N. Medical College and SRN Hospital, Allahabad. Out of them 80 were CKD patients who were taken as cases and remaining 80 patients were non CKD and taken as controls. Ambulatory blood pressure monitoring, clinic BP, eGFR, and other clinical data were collected for 1 year duration. Statistical analysis was done by using unpaired t-test for independent variables. Results-out of 160 non diabetic hypertensive patients, 48(60%) cases and 28(35%) controls were found nondippers, while remaining 32(40%) cases and 52(65%) controls were have dipper BP pattern. Patients with non-dipping BP pattern had the worst renal function (P <0.05). The eGFR shown significant relationship with the nocturnal BP. Conclusion-Ambulatory blood pressure measurement allows a better risk stratification compared to clinic blood pressure measurement. Non-dipping status is closely related to severe renal damage in CKD patients. Hence 24-hr ABPM can be used as prognostic markers in non diabetic CKD patients, and Lowering of nocturnal BP will reduce the risk of renal damge in these patients.

Journal of medical science and clinical research, Jul 16, 2020

Sri Lanka Journal of Diabetes Endocrinology and Metabolism, 2016

Background: The role of testosterone in the pathogenesis of metabolic syndrome and diabetes melli... more Background: The role of testosterone in the pathogenesis of metabolic syndrome and diabetes mellitus has been well documented. Low testosterone levels have been associated with an increased risk of insulin resistance and type 2 diabetes mellitus (T2DM) and testosterone supplementation has been found to reduce insulin resistance and blood glucose levels. However, there is limited data available regarding the influence of testosterone levels on microvascular complications in patients with diabetes. This study was undertaken with the objective of evaluating levels of serum testosterone in newly diagnosed male patients with T2DM and to correlate serum testosterone levels with microvascular complications. Materials and Methods: A single point cross sectional case-control study was conducted at MLN Medical College, Allahabad and its associated SRN Hospital, Allahabad from March 2013 to July 2014. 168 males between 18-60 years of age were recruited for the study. From these patients, 83 patients who were diagnosed with T2DM during the last 3 months were considered as cases and remaining 85 patients without diabetes were taken as controls. Detailed history was obtained and clinical examination was performed. Serum low testosterone was defined as total testosterone<241 ng/dl and the prevalence of its deficiency was calculated. The values of serum testosterone were correlated with microvascular complications of diabetes viz. neuropathy, retinopathy and nephropathy. Results: Out of the 83 patients of T2DM, low serum testosterone was found in 37(44.58%) while it was present in only 10(11.8%) of 85 controls, which was statistically significant (χ2 = 20.84, df =1, p <0.0001). Microvascular complications were seen in 25(67.56%) patients with low testosterone while only 4(8.7%) patients had microvascular complications with normal testosterone level which was statistically significant (p<0.0001). Conclusions: Prevalence of hypogonadism was significantly (P<0.0001) higher in T2DM patients compared to controls. Subjective evidence of hypogonadism and microvascular complications were observed more frequently in patients with low testosterone compared to normal testosterone.

International Journal of Advances in Medicine, Dec 23, 2019

Normal thyroid function is important to maintain normal reproduction, via its interaction in seve... more Normal thyroid function is important to maintain normal reproduction, via its interaction in several pathways. 1 dysfunction has also been linked to reduced fertility and pregnancy complications. Previously several studies were done on animal models and in humans with overt hypothyroidism to evaluate hypothalamo-pituitarygonadal axis. It was shown that in overt hypothyroidism basal gonadotropin levels were normal as in healthy subjects but there was a sluggish response to stimulation with gonadotropin releasing hormone when compared to healthy subjects. SHBG is decreased resulting in low Total E2 and T, but free hormone is normal when compared with euthyroid healthy individuals. But there are very few studies in patients with subclinical hypothyroidism. Subclinical hypothyroidism is a condition of mild to moderate thyroid failure defined biochemically by normal levels of thyroid hormones with mildly elevated TSH concentrations. 2 It has variety of designations, including mild thyroid failure, as well as compensated, early latent, mild, minimally symptomatic, ABSTRACT Background: In females, hypothyroidism can cause menstrual disturbances mainly oligomenorrhea. Thyroid dysfunction has also been linked to reduced fertility and pregnancy complications. Several studies have been done to evaluate gonadal dysfunctions in overt hypothyroidism but very few studies are there regarding subclinical hypothyroidism. Present study evaluates the gonadal functions of women with subclinical hypothyroidism. Methods: Total 20 females of age 18 to 35 years with newly diagnosed subclinical hypothyroidism were taken as cases and 20 age and body mass index (BMI) matched healthy females were taken as controls. Both in cases and controls, basal FSH, LH, estradiol were measured on 3 rd or 4 th day of menstrual cycle at 8 AM on fasting. Thereafter Leuprolide 20 mcg/kg was given subcutaneously on the same day. One hour after injection, LH and estradiol were measured. Basal and stimulated values were compared between both groups. Results: Basal LH was significantly higher in controls (6.63±2.38 m IU/ml) when compared to cases (6.06±2.10 m IU) with a p value 0.01 (<0.05). No significant differences were found between stimulated LH and estradiol in both the groups. Conclusions: In mild thyroidal failure the response of pituitary gonadotrophs to leuprolide is normal in contrast to overt hypothyroidism where the response is sluggish. This is the first study to be done in subclinical hypothyroid subjects to asses both basal and stimulated gonadotropin levels. Further studies are required in large samples to confirm these findings.

Internet Journal of …, 2012

ABSTRACT: The aim of this study was to observe whether levothyroxine replacement therapy has an e... more ABSTRACT: The aim of this study was to observe whether levothyroxine replacement therapy has an effect on hypertension in patients of hypothyroidism. This prospective study included all newly diagnosed cases of hypothyroidism (overt or subclinical) with ...

International Journal of Medical and Health Research, 2020

International Journal of Advanced Research, 2016

Background-Hypertension is one of the leading risk factor for Chronic Kidney Disease and non-dipp... more Background-Hypertension is one of the leading risk factor for Chronic Kidney Disease and non-dipper pattern of blood pressure is very common in chronic kidney disease patients and affects the renal outcome in these patients.Ambulatory blood pressure monitoring assists in targeting this population. Methods-Total 160 non diabetic hypertensive patients were enrolled between 10/04/14 to 15/05/15 at M.L.N. Medical College and SRN Hospital, Allahabad. Out of them 80 were CKD patients who were taken as cases and remaining 80 patients were non CKD and taken as controls. Ambulatory blood pressure monitoring, clinic BP, eGFR, and other clinical data were collected for 1 year duration. Statistical analysis was done by using unpaired t-test for independent variables. Results-out of 160 non diabetic hypertensive patients, 48(60%) cases and 28(35%) controls were found nondippers, while remaining 32(40%) cases and 52(65%) controls were have dipper BP pattern. Patients with non-dipping BP pattern had the worst renal function (P <0.05). The eGFR shown significant relationship with the nocturnal BP. Conclusion-Ambulatory blood pressure measurement allows a better risk stratification compared to clinic blood pressure measurement. Non-dipping status is closely related to severe renal damage in CKD patients. Hence 24-hr ABPM can be used as prognostic markers in non diabetic CKD patients, and Lowering of nocturnal BP will reduce the risk of renal damge in these patients.

International Journal of Research in Medical Sciences, 2019

Background: Hypothyroidism can cause menstrual disturbances mainly oligoanovualtory cycles and so... more Background: Hypothyroidism can cause menstrual disturbances mainly oligoanovualtory cycles and sometimes menorrhagia. It has also been seen to cause subfertility and pregnancy related complications. Various studies have been done to evaluate gonadal dysfunctions in overt hypothyroidism but very few studies are there which have done using a gonadotrophin response in that subset of patients. Present study evaluates the response of leuprolide on gonadal functions of women with overt hypothyroidism in a tertiary care centre at Meerut.Methods: In this study 50 females of age 20 to 40 years with newly diagnosed overt hypothyroidism were taken as cases and age and Body Mass Index (BMI) matched healthy females were taken as controls. Both in cases and controls, basal FSH, LH, estradiol was measured on 2nd day to 5th day of menstrual cycle. Thereafter Leuprolide 20 mcg/kg was given subcutaneously on the same day. Post leuprolide test, stimulated LH, FSH and estradiol were measured. Basal and...

journal of medical science and clinical research, 2020

This is a short report based on personal experience of clinicians and senior residents working in... more This is a short report based on personal experience of clinicians and senior residents working in a superspeciality department at a tertiary care center in Western Uttar Pradesh. It highlights the issues and hindrances faced by them during managing the patients of diabetes attending the superspecialty OPD.