PubMed Health⌕ Search

Biomedical subjects

Shashank R Joshi

Publications and source records attributed to Shashank R Joshi.

At least 19 recordsLinked to original sources
PubMed2006

Index of central obesity - A novel parameter.

Waist circumference (WC) is globally used as a parameter to quantify central obesity, the key culprit in insulin resistance and related disorders. Hitherto globally in various definitions of metabolic syndrome and risk scores, WC is used to quantify central obesity. For defining central obesity, which is a single entity numerous WC cutoffs have been suggested, separately for males and females and various races. We believe that this difference is amenable to differences in their average heights. To quantify proportion of visceral fat in the total body fat, WC alone is not sufficient. We hereby hypothesize that Index of central obesity (ICO) defined by us, as a ratio of WC and height is a better parameter of central obesity. If ICO is used in place of WC we may do away with various WC cutoffs and may have a single cutoff applicable to all races and both genders. Using average heights of various countries and their respective WC cutoffs suggested by IDF consensus definition for defining metabolic syndrome (MS) we derived their ICO cutoffs mathematically. The ICO cutoffs obtained ranged from 0.51 to 0.58 among males and 0.47 to 0.54 among females. The range has narrowed down compared to wide range of cutoffs for WC i.e. 90-102 cm for males and 80-88 cm for females. To test superiority of ICO over WC even among people of same race and same gender we conducted a pilot study in which, we compared two subjects with same WC and body mass index (BMI), though they differed in their stature. Body fat distribution was compared on DEXA and oral glucose tolerance was tested. Percentage of total body fat contributed by truncal fat was 36.11% in taller subject (Dr. P) and 46.31% in the shorter one (Mr. P). On investigation Dr P had normal glucose tolerance while Mr. P was diagnosed to be diabetic. These differences unexplained by identical WC and BMI could be explained by difference in their ICO (0.557 vs 0.645). ICO has a potential to be a better parameter of central obesity. It may obviate the need for numerous WC cutoffs and may even be applicable to children where existing parameters are not useful.

Absorptiometry, Photon↗
PubMed2006

Intensive glycemic control in diabetic pregnancy with intrauterine growth restriction is detrimental to fetus.

Hyperglycemia during early pregnancy can lead to congenital malformations and/or spontaneous abortion while in the last few days of pregnancy it causes neonatal metabolic complications. Macrosomia is the most common complication and is due to maternal hyperglycemia in second and third trimester of pregnancy. In view of all these, intensive glycemic control of the mother is recommended throughout pregnancy. Intrauterine growth restriction (IUGR) is a well known complication of pre-gestational diabetic patients due to vasculopathy and is also seen in gestational diabetes mellitus (GDM) due to overinsulinisation. Hitherto there are no separate recommendations for glycemic targets in pregnant diabetic patients with IUGR. In presence of IUGR due placental vascular insufficiency, intensive glycemic control may deprive fetus of nutrition. Secondly frequent hypoglycemias which are inevitable complication of insulin treatment may further worsen the IUGR. In presence of IUGR, macrosomia is a rare possibility, and in such situation intensive glycemic control throughout pregnancy may not be justifiable and may actually be detrimental. Neonatal metabolic complications can be avoided by strict glycemic control during last two weeks of pregnancy.

Female↗
PubMed2006

Gestational diabetes mellitus--guidelines.

The Diabetes In Pregnancy Study group India (DIPSI) is reporting practice guidelines for GDM in the Indian environment. Due to high prevalence, screening is essential for all Indian pregnant women. DIPSI recommends that as a pregnant woman walks into the antenatal clinic in the fasting state, she has to be given a 75g oral glucose load and at 2 hrs a venous blood sample is collected for estimating plasma glucose. This one step procedure of challenging women with 75 gm glucose and diagnosing GDM is simple, economical and feasible. Screening is recommended between 24 and 28 weeks of gestation and the diagnostic criteria of ADA are applicable. A team approach is ideal for managing women with GDM. The team would usually comprise an obstetrician, diabetes physician, a diabetes educator, dietitian, midwife and pediatrician. Intensive monitoring, diet and insulin is the corner stone of GDM management. Oral agents or analogues though used are still controversial. Until there is evidence to absolutely prove that ignoring maternal hyperglycemia when the fetal growth patterns appear normal on the ultrasonogram, it is prudent to achieve and maintain normoglycemia in every pregnancy complicated by gestational diabetes. The maternal health and fetal outcome depends upon the care by the committed team of diabetologists, obstetricians and neonatologists. A short term intensive care gives a long term pay off in the primary prevention of obesity, IGT and diabetes in the offspring, as the preventive medicine starts before birth.

Continuity of Patient Care↗
PubMed2006

Paget's disease from Western India.

AIM AND OBJECTIVE: To prospectively study prevalence of Paget's disease from Western India. METHODS AND MATERIALS: Seventeen consecutive cases from Western India from 1998 to 2005 are analysed for the clinical, biochemical, skeletal profile. Seventeen cases (15 males & 2 females) with mean age of 62 were diagnosed RESULTS: The Western Indian cohort of Paget's disease has male preponderance with a mean age of 62 years at onset. Its clinical features are pain, fracture and typical skeletal involvement. It is a non-familial, polyostotic disease with pelvis, skull, spine and femur being the commonly affected bone sites. Elevated alkaline phosphatase is typical which responds well to bisphosphonate therapy in 6 months. Most cases do well with low dose alendronate (10-20mg/day). CONCLUSIONS: Paget's disease in western India is rare with classical clinical, radiological and biochemical features and responds well to low dose alendronate therapy. In eight years, seventeen cases of Paget's disease were seen from Western India indicating though still rare is present in this population of Western India.

Aged↗
PubMed2006

Association of adipocytokines (leptin, adiponectin TNF-alpha), insulin and proinsulin with diabetes--the Mumbai Obesity Project [MOP].

Asian Indians have a unique phenotype characterized by increased abdominal obesity and visceral fat despite low body mass index [BMI]. Though studies have indicated some adipocytokines to be associated with diabetes and obesity in Indians, there are virtually no studies relating adipocytokines and proinsulin with diabetes and obesity in Asian Indians. In this study we looked at adipocytokines--leptin, adiponectin and tumour necrosis factor-a [TNF-alpha] and insulin and proinsulin in subjects with diabetes and obesity. Thirty five diabetic subjects and 50 healthy controls were recruited for the study. Leptin [p=0.002J and adiponectin levels [p=0.011] were lower and proinsulin values higher [p<0.001] in diabetic subjects compared to non-diabetic subjects. In addition, leptin [p<0.001] and proinsulin [p<0.001] were higher and adiponectin [p<0.001] lower, in obese subjects compared to non-obese subjects. TNF-alpha failed to show any significant difference between the study groups. Leptin and proinsulin showed a significant and positive correlation with BMI [p<0.001] and waist circumference [p<0.001]. Adiponectin showed an inverse correlation with BMI [p=0.050] and waist circumference [p=0.002]. Proinsulin showed a significant negative association with adiponectin [p=0.002]. Logistic regression analysis revealed leptin to be negatively associated [Odds ratio [OR]: 0.864, 95% confidence interval [95% CI]: 0.775 -0.963, p=0.008] and proinsulin [OR: 1.567, 95% CI: 1.246-1.971, p<0.001] to be positively associated with diabetes even after adjusting for age, gender and BMI. Leptin [OR: 1.365, 95% CI: 1.170-1.592, p<0.001] and proinsulin [OR: 1.617, 95% CI: 1.218 -2.147, p=0.001] showed a significant positive association with obesity, while adiponectin [OR: 0.927, 95% CI: 0.865 - 0.995, p=0.035] had a significant inverse association. Linear regression analysis revealed that adiponectin is inversely associated with proinsulin even after the addition of age, gender and diabetes status [beta= -0.61, p=0.033] into the model. In conclusion, in urban Asian Indians in western India, proinsulin levels showed a positive association, while leptin and adiponectin showed a negative association with diabetes. With regard to obesity, leptin and proinsulin had a positive association, while adiponectin had a negative association. Proinsulin levels showed an inverse association with adiponectin indicating a possible link between insulin secretion and insulin resistance.

Adiponectin↗
PubMed2005

Kaposi's sarcoma with thrombocytopenia in a heterosexual Asian Indian male.

A 45-year-old heterosexual male patient with retroviral disease since 12 years presented with hyperpigmented lesions, misdiagnosed initially as purpura due to an associated thrombocytopenia, but was biopsy proven to be Kaposi's sarcoma (KS). Bone marrow examination revealed excess megakaryocytes. Low CD4 count and absence of platelet specific IgG reduced the likelihood of immune thrombocytopenia (ITP). However after 6 weeks of antiretroviral therapy the patient's lesions have reduced and platelet counts are improving, possibly suggesting a sequestration thrombocytopenia in the abnormal tumor vessels of KS.

Diagnosis, Differential↗
PubMed2005

Study of efficacy and safety of losartan (losar) in Asian Indian hypertensives.

Although there has been widespread dissemination of knowledge about hypertension, it remains poorly treated in most populations. Systemic hypertension is associated with increased risk for coronary artery disease, stroke, nephrosclerosis, peripheral vascular disease, etc. The treatment of hypertension includes non-pharmacological measures and the specific drug therapy. Losartan potassium is an orally active, non-peptide angiotensin II receptor antagonist. It is the first of this new class of drugs introduced for clinical use in hypertension. Data was obtained of 347 patients from 140 general physicians. The study revealed that losartan potassium is used in the treatment of mild to moderate hypertension with excellent to good response in 98.8% of the cases. Mild adverse reactions were reported in 5.8% of the cases. None of the adverse reactions were severe enough which required discontinuation of therapy or needed hospitalisation. Thus, the present postmarketing surveillance study confirms the safety and efficacy of losartan potassium in Indian population.

Antihypertensive Agents↗