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Background: The Indian subcontinent has shown higher prevalence for both thyroid dysfunction and autoimmunity as well as diabetes complicating pregnancy when compared to the Western population. Despite the potential serious implications of this problem, not enough attention has been paid in our country to understand this, and there is an urgent need to explore the same. Aims: To assess the proportion of women with thyroid autoimmunity and thyroid dysfunction in pregnancy complicated by diabetes mellitus and determine association of the same with diabetes in pregnancy and maternal and perinatal outcomes. Methods: We conducted a cross sectional study in which pregnant women with gestational as well as pregestational diabetes were enrolled and the proportion of those with thyroid dysfunction were assessed. Thyroid autoimmunity was evaluated in the same population using anti TPO and anti-thyroglobulin antibodies. The proportion of women with thyroid autoimmunity as well as thyroid dysfunction was calculated and the association of these with gestational and pregestational diabetes was evaluated. Those with thyroid autoimmunity was compared with those without autoimmunity and the association of each group with the presence of diabetes mellitus was evaluated. The same tests were done on pregnant women without diabetes or thyroid disease who served as controls. Results: The mean age of the study population was 26.62 ± 4.34 years. Among the gestational diabetics, the mean gestational age at diagnosis was 28.39 ± 4.69 weeks. The average duration of diabetes among those with pregestational diabetes was 3.10 ± 1.32 years. 40.67% participants had a family history of diabetes and 14% had family history of hypothyroidism. 56% were diagnosed with GDM and the rest had preGDM. Acanthosis nigricans was noted in 63.34% participants and 37.3% had goitre. 26.6% of the study population were diagnosed with hypothyroidism, none had hyperthyroidism. Of these, 45% were newly diagnosed during the current pregnancy.30.95% of those with GDM were noted to have hypothyroidism whereas it was 21.2% in preGDM. The prevalence of anti TPO antibody positivity was assessed in 140 patients which was found to be 9.29% whereas that of anti-thyroglobulin antibody was 3.57%.4.67% participants were noted to have oligohydramnios and 10% had polyhydramnios. 46.6% of those with polyhydramnios were found to have associated hypothyroidism which was statistically significant (P=.01). Maternal complications like gestational hypertension, pre term delivery, post-partum hemorrhage and caesarean section as well as neonatal complications like neonatal jaundice were higher in women with combined endocrinopathy. Conclusion: The prevalence of hypothyroidism in pregnancy complicated by diabetes mellitus is higher than the prevalence in normal pregnancy. About one third of those with gestational diabetes and more than one fifth of those with pregestational diabetes were found to have hypothyroidism in our study. Almost half of patients with polyhydramnios were found to have associated hypothyroidism. Maternal complications and neonatal jaundice were found to be higher among those with combined endocrinopathy. However, the prevalence of thyroid autoimmunity in our study was lower as compared to previously published data which could be because of regional differences in iodine sufficiency or other unrecognised endocrine disruptors which could be at play. Nevertheless, our study emphasises the fact that women with diabetes in pregnancy should receive early and periodic screening for thyroid dysfunction in pregnancy.

Background: Ramadan is a holy month in the Islamic calendar during which Muslims all over the world observe a fast between dawn and sunset. The management of people with diabetes who fast during Ramadan had previously been based on expert opinion rather than medical evidence gained from scientific data. Risk stratification is an essential aspect of all diabetes and Ramadan recommendations. The International Diabetes Federation has recently in 2021 formulated an excellent tool based on recent evidences that will help people with diabetes and their health care professionals to make better decisions regarding fasting during Ramadan. Through this study we aimed to apply this risk stratification tool in our patients with diabetes who opted to fast during Ramadan as well as compare their glycemic control and change in clinical and biochemical parameters pre and post Ramadan. Aims: To study the effect of Ramadan fasting on the glycemic control, occurrence of hypoglycemia as well as clinical and biochemical parameters of patients with diabetes and to categorize them based on risk stratification. We also aimed to assess the impact of adjustment of antidiabetic medications and their dosages with specific emphasis on hypoglycemia. Methods: We conducted an observational, single centre, prospective study in the outpatient clinic of department of Endocrinology at Osmania Medical College, Hyderabad. 150 patients who satisfied inclusion criteria were recruited at least 1 week prior to the month of Ramadan after taking informed written consent. A structured questionnaire was undertaken which included demographic details, type of diabetes, antidiabetic medications used (oral antidiabetic agents/insulin), any other chronic drug intake and comorbidities. Risk stratification tool as proposed by IDF in 2021 was used to categorise patients into low risk, moderate risk and high risk and appropriate health education and counselling were given. The patients were divided into 5 drug groups based on the drug modifications done for Ramadan. Modifications to treatment regimens were done as per standard protocols in order to achieve glycemic control and avoid the risk for hypoglycemia. The patients were followed up 1 week after Ramadan to assess the number of individuals who developed hypoglycemia during fasting and parameters like BMI, lipid profile, FBS, PPBS, HbA1c were measured. Results: The mean age of the study population was 47.63+/- 10.5 years.140 patients had type 2 diabetes and 10 patients had type 1 diabetes. 44% of study population belonged to low risk, 33% into moderate risk and 23% into high-risk category as per IDF 2021 risk stratification tool. Out of the total 150 study participants, 137 of them had fasted in the previous year's Ramadan (2020).46 of 137 (33.57%) patients gave history of experiencing hypoglycemia during the previous year's fasting (2020) as compared to only 27/148 (18.24%) in 2021. Among these, 62.9% were from the high-risk group. Comparison of the patient characteristics between Ramadan 2020 and Ramadan 2021 revealed that pre-Ramadan education resulted in lower number of patients with hypoglycemic episodes (16.05% vs 33.57%), motivated more number of patients to do SMBG during fasting (12.4% to 21.8%) and lower number of patients with hyperglycemia (10.94% to 5.83%). The percentage of individuals who fasted for at least 15 days increased from 90.5% to 97.08%. BMI showed an improving trend post Ramadan (25.97 ± 2.63 kg/m2 vs 25 kg/m2 ± 1.98) which was also statistically significant (P < .0001). Other parameters like Blood pressure, HbA1c, FBS, PPBS and LDL cholesterol showed improving trends post Ramadan although statistical significance could not be achieved. It was also noted that those who were prescribed Acarbose did not experience any hypoglycemic episodes as compared to other drug regimens like gliptins, metformin glimepiride combination, repaglinide and insulin and this difference was also statistically significant (P < .001). Maximum number of hypoglycemic episodes were reported in the insulin group (63.1%; 12/19), majority of them being type 1 diabetics (42.1%; 8/19), which highlights the importance of focusing on this group with regard to counselling and advice as well as risk stratification. Conclusion: The development and utilization of Ramadan-focused diabetes education programs is essential to provide better care and ensure the safety of people with diabetes who fast during Ramadan. The findings of this study clearly emphasize the continuous need to prioritize risk stratification and to institute pre-Ramadan assessment and interventions in advance. It is essential to promote and strengthen a structured approach to Ramadan focused diabetes education and self-monitoring to ensure safe fasting, thereby preventing and reducing complications. It also highlights potential role of Acarbose for use among diabetics during Ramadan.

Background: In refractory primary hypothyroidism, even after ruling out important organic causes the resistance may persist and is called pseudo-malabsorption. If non-adherence is suspected, but not volunteered, the options to confirm the possibility are limited. We conducted this study to assess the use of Levothyroxine absorption test to diagnose pseudo-malabsorption and once weekly Levothyroxine to treat such patients Methods: This was an open labelled Randomized Control Trial with a Parallel design. All patients with age 18 or above attending Endocrinology OPD who was diagnosed with Primary Hypothyroidism but had TSH levels more than 10 mIU/L despite treatment with daily Levothyroxine at a dose of 2.5 mcg/kg/day for a period of 6 months or more were included after applying exclusion criteria after getting informed consent. Levothyroxine absorption test was done according to previously validated protocol and Absorption percentage was calculated using previously validated formula. If more than 60% it was suggestive of pseudo-malabsorption. They were randomised by simple randomization to receive oral Levothyroxine of a same standard brand either weekly once under direct supervision with a dose equal to the cumulative dose with a maximum of 14 mcg/kg (weekly dose group) or to continue to receive the same daily dose prior to randomization (daily dose group). Both groups received healthcare advice on adherence, adequate spacing and storage. Thyroid function tests were repeated at 8 weeks and at 12 weeks if not controlled at 8 weeks. Results: After randomization of 70 subjects selected after levothyroxine absorption, 40 were in the weekly once group and 30 were in the daily once group. 38 subjects in the weekly once group (95%) had controlled TFT levels by 12 weeks with 32 (80%) among them under control by 8 weeks whereas 18 subjects in the daily once group (60%) had controlled TFT levels by 12 weeks and had a statistically significant difference between the two groups (p value = 0.0005). There were no significant differences in the adverse events. 4 subjects in the weekly once group (10%) and 2 subjects in the daily once group had headache. 2 subjects in the weekly once group withdrew from the study due to headache. Conclusion: The weekly once dosage can be considered as a safe and effective option for every subject with refractory primary hypothyroidism when pseudo-malabsorption is suspected.

Background: Lipodystrophy constitutes a spectrum of diseases characterized by generalized or partial absence of adipose tissue. Underscoring the role of healthy fat in maintenance of metabolic homeostasis, fat deficiency in lipodystrophy typically leads to metabolic disturbances including insulin resistance, hypertriglyceridemia and ectopic fat accumulation. While rare recent genetic studies indicate that lipodystrophy is more prevalent than has been previously thought, suggesting underdiagnosis in clinical practice. Aims and Objectives: The present case series highlights the spectrum of lipodystrophy syndromes, clinical profile and complications. Case Details C1 & C2 who wer 28 yr & 26 yr female siblings presented with neck swelling, double chin appearance, loss of fat in extremities and not gaining weight, inspite of increased appetite. History of father having CAD mortality at 30 yr age.C3: 22 y/o female came with c/o oligomenorrhea, polyuria, polydipsia. On examination generalized loss of body fat was present.C4: 20 y/o female presented with c/o generalized fat loss, hirsutism, muscular appearance, polyuria and polydipsia. On evaluation of C1 & C2 a clinical diagnosis of Familial Partial lipodystrophy was made. Investigations revealed Prediabetes and Hypertriglyceridemia. C3 & C4 were clinically diagnosed as Congenital Generalized Lipodystrophy. Investigations revealed T2DM, PCOS, Hypertriglyceridemia which were appropriately managed. Conclusion: The aetiology and clinical features of lipodystrophy are variable. Awareness and early recognition in these cases is necessary for optimal management of the patient.

Introduction: Glycated hemoglobin (HbA1c) is commonly used for monitoring glycemic control and as predictor of diabetes complications. Recently, HbA1c has also boon recommended as a diagnostic test for diabetes mellitus by the American Diabetes Association (ADA). Anaemia is cited as major confounding factor to this use. Elevated HbA1c levels are documented in Iron Deficiency Anaemia (IDA) patients without any history of diabetes. The aim of this study is to determine the effect of IDA on the HbA1c levels in non-diabetic patients. Materials: 63 non-diabetic, anaemic patients and 63 age-matched healthy subjects were enrolled in this study. The patients with glucose tolerance abnormalities (impaired glucose tolerance or diabetes mellitus), hemoglobinopathies, hemolytic anaemia, chronic alcohol ingestion, chronic renal failure and pregnant females were excluded from the study. Complete hemogram with peripheral smear, serum ferritin, FBS, PLBS and HbA1c levels were measured in all the subjects. Observations: The mean HbA1c (6.13±0.6%) level in the patients with IDA was higher than that in the control group (5.12±0.5%) (p<0.001). There were no differences in the levels of FBS, PLBS between both groups (p>0.05). The hemoglobin, serum ferritin, FBS, PLBS and the HbA1c levels were normal in the control group (p > 0.05). Conclusion; It was found that Iron Deficiency Anaemia was common among the reproductive age group women. It was associated with shift in the HbA1c levels to higher side, primarily between 6premenopausal females, who are at increased risk of iron deficiency; the concomitant increase in HbA1c values in these patients due to iron deficiency will move the diagnosis of pre-diabetes to diabetes. It is hence prudent to rule out IDA before making a therapeutic decision, based on the HbA1c levels..0% and 6.5%. As the incidence and prevalence of young onset obesity is increasing, many of whom are child bearing and

Before onset of synthetic era, man was completely dependent on medicinal plants for prevention and treatment of diseases. Medicinal plants, herbs, spices and their remedies are known to ayurveda in India since long times. The value of medicinal plants, herbs and spices as herbal remedies is being lost due to lack of awareness and deforestation. Hence as a result, many valuable medicinal herbs are becoming rare and thus the precious information is lost. Of the estimated 500,000 plants on our planet, it is thought that around 10,000 are regularly used for medicinal purposes. Significant proportions of these herbs have been well researched and the most are excellent for home use. The medicinal plants find application in pharmaceutical, cosmetic, agricultural and food industry. The use of the medicinal herbs for curing disease has been documented in history of all civilizations. The Indian system of herbal medicine has been regarded by many of the western scholars. It has been said that Indian herbal medicine is a rich mine of knowledge from which many useful things might be unearthed. The earliest mention of the medicinal use of plants is to be found in the Rig-Veda, which is one of the oldest repositories of human knowledge, having written between 4500 and 1600 BC. Even in late as the 1930s, around 90% of medicines prescribed by doctors are sold over the counters were herbal medicines. The major pharmaceutical companies now a days have realized that rainforest; grasslands and even had growers and fields are sources of potentially invaluable medicines. As a result they are investing large sums of money to try to find new plant chemicals that can be marketed as medicines.

In many organisms, stress responses to adverse environments can trigger secondary functions of certain proteins by altering protein levels, localization, activity, or interaction partners. Escherichia coli cells respond to the presence of specific cationic antimicrobial peptides by strongly activating the PhoQ/PhoP two-component signaling system, which regulates genes important for growth under this stress. As part of this pathway, a biosynthetic enzyme called QueE, which catalyzes a step in the formation of queuosine (Q) tRNA modification is upregulated. When cellular QueE levels are high, it co-localizes with the central cell division protein FtsZ at the septal site, blocking division and resulting in filamentous growth. Here we show that QueE affects cell size in a dose-dependent manner. Using alanine scanning mutagenesis of amino acids in the catalytic active site, we pinpoint residues in QueE that contribute distinctly to each of its functions–Q biosynthesis or regulation of cell division, establishing QueE as a moonlighting protein. We further show that QueE orthologs from enterobacteria like Salmonella typhimurium and Klebsiella pneumoniae also cause filamentation in these organisms, but the more distant counterparts from Pseudomonas aeruginosa and Bacillus subtilis lack this ability. By comparative analysis of E . coli QueE with distant orthologs, we elucidate a unique region in this protein that is responsible for QueE’s secondary function as a cell division regulator. A dual-function protein like QueE is an exception to the conventional model of “one gene, one enzyme, one function”, which has divergent roles across a range of fundamental cellular processes including RNA modification and translation to cell division and stress response.

Microstructural characterization and analysis is the foundation of microstructural science, connecting materials structure to composition, process history, and properties. Microstructural quantification traditionally involves a human deciding what to measure and then devising a method for doing so. However, recent advances in computer vision (CV) and machine learning (ML) offer new approaches for extracting information from microstructural images. This overview surveys CV methods for numerically encoding the visual information contained in a microstructural image using either feature-based representations or convolutional neural network (CNN) layers, which then provides input to supervised or unsupervised ML algorithms that find associations and trends in the high-dimensional image representation. CV/ML systems for microstructural characterization and analysis span the taxonomy of image analysis tasks, including image classification, semantic segmentation, object detection, and instance segmentation. These tools enable new approaches to microstructural analysis, including the development of new, rich visual metrics and the discovery of processing-microstructure-property relationships.

Previous studies have shown that exponentially growing Escherichia coli can detect mild acidity (~pH 5.5) and, in response, synthesize enzymes that protect against severe acid shock. This adaptation is controlled by the EvgS/EvgA phosphorelay, a signal transduction system present in virtually every E. coli isolate whose genome has been sequenced. Here we show that, despite this high level of conservation, the EvgS/EvgA system displays a surprising natural variation in pH-sensing capacity, with some strains entirely non-responsive to low pH stimulus. In most cases that we have tested, however, activation of the EvgA regulon still confers acid resistance. From analyzing selected E. coli isolates, we find that the natural variation results from polymorphisms in the sensor kinase EvgS. We further show that this variation affects the pH response of a second kinase, PhoQ, which senses pH differently from the closely related PhoQ in Salmonella enterica. The within-species diversification described here suggests EvgS likely responds to additional input signals that may be correlated with acid stress. In addition, this work highlights the fact that even for highly conserved sensor kinases, the activities identified from a subset of isolates may not necessarily generalize to other members of the same bacterial species.