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1.  A Study of Insulin Resistance and its Clinico-Metabolic Associations Among Apparently Healthy Individuals Attending a Tertiary Care Hospital 
Insulin resistance (IR), as a result of unhealthy life-styles and westernization, most likely contributes to the increased incidence of metabolic abnormalities and consequently, the development of metabolic syndrome (MS).
The present study was undertaken to determine the magnitude of IR and associated clinico-metabolic risk factors among the out-patients of a tertiary care hospital in Bihar, India.
Subjects and Methods:
Anthropometric profile, lipid profile, fasting blood glucose, C-reactive protein (CRP) and C-peptide of 112 individuals were measured using the standard procedures. IR was assessed using the homeostasis model (Homeostatic model assessment [HOMA]-IR).
The mean IR was 1.5 (1.0). Individuals with MS, higher body mass index and CRP ≥6 mg/l had higher IR. Linear regression showed, among the components of MS, waist circumference had the highest contribution toward IR. The optimal cut-off value to detect IR by HOMA2-IR was 1.35.
IR was found to have a strong association with various clinico-metabolic risk factors.
PMCID: PMC4199182  PMID: 25328801
C-reactive protein; Homeostatic model assessment insulin resistance; Insulin resistance; Metabolic syndrome
2.  Drug Utilization Study in Ophthalmology Out-patient Department of a Medical College in India 
Drug utilization studies provide a pharmacoeconomic basis for making evidence-based health-care decisions. In ophthalmology practice, rational prescribing plays a crucial role in reducing the ocular disease burden.
The aim of the study was to investigate the drug utilization pattern in ophthalmology out-patient department (OPD) of a Medical College in India.
Subjects and Methods:
A prospective, cross-sectional study was conducted for a period of 2 months. The prescriptions for all consecutive patients attending the OPD for the first time (first time encounter) were included and audited using a pre-designed form to record information from the OPD prescription cards of each patient. Data analysis was carried out using the descriptive statistical methods: Frequencies, percentage, mean and standard deviation.
A total of 640 prescriptions were analyzed with the average number of drugs per prescription being 2.4 (0.9). The most common disorders diagnosed were refractive errors (31.6% [202/640]) followed by cataract, glaucoma and others. Drugs were prescribed in different dosage forms with eye drops being the most common (70.8% [1073/1516]) followed by tablets (15.9% [241/1516]), ointment (6.1% [93/1516]), syrup (1.1% [16/1516]) and others; injections contributed 2.1% (30/1516) of all dosage forms. The frequency of drug administration and duration of treatment was recorded in 96% (614/640) and 75% (480/640) of all prescriptions respectively. Antimicrobials were most commonly prescribed (36.4% [552/1516]) followed by anti-inflammatory and anti-allergic (24.2% [367/1516]), anti-glaucoma medications (21.4% [323/1516]), mydriatic and cycloplegics (7.2% [109/1516]), miotics (6.2% [94/1516]), multivitamins (4.6% [70/1516]). Drugs were predominantly prescribed in brand name 83% (1258/1516) instead of generic name. A total of 62% (940/1516) of drugs were prescribed from national essential medicine list.
The present study revealed certain lacunae in the prescribing practices of the Ophthalmologists of the institute as evidenced by low generic prescribing, inadequate information about frequency of administration and duration of therapy in many prescriptions. This can be addressed through proper sensitization of clinicians in the art of rational prescribing.
PMCID: PMC4160702  PMID: 25221726
Drug utilization study; Ophthalmology; Out-patient department
3.  Dominantly acting ABCC8 mutations in patients with medically unresponsive hyperinsulinaemic hypoglycaemia 
Clinical Genetics  2011;79(6):582-587.
Flanagan SE, Kapoor RR, Banerjee I, Hall C, Smith VV, Hussain K, Ellard S. Dominantly acting ABCC8 mutations in patients with medically unresponsive hyperinsulinaemic hypoglycaemia.
Recessive inactivating mutations in the ABCC8 and KCNJ11 genes encoding the adenosine triphosphate-sensitive potassium (KATP) channel subunit sulphonylurea receptor 1 (SUR1) and inwardly rectifying potassium channel subunit (Kir6.2) are the most common cause of hyperinsulinaemic hypoglycaemia (HH). Most of these patients do not respond to treatment with the KATP channel agonist diazoxide. Dominant inactivating ABCC8 and KCNJ11 mutations are less frequent, but are usually associated with a milder form of hypoglycaemia that is responsive to diazoxide therapy. We studied five patients from four families with HH who were unresponsive to diazoxide and required a near total pancreatectomy. Mutations in KCNJ11 and ABCC8 were sought by sequencing and dosage analysis. Three novel heterozygous ABCC8 mis-sense mutations (G1485E, D1506E and M1514K) were identified in four probands. All the mutations affect residues located within the Nucleotide Binding Domain 2 of the SUR1 subunit. Testing of family members showed that the mutations had arisen de novo with dominant inheritance in one pedigree. This study extends the clinical phenotype associated with dominant KATP channel mutations to include severe congenital HH requiring near total pancreatectomy in addition to a milder form of diazoxide responsive hypoglycaemia. The identification of dominant vs recessive mutations does not predict clinical course but it is important for estimating the risk of HH in future siblings and offspring.
PMCID: PMC3375476  PMID: 20573158
ABCC8; diazoxide; hyperinsulinaemic hypoglycaemia; pancreatectomy
4.  Diazoxide-responsive hyperinsulinemic hypoglycemia caused by HNF4A gene mutations 
European Journal of Endocrinology  2010;162(5):987-992.
The phenotype associated with heterozygous HNF4A gene mutations has recently been extended to include diazoxide responsive neonatal hypoglycemia in addition to maturity-onset diabetes of the young (MODY). To date, mutation screening has been limited to patients with a family history consistent with MODY. In this study, we investigated the prevalence of HNF4A mutations in a large cohort of patients with diazoxide responsive hyperinsulinemic hypoglycemia (HH).
Subjects and methods
We sequenced the ABCC8, KCNJ11, GCK, GLUD1, and/or HNF4A genes in 220 patients with HH responsive to diazoxide. The order of genetic testing was dependent upon the clinical phenotype.
A genetic diagnosis was possible for 59/220 (27%) patients. KATP channel mutations were most common (15%) followed by GLUD1 mutations causing hyperinsulinism with hyperammonemia (5.9%), and HNF4A mutations (5%). Seven of the 11 probands with a heterozygous HNF4A mutation did not have a parent affected with diabetes, and four de novo mutations were confirmed. These patients were diagnosed with HI within the first week of life (median age 1 day), and they had increased birth weight (median +2.4 SDS). The duration of diazoxide treatment ranged from 3 months to ongoing at 8 years.
In this large series, HNF4A mutations are the third most common cause of diazoxide responsive HH. We recommend that HNF4A sequencing is considered in all patients with diazoxide responsive HH diagnosed in the first week of life irrespective of a family history of diabetes, once KATP channel mutations have been excluded.
PMCID: PMC2857991  PMID: 20164212
5.  Polymerase chain reaction in the detection of an ‘outbreak’ of asymptomatic viral infections in a community birth cohort in south India 
Epidemiology and infection  2007;136(3):399-405.
Asymptomatic enteric infections are important where sequelae or protection from subsequent illness is an outcome measure. The use of reverse transcription–polymerase chain reaction (RT–PCR) to identify asymptomatic enteric infections in a birth cohort followed for rotaviral infections in a south Indian urban slum is reported. Of 1191 non-diarrhoeal samples from 371 children collected in May–June 2003, 22 (1·9%) were positive by ELISA. A total of 147 (40·6%) of 362 samples tested by VP6 RT–PCR were positive. In those samples that could be typed, a high diversity of G types including G1, G2, G4, G8, G9 and G10, and a high proportion (34·4%) of mixed infections were detected. Noroviruses were identified in 6/28 (21·4%) samples tested. The identification of infections undetectable by conventional techniques indicates the importance of the use of sensitive diagnostic techniques in research studies. Asymptomatically infected children may also act as a source of infection for other susceptible hosts.
PMCID: PMC2467457  PMID: 17521476
6.  Osteogenesis imperfecta and intravenous pamidronate 
Archives of Disease in Childhood  2002;87(6):562-563.
PMCID: PMC1755843  PMID: 12456578

Results 1-6 (6)