Commentary
Abstract
Full TextPDF
Objective - To explore alternative ways of engaging obese men in more tailored services, especially as men are far less likely than women to engage in current health services. This article explores ways of de-medicalizing services, giving men the opportunity to discuss health issues before becoming ill. Men are much less likely to recognize the health implications of obesity or seek help to lose weight.
Research Article
Full Text
Research Article
Abstract
Full TextPDF
Objective: To conduct a systematic review and meta-analysis to evaluate the safety and efficacy of oral testosterone therapy in hypogonadal men. The primary outcome is the assessment of safety, focusing on cardiovascular risks, liver toxicity, and prostate safety. Secondary outcomes include evaluations of bone mass, cardiovascular benefits, cognitive function, and potential reductions in mortality.
Methods: A systematic search was conducted using databases such as PubMed, Embase, and Cochrane Library, identifying peer-reviewed studies published until August 2024. The search included randomized controlled trials (RCTs), cohort studies, and large clinical trials. The studies involved a total of 3,183 hypogonadal men. Data were extracted and analyzed to assess primary and secondary outcomes. Statistical methods for meta-analysis included fixed-effects and random-effects models to calculate pooled estimates and assess heterogeneity.
Results: The analysis included 11 studies, encompassing a total of 3,183 hypogonadal men. Oral testosterone therapy demonstrated a safety profile comparable to other testosterone replacement therapy (TRT). No significant increase in liver toxicity was observed, supported by studies showing no liver damage after long-term oral testosterone undecanoate (TU) administration. Cardiovascular safety results were mixed; some studies noted minor increases in systolic blood pressure (SBP), but there was no consistent evidence of a significant increase in major cardiovascular events compared to other TRT forms. The prostate safety profile was consistent with existing TRT modalities, with only minor increases in prostate-specific antigen (PSA) levels noted. Secondary outcomes were generally favorable: bone density improved, fat mass was reduced, and there were indications of cognitive benefits, although these findings varied across studies. However, the evidence for mortality reduction was inconclusive, with no strong data supporting a significant effect of oral testosterone on reducing mortality.
Conclusion: Oral testosterone therapy appears to be a safe and effective treatment for hypogonadal men, with a risk profile comparable to other TRT forms. It offers potential benefits in bone health and cognitive function but requires careful monitoring of cardiovascular health and prostate safety during treatment. The findings suggest that oral testosterone therapy can be a valuable option for hypogonadal men, though long-term studies are needed to better understand its full range of effects, particularly concerning mortality and cardiovascular outcomes.
Commentary
Full TextPDF
Research Article
Abstract
Full TextPDF
India has around 101 million people living with diabetes and another 136 million in the prediabetes stage with a significant majority remaining undiagnosed. Lifestyle factors, such as insufficient physical activity, sedentary behavior, and poor dietary patterns, contribute to the development of type 2 diabetes. Innovative solutions are needed to aid patients in effectively managing their health. The study aimed to evaluate the efficacy of the Lifestyle Score Calculator, integrated into the BeatO mobile application, in promoting positive lifestyle changes among individuals managing diabetes. The study included 908 active users with diabetes who used the BeatO application for lifestyle score assessments at least four times between August 1, 2023, and January 30, 2024. In their initial assessment, 21% of patients were classified as having low lifestyle scores, 51% as medium, and 29% as high. Transition analysis revealed significant improvements over time, with 83% of patients initially categorized with a low lifestyle score successfully moving up to higher categories. Category-specific analysis showed notable improvements in eating and drinking habits, physical activity levels, blood glucose management, and medication adherence. The findings demonstrate the effectiveness of the Lifestyle Score Calculator in fostering positive transitions across lifestyle categories, particularly among those with initially lower scores. These results affirm the potential of personalized interventions based on lifestyle scores to facilitate sustained positive lifestyle changes among individuals managing diabetes. Further research and continuous monitoring are needed to understand the long-term impact of these interventions and refine personalized diabetes management strategies.
Research Article
Abstract
Full TextPDF
Non-alcoholic fatty liver disease (NAFLD) is the commonest chronic liver disease. It is characterized by a wide range of symptoms like fatigue, pain, or dullness in the upper right quadrant of the abdomen or none at all. The risk factors linked to NAFLD are type 2 diabetes mellitus (T2DM), obesity, and genetic predisposition. In this study, the clinical, biochemical, and ultrasonography findings were compared in NAFLD patients with and without T2DM. The liver elastography (FibroScan) measured liver stiffness (LSM), and the liver fibrosis index 4 (FIB-4) were both significantly higher in diabetic patients. The controlled attenuation parameter (CAP) was not statistically significant when compared in the two groups. There was a significant negative correlation between FIB-4 and platelet counts in both groups; p = 0.006 in non-diabetics and p = 0.001 in diabetics. There was a significant positive correlation between FIB-4 and aspartate aminotransferase (AST) in the non-diabetic group only. The non-invasive diagnostic and prognostic markers of NAFLD that are LSM, and FIB-4 are more reliable than inflammatory markers. Though the dietary habits, anthropometric measurements, and physical activity were not different and did not pose risk factors in our population, we need to study the genetic and epigenetic factors in our population.
Case Report
Abstract
Full TextPDF
Introduction: Fetal alcohol syndrome (FAS) is associated with a positive maternal history of drinking during pregnancy and the presence of characteristic dysmorphic features due to alcohol teratogenic effect. No evidence is yet available regarding the use of growth hormone (GH) for children with FAS for whom GH deficiency has not been confirmed.
Case Presentation: We have highlighted an improvement in auxological parameters of a child with FAS and normal GH stimulation tests, using a GH dosage similar to that used in idiopathic GH deficit, without side effects.
Conclusion: GH therapy in children with FAS may lead to an improvement in growth rate and an increase in final height, although, this condition is not included in the specific recommendations for use of GH. Prolonged follow-up and prospective studies are needed to evaluate long-term efficacy and monitor any possible onset of side effects.
Protocol Paper
Duggal M*, Chauhan A*, Gupta V, Kankaria A, Sood N, Miglani V, Tigari B, Kaur G, Kumar L, Naveen M, Budhija D, Badada SK and Vale L
Comparing the Implementation of Different Diabetic Retinopathy Screening Models in Primary Health Care Settings in Northern India: Pragmatic Three-Arm Observational Study Read More »
Abstract
Full TextPDF
Supplementary File
Introduction: Early screening is recommended to prevent vision impairment (VI) and blindness globally due to diabetic retinopathy (DR). We aim to analyze the factors influencing the implementation of DR screening models in primary healthcare facilities.
Methods: A pragmatic three-arm observational study will be conducted in the district of Mohali in Punjab, India. The study will compare three equal-sized groups with type 2 diabetes mellitus (T2DM) at age 30 and above. The T2DM participants and healthcare providers (HCPs) will be interviewed to identify the barriers to retinal examinations in primary healthcare settings. The study includes a comprehensive economic evaluation to determine the cost-effectiveness of implementing different DR screening models in primary health settings. The present study will use the RE-AIM framework (reach, effectiveness, adoption, implementation, and maintenance), to assess the implementation of two DR screening interventions and the extent of variation in outcomes. Qualitative and quantitative data collected from participants and research team observations will be examined to report on the five RE-AIM domains.
Discussion: A screening program should ensure early detection and referral for DR treatment before it results in irreversible vision loss. However, understanding the problems of accessing DR screening and estimating the cost-effectiveness of such programs in a primary health setting is important before allocating public health resources.
Research Article
Abstract
Full TextPDF
Objective: Osteoporotic fractures are a major public health problem worldwide. Effective therapies have been available since 1995, with bisphosphonates (BPs) as the most used first-line drugs. Zoledronic acid and denosumab (Dmab) became available soon thereafter. However, both BPs and Dmab, but not other osteoporosis therapies, are associated with rare occurrences of osteonecrosis of the jaw (ONJ) and atypical femur fracture (AFF), the two most common major barriers either for initiating or maintaining effective anti-fracture therapies. In this pilot study, we aimed to determine dentists’ perceptions and practice patterns to mitigate ONJ.
Methods: After approval from the Institutional Review Board, we e-mailed an online 7-point survey questionnaire to licensed dental practitioners, the members of the Michigan Dental Association (MDA), to ascertain the range of approaches dentists would take to treat patients who were using osteoporosis medications.
Results: Members of the MDA were surveyed with a series of questions, and 40 responses were received. Respondents were 50% women, and 28 worked in suburban areas, 8 in urban areas, and 4 in rural areas. 48% of the dentists have been practicing for > 20 years, 32% for 5–20 years, and 20% for < 5 years. When asked about the interruption of osteoporosis medications for low-risk dental procedures, such as cavities, 68% never stopped therapy, 17% stopped in certain scenarios, and 15% reported stopping after a discussion with the patient’s provider. When asked about the interruption of osteoporosis medications for high-risk dental procedures, such as tooth extractions, 15% would not interrupt therapy, 23% would interrupt in certain scenarios, 7% would always interrupt therapy, and 55% would interrupt therapy after discussion with the patient’s provider.
Conclusion: Despite the extreme rarity of ONJ, no specific guidelines exist from the American Dental Association (ADA), and dentists’ perspectives on mitigating ONJ are quite varied. Our study suggests that many dentists feel that osteoporosis therapy is a major barrier to safe dental practice and indicates an urgent need for education of our dentist colleagues on the rationale and validity of interrupting osteoporosis therapies.
Research Article
Abstract
Full TextPDF
Type 2 diabetes mellitus (T2DM) is a metabolic disorder with multiple causes. The prevalence of T2DM is on the rise, however, on the African continent, nearly 70% of all T2DM cases go undiagnosed. T2DM places a great burden on the already stretched healthcare systems. Current tests do not provide predictive measures in terms of the possible onset of the disease. Biomarker and gene analysis have been used to predict the onset of the disease, but this has seen very limited use in the African population groups. Identification of variances in biomarkers and subsequent genetic aberrations at early diagnosis could enable clinical focus on patients more likely to develop insulin resistance. The aim of the study was to compare T2DM-associated biomarker levels between T2DM patients and non-T2DM participants and identify genetic variances in single nucleotide polymorphisms (SNPs) associated with the biomarkers. Two cohorts (n = 78) were screened for associated biomarkers using a commercially available enzyme-linked immunosorbent assay (ELISA) kit. The results of this analysis were used to select SNPs in genes associated with the screened biomarkers. The molecular genotyping was completed using quantitative polymerase chain reaction (qPCR) assays. The biomarker analysis revealed significant statistical differences between four of the ten screened biomarkers: Glucose-dependent insulinotropic polypeptide (GIP) (p = 0.0004), resistin (p = 0.0398), visfatin (p = 0.0009), and glucagon (p = 0.0034). The SNPs selected for molecular genotyping were rs6235 in proprotein convertase subtilisin/kexin type 1 (PCSK1) and rs2208203 in proprotein convertase subtilisin/kexin type 2 (PCSK2). Both these genes are involved in the biosynthesis of various biomarkers that were screened. The results from the molecular genotyping failed to show any significant difference between the control and T2DM case groups. While some biomarkers were shown to have significant statistical differences between the two study cohorts, more work needs to be conducted to understand the role of each biomarker in T2DM.
