Browsing by Author "Neeraj Kumar Agrawal"

Now showing 1 - 20 of 21

Case studies for a systematic understanding of development of dementia in diabetic or prediabetic patients
(Elsevier, 2025) Rameshwar Nath Chaurasia; Neeraj Kumar Agrawal; Sanchit Shailendra Chouksey
Dementia, a growing public health concern, is projected to affect 115 million individuals worldwide by 2050. Type 2 diabetes mellitus has the potential risk to impact cognitive health and exacerbate cognitive decline through various mechanisms, including chronic hyperglycemia, vascular complications, and insulin resistance. Research indicates that diabetes contributes to neurodegeneration and cognitive deficits, as evidenced by studies linking glycemic control to cognitive function. Additionally, vascular cognitive impairment, resulting from cerebrovascular disease, highlights the relationship between vascular health and dementia risk. With diabetes, there is 3-5 times the likelihood of developing vascular dementia and increasing the risks associated with Alzheimer’s disease; it is crucial to address diabetes management as part of dementia prevention strategies. These findings highlight the significance of focusing on vascular health and metabolic factors to reduce cognitive decline. This article reviews several cases linking diabetes to cognitive impairment, emphasizing the necessity for early intervention and lifestyle changes to improve both mortality and morbidity © 2026 Elsevier Inc. All rights reserved..
Clinical Prediction of Type 2 Diabetes Mellitus (T2DM) via Anthropometric and Biochemical Variations in Prakriti
(Multidisciplinary Digital Publishing Institute (MDPI), 2022) Shriti Singh; Neeraj Kumar Agrawal; Girish Singh; Sangeeta Gehlot; Santosh Kumar Singh; Rajesh Singh
Type 2 Diabetes Mellitus (T2DM) is a complicated multifactorial illness involving hereditary and external environmental variables. The symptoms typically appear gradually over a number of years without realizing it. This viewpoint is further supported by the Ayurvedic constitution concept (Prakriti). Prakriti explains the biological variability that is observed in different individuals. This study was conducted a retrospective investigation to examine if there was a link between type 2 diabetes and an individual’s constitution based on anthropometric and biochemical characteristics. Physical and mental characteristics and anthropometric and biochemical markers were used to determine reported cases’ prevailing Dosha Prakriti (constitution). Based on biochemical and anthropometric data, significant differences in Prakriti were found between the case (T2DM patients) and control (person without diabetes) groups. The incidence of numerous secondary problems linked with T2DM patients was also evaluated according to their Prakriti types, which revealed a positive relationship. The three primary contributing parameters, such as waist-hip ratio, postprandial blood sugar, and serum creatinine, were correctly classified all person with or without diabetes subjects to 90.6% of the time, whereas the constitution-wise study classified person with diabetes and without diabetes individuals of Pitta and Kapha Prakriti to 94.3% and 90%, respectively. A discriminant function was created to predict a person with diabetes and without diabetes based on these three contributing factors. The primary contributing biochemical parameters discovered by Prakriti in the current study could be used as a biochemical disease diagnostic for predicting type 2 diabetes susceptibility. © 2022 by the authors.
Clinical profile of patients of turner syndrome (TS) with karyotype-phenotype corelation from a tertiary care hospital in Eastern Uttar Pradesh (UP), India
(IP Innovative Publication Pvt. Ltd., 2023) Asha Ranjan; Neeraj Kumar Agrawal; Surya Kumar Singh; Saurabh Arora; Dhananjya Melkunte Shanthaiah; Rujul Jain; Vahid Bharmal
Objective: The present study was done to study the clinical profile and karyotype-phenotype corelation of turner syndrome patients in eastern UP, India. Materials and Methods: The present study was a retrospective observational study conducted from January 2018 to December 2020 on newly diagnosed TS patients. All patients were screened for thyroid dysfunction, celiac disease, diabetes mellitus (DM), dyslipidaemia, liver dysfunction, hearing loss, cardiovascular anomalies and renal anomalies. Data was tabulated in Microsoft excel sheet and averages and means were calculated. Fischer exact test was used to assess the corelation of karyotype with clinical phenotypic features. Results: Total 16 patients were diagnosed with TS and 37.5% were classic 45 XO, 18.5% were mosaic 45X/46XX and rest 43.75% were of rarer TS variants. One patient had mosaicism for X chromosome with reciprocal autosomal translocation-45X, t(12,20)(q24.1p13), 46X, t(12,20)(q24.1p13) *marker karyotype which is the first case reported so far. The average age of presentations was 16.8years ± 3.4years (range 8 to 23 years). One patient with karyotype 46,X, del(Xq22-28) had DM with negative anti-GAD antibodies and one patient with karyotype 46XX/46,X+marker had systemic lupus erythematosus (SLE). No significant karyotype and phenotype corelation was found in our study. Conclusion: We report rare association of SLE with TS and a novel karyotype in TS involving mosaicism for X with autosomal translocation t(12,20). No significant karyotype-phenotype corelation was found in our study. More focused studies are needed to study the genes responsible for various manifestations in TS, pathogenic mechanisms of DM and SLE in TS and the effect of autosomal translocations in TS phenotype. © 2023 Innovative Publication. All rights reserved.
Congenital adrenal hyperplasia complicated by gonadotropin-dependent precocious puberty
(BMJ Publishing Group, 2024) Ahmad Alam; Neeraj Kumar Agrawal; Surya K. Singh
Precocious puberty, characterised by the early appearance of secondary sexual characteristics, poses challenges in diagnosis and management. Here, we describe a case of precocious puberty diagnosed in a boy in middle childhood, who presented with progressive phallus enlargement, pubic hair development and increased aggressive behaviour. Hormonal evaluation confirmed the diagnosis of congenital adrenal hyperplasia (CAH), complicated by gonadotropin-dependent precocious puberty. The case highlights the importance of assessment of testicular volume in a patient presenting with precocious puberty. Symmetrical testicular enlargement in a patient with CAH suggests premature activation of the hypothalamic-pituitary-gonadal axis. The patient received glucocorticoid therapy to suppress androgen production related to CAH and gonadotropin-releasing hormone analogue therapy to control premature activation of the hypothalamic-pituitary-gonadal axis. Follow-up visits showed regression of secondary sexual characteristics and improved growth velocity. © BMJ Publishing Group Limited 2024. No commercial re-use. See rights and permissions. Published by BMJ.
COVID-19-associated Mucormycosis: A clinico-epidemiological study
(Elsevier Inc., 2022) Jaya Chakravarty; Munesh Kumar Gupta; Ragini Tilak; Rajesh kumar; Rajendra Prakash Maurya; Nilesh Kumar; Susheel Kumar Aggarwal; Shiva S; Naresh Kumar Sharma; Neeraj Kumar Dhiman; Manaswi chaubey; Vishambhar Singh; Ashish verma; Tuhina Banerjee; Neeraj Kumar Agrawal; Ravi Shankar Prasad
Background: There was an unprecedented increase in COVID-19-associated-Mucormycosis (CAM) cases during the second pandemic wave in India. Methods: This observational study was done to know the epidemiological profile of CAM cases andincluded all patients admitted with mucormycosis between May 2021 and July 2021. Results: Out of the enrolled 208 CAM cases (either SARS-CoV-2 RT-PCR or serology positive), 204, three and one had rhino-orbital-cerebral, pulmonary and gastrointestinal mucormycosis, respectively. 95.7 % of the patients had diabetes, out of which 42.3 % were recently diagnosed. Mean HbA1c was 10.16 ± 2.56 %. 82.5 % of the patients were unvaccinated. During their COVID-19 illness, 86.5 % were prescribed antibiotics, 84.6 % zinc preparations, 76.4 % ivermectin, and 64.9 % steroids, while only 39.5 % required oxygen therapy. The frequency of blood groups A, B, O and AB in our CAM patients was 29.5 %, 18.9 %, 38.9 % &12.6 %, respectively. At three months follow up, 60 (28.8 %) patients died, four (1.9 %) stopped antifungal treatment, and 144(69.23 %) were on antifungal treatment. 55 % (n = 33) of deaths occurred within 15 days of admission. Mortality was significantly associated with higher age, RT-PCR positive for SARS-CoV-2, raised serum creatinine and alkaline phosphatase during treatment. At 6 months follow-up, eight more patients died, three due to chronic kidney disease, four patients who had stopped treatment and one patient who was on a ventilator due to COVID-19 associated pneumonia and the rest 140(67.3 %) survived. Conclusion: Uncontrolled hyperglycemia, SARS-CoV-2 infection, rampant use of antibiotics, zinc supplementation and steroids were some of the risk factors for mucormycosis. Despite the overwhelming number of patients with an uncommon disease like mucormycosis, the six months mortality was much lower than expected. © 2022
Diabetes and rhino-orbito-cerebral mucormycosis – A deadly duo
(Springer Science and Business Media Deutschland GmbH, 2021) Parminder Singh; Saurabh Arora; Naveen Mittal; Amroz Singh; Rohit Verma; Sarit Sharma; Neeraj Kumar Agrawal; Saloni Goyal
Background: Rhino-orbito-cerebral mucormycosis(ROCM) is an uncommon yet potentially fatal fungal infection predominantly seen in immunocompromised individuals. However, there is very limited data available from India regarding outcome of patients with ROCM and diabetes mellitus. Objective: To ascertain clinical parameters and factors in the final outcome of patients with diabetes mellitus and ROCM. Materials and Methods: This series included retrospective analysis of medical records of 91 patients with diabetes mellitus who were diagnosed with ROCM from january 2007 to june 2019 at a tertiary care hospital in Punjab. Results: The mean age of patients was 52.6 years (range 18–82 years), with men constituting the majority (71.4 %). Ophthalmoplegia was the most frequent presenting feature seen in 77 % of patients followed by proptosis (71 %). Intracranial involvement was seen in 20 % of the patients and cavernous sinus thrombosis was diagnosed in 9(10 %) patients. Out of 91 patients, 81 patients were subjected to appropriate surgical procedure depending upon site and extent of involvement by mucorales. A total of 53 (58.2 %) patients survived while 38(41.8 %) patients succumbed. Delay in presentation to hospital, intracranial extension and loss of vision at presentation adversely affected the outcome (p < 0.05). Aggressive surgical management in the form of multiple debridements was superior to single debridement (p < 0.05). Diabetic ketoacidosis did not significantly affect the outcome (p = 0.359). Conclusions: ROCM in patients with diabetes mellitus, is a rapidly progressive disease with a high fatality rate and grave outcome unless diagnosed early and managed aggressively. © 2021, Springer Nature Switzerland AG.
Does using a high sun protection factor sunscreen on face, along with physical photoprotection advice, in patients with melasma, change serum Vitamin D concentration in Indian conditions? A pragmatic pretest-posttest study
(Wolters Kluwer Medknow Publications, 2019) Sanjay Singh; Bandana Jha; Narendra Kumar Tiwary; Neeraj Kumar Agrawal
Background: Use of sunscreens on the face is becoming popular, and patients with melasma are prescribed sunscreen for use on the face. Results of a few Western studies on the effect of sunscreen use on serum vitamin D concentration are not applicable to Indian conditions. Aims: To examine the effect of use of a high sun protection factor (SPF 50+, PA++++) sunscreen on face in patients with melasma on serum concentration of 25-hydroxyvitamin D. Methods: Forty-five Indian patients (Fitzpatrick skin types III and IV) with melasma were advised to use a sunscreen with SPF 50 + for 3 months, 43 (33 female, 10 male; age 32.9 ± 8 years) completed the study. Patients staying outdoor for <4 hours applied sunscreen once daily after bath. Patients staying outdoors for >4 hours reapplied sunscreen 4 hours after first application. Patients were provided a container to measure the amount of sunscreen for use, which was approximately equal to recommended thickness. Compliance was tested by weighing the used tubes and tubes in use during monthly visits. Serum concentration of 25-hydroxyvitamin D was tested before and after the study period. Results: Amount of sunscreen advised (100.5 ± 29.2 ml) and the actual amount used (96.6 ± 27.9 ml) were similar (P = 0.53, t-test). The difference between serum concentrations of 25-hydroxyvitamin D at the baseline (19.20 ± 9.06 ng/ml) and at 3 months (18.91 ± 8.39 ng/ml) was not significant (P = 0.87, paired t-test, 95% confidence interval of difference-3.33 to 3.92). No correlation was found between the amount of sunscreen used and the percentage change in serum 25-hydroxyvitamin D concentration at 3 months (rho = 0.099, P = 0.528, Spearman's rank correlation). Limitations: Longer duration of application and a larger sample size may detect minor differences in vitamin D concentration. Conclusion: Using a high SPF sunscreen on the face, along with physical photoprotection advice, in patients with melasma for 3 months does not influence serum 25-hydroxyvitamin D concentration in Indian conditions. © 2019 Indian Journal of Dermatology, Venereology and Leprology | Published by Wolters Kluwer-Medknow.
Early detection of cutaneous complications of insulin therapy in type 1 and type 2 diabetes mellitus
(Elsevier Ltd, 2021) Saurabh Arora; Neeraj Kumar Agrawal; Dhananjaya Melkunte Shanthaiah; Ashish Verma; Sanjay Singh; Shashikant C.U. Patne; Sanjay Kalra; Parminder Singh; Saloni Goyal
Background: Subcutaneous insulin therapy is associated with important injection site complications, which can influence insulin pharmacokinetics resulting in glycemic fluctuations above and below target levels for blood glucose. Objective: Our objective was to assess the prevalence and risk factors of cutaneous complications including insulin derived amyloidosis in insulin-injecting diabetes patients and to study the role of ultrasonography (in comparison to gel-assisted palpation) in early diagnosis of lipohypertrophy (LH). Methods: This was a cross-sectional study conducted at a tertiary care center in India, wherein 500 patients injecting insulin for ≥2 years were randomly enrolled and evaluated for the presence of cutaneous complications of insulin therapy through clinical examination, ultrasonography and punch biopsy of skin. Results: Clinical examination detected LH in 44.6% of patients. Ultrasonography diagnosed additional 13.4% of patients with LH which were missed on clinical examination. Incorrect rotation of sites (P < 0.001) and insulin syringe reusage for more than five times (P < 0.001) significantly increased the risk of LH. Skin biopsy was performed in 100 cases, out of which two patients showed apple green birefringence and its association with insulin was confirmed by positive staining with anti insulin antibody in these two patients. Conclusion: Improper rotation of sites and reuse of needles were the leading causes of LH in Indian diabetic patients. Ultrasonography is more objective and reliable method of detecting LH. Insulin-derived amyloidosis may be a more common complication of insulin therapy than previously thought. © 2021 Primary Care Diabetes Europe
FAS-670 A/G and FAS-1377 G/A polymorphism in cell death pathway gene FAS and human male infertility
(Elsevier (Singapore) Pte Ltd, 2012) Deepika Jaiswal; Udai Shankar Dwivedi; Neeraj Kumar Agrawal; Sameer Trivedi; Kiran Singh
Objective: To study the role and association of functional variations present in FAS gene with idiopathic male infertility. Methods: The case-control study comprised of two groups: 160 idiopathic infertile nonobstructive azoospermia patients and 200 fertile healthy control men. Genotyping for single-nucleotide polymorphism of FAS-670 A/G (rs1800682) and FAS-1377 G/A (rs2234767) was done by PCR-RFLP method. DNA sequencing was used to ascertain PCR-RFLP results. For FAS-670 A/G and FAS-1377 G/A functional polymorphism, allele and genotype distribution were evaluated using Chi-square test. Results: Allele and genotype distribution did not differ significantly between patients and controls for FAS-670 A/G and FAS-1377 G/A. Conclusions: Human male infertility is a complex disorder and thus other genetic or environmental factors may be contributing to the complex etiology. © 2012 Hainan Medical College.
Genome-wide differential methylation analyses identifies methylation signatures of male infertility
(Oxford University Press, 2018) Kumar Mohanty Sujit; Saumya Sarkar; Vertika Singh; Rajesh Pandey; Neeraj Kumar Agrawal; Sameer Trivedi; Kiran Singh; Gopal Gupta; Singh Rajender
STUDY QUESTION: Do methylation changes in sperm DNA correlate with infertility? STUDY ANSWER: Loss of spermatogenesis and fertility was correlated with 1680 differentially-methylated CpGs (DMCs) across 1052 genes. WHAT IS KNOWN ALREADY: Methylation changes in a number of genes have been correlated with reduced sperm count and motility. STUDY DESIGN, SIZE, DURATION: This case-control study used spermatozoal DNA from 38 oligo-/oligoastheno-zoospermic infertile patients and 26 normozoospermic fertile men. PARTICIPANTS/MATERIALS, SETTINGS, METHODS: Genome-wide methylation analysis was undertaken using 450 K BeadChip on spermatozoal DNA from six infertile and six fertile men to identify DMCs. This was followed by deep sequencing of spermatozoal DNA from 32 infertile patients and 20 fertile controls. MAIN RESULTS AND THE ROLE OF CHANCE: A total of 1680 DMCs were identified, out of which 1436 were hypermethylated and 244 were hypomethylated. Classification of DMCs according to the genes identified BCAN, CTNNA3, DLGAP2, GATA3, MAGI2 and TP73 among imprinted genes, SPATA5, SPATA7, SPATA16 and SPATA22 among spermatogenesis-associated genes, KDM4C and JMJD1C, EZH2 and HDAC4 among genes which regulate methylation and gene expression, HLA-C, HLA-DRB6 and HLA-DQA1 among complementation and immune response genes, and CRISPLD1, LPHN3 and CPEB2 among other genes. Genes showing significant differential methylation in deep sequencing, i.e. HOXB1, GATA3, EBF3, BCAN and TCERG1L, are strong candidates for further investigations. The role of chance was ruled out by deep sequencing of select genes. LARGE-SCALE DATA: N/A. LIMITATIONS, REASON FOR CAUTION: Genome-wide analyses are fairly accurate, but may not be exactly validated in replication studies across all DMCs. We used the 't' test in the genome-wide methylation analysis, whereas other tests could provide a more robust and powerful analysis. WIDER IMPLICATIONS OF THE FINDINGS: DMCs can serve as markers for inclusion in infertility screening panels, particularly those in the genes showing differential methylation consistent with previous studies. The genes validated by deep sequencing are strong candidates for investigations of their roles in spermatogenesis.STUDY FUNDING/COMPETING INTEREST(S): The study was funded by the Council of Scientific and Industrial Research (CSIR), Govt. of India with grant number BSC0101 awarded to Rajender Singh. None of the authors has any competing interest to declare. © The Author(s) 2018. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved.
HPG axis: The central regulator of spermatogenesis and male fertility
(Springer Singapore, 2017) Vertika Singh; Neeraj Kumar Agrawal; Rajesh Verma; Kiran Singh
Pituitary gonadotropins have been established as essential components for the differentiation of the male reproductive organs. Human sexual maturation and spermatogenesis are intricately regulated by the hypothalamic-pituitary-gonadal (HPG) axis, which eventually determines the reproductive potential of an organism. Alterations affecting this fine balance can severely impair sexual development and fertility. These defects may result from mutations, small deletions or polymorphic changes within the regulatory genes involved in the biosynthesis of hormones, hormone receptors, growth factors and their associated signal transduction pathways. This present chapter summarizes the functioning and regulation of the HPG axis, its control over spermatogenesis by means of FSH and LH synthesis, and the impact of endocrine disruptors on this central axis regulating fertility. © Springer Nature Singapore Pte Ltd. 2017. All rights reserved.
Integrated use of contrast-enhanced and grey-scale ultrasound in assigning American College of Radiology Thyroid Imaging–Reporting and Data System scores for characterisation of thyroid nodules: A prospective observational study
(SAGE Publications Ltd, 2024) Ashish Verma; Adith Krishna K; Ishan Kumar; Pramod Kumar Singh; Amrita Ghosh Kar; Neeraj Kumar Agrawal
Background: The advent and increased use of high-resolution ultrasonography has resulted in improved detection of thyroid nodules. Even with the use of various Thyroid Imaging–Reporting and Data System, accurate imaging diagnosis of malignant thyroid nodules has been suboptimal, which necessitated use of newer modalities like contrast-enhanced ultrasonography alone and in combination for this purpose. Although the combined use of various Thyroid Imaging–Reporting and Data System and contrast-enhanced ultrasonography has turned out to be accurate in many studies, the ideal way to integrate contrast-enhanced ultrasonography into the Thyroid Imaging–Reporting and Data System algorithm is under-investigated. Purpose: To estimate and compare the diagnostic accuracy of American College of Radiology Thyroid Imaging–Reporting and Data System and contrast-enhanced ultrasonography in differentiating benign and malignant nodules alone and in combination. To estimate the diagnostic accuracy of contrast-enhanced ultrasonography in re-categorisation of Thyroid Imaging–Reporting and Data System 3 and Thyroid Imaging–Reporting and Data System 4 thyroid nodules. Materials and methods: This was a prospective cohort study performed in a tertiary care university–based hospital for 3 years. Adult patients with clinical or previous sonographic diagnosis of thyroid nodules were selected. Each of the nodules were assessed using ultrasonography and categorised using American College of Radiology Thyroid Imaging–Reporting and Data System criteria. The lesion was then assessed for contrast-enhanced ultrasonography features. The final diagnosis of the nodules was made using fine needle aspiration cytology. The diagnostic accuracy in diagnosis of malignant thyroid nodules for each of the American College of Radiology Thyroid Imaging–Reporting and Data System and contrast-enhanced ultrasonography alone and in combination was assessed. The diagnostic accuracy of contrast-enhanced ultrasonography in diagnosis of malignant thyroid nodules categorised as Thyroid Imaging–Reporting and Data System 3 and Thyroid Imaging–Reporting and Data System 4 was also assessed. Results: American College of Radiology Thyroid Imaging–Reporting and Data System had a sensitivity, specificity, negative predictive value, positive predictive value and diagnostic accuracy of 86.6%, 54.5%, 17.4%, 97.3% and 57.7%, respectively, in diagnosis of malignant thyroid nodules. Contrast-enhanced ultrasonography had a sensitivity, specificity, negative predictive value, positive predictive value and diagnostic accuracy of 86.6%, 95.4%, 67.9%, 98.4% and 94.4%, respectively, in diagnosis of malignant thyroid nodules. Contrast-enhanced ultrasonography had sensitivity, specificity, negative predictive value, positive predictive value and diagnostic accuracy of 93.3%, 100.0%, 100.0%, 99.2% and 99.3%, respectively, in re-categorisation of Thyroid Imaging–Reporting and Data System 3 and Thyroid Imaging–Reporting and Data System 4 nodules. Conclusion: Contrast-enhanced ultrasonography can play a key role in diagnosis of malignant thyroid nodules which are categorised as indeterminate on grey-scale ultrasound. © The Author(s) 2024.
Melatonin alleviates hyperthyroidism induced oxidative stress and neuronal cell death in hippocampus of aged female golden hamster, Mesocricetus auratus
(Elsevier Inc., 2016) Geeta Rao; Rakesh Verma; Arun Mukherjee; Chandana Haldar; Neeraj Kumar Agrawal
Oxidative stress is a well known phenomenon under hyperthyroid condition that induces various physiological and neural problems with a higher prevalence in females. We, therefore investigated the antioxidant potential of melatonin (Mel) on hyperthyroidism-induced oxidative stress and neuronal cell death in the hippocampus region of brain (cognition and memory centre) of aged female golden hamster, Mesocricetus auratus. Aged female hamsters were randomly divided into four experimental groups (n = 7); group-I: control, group-II: Melatonin (5 mg kg− 1 day− 1, i.p., for one week), group-III: Hyperthyroid (100 μg kg− 1 day− 1, i.p., for two weeks) and group-IV- Hyper + Mel. Hormonal profiles (thyroid and melatonin), activity of antioxidant enzymes (SOD, CAT and GPX), lipid peroxidation level (TBARS) and the specific apoptotic markers (Bax/Bcl-2 ratio and Caspase-3) expression were evaluated. A significant increase in the profile of total thyroid hormone (tT3 and tT4) in hyperthyroidic group as compared to control while tT3 significantly decreased in melatonin treated hyperthyroidic group. However, Mel level significantly decreased in hyperthyroidic group but increased in melatonin treated hyperthyroidic group. Further, the number of immune-positive cells for thyroid hormone receptor-alpha (TR-α) decreased in the hippocampus of hyperthyroidic group and increased in melatonin treated hyperthyroidic group. Profiles of antioxidant enzymes showed a significant decrease in hyperthyroidic group with a simultaneous increase in lipid peroxidation (TBARS). Melatonin treatment to hyperthyroidic group lead to decreased TBARS level with a concomitant increase in antioxidant enzyme activity. Moreover, increased expression of Bax/Bcl-2 ratio and Caspase-3, in hyperthyroidic group had elevated neuronal cell death in hippocampal area and melatonin treatment reduced its expression in hyperthyroidic group. Our findings thus indicate that melatonin reduced the hyperthyroidism-induced oxidative stress and neuronal cell death in the hippocampus region of brain, suggesting a novel therapeutic approach of melatonin for management of cognition and memory function in females under hyperthyroid condition. © 2016 Elsevier Inc.
Molecular study of the KCNJ11 gene and its correlation with Prakriti to preventing and managing type 2 diabetes
(National Taiwan University, 2024) Shriti Singh; Sangeeta Gehlot; Neeraj Kumar Agrawal; Girish Singh; Devshree Singh; Prabhjot Kaur; Santosh Kumar Singh; Rajesh Singh
In Ayurveda, every individual is believed to possess a unique entity known as Prakriti, which distinguishes them from others physically, physiologically, and psychologically. This entity also determines an individual's response to a particular stimulus, and it is believed that such responses are not solely determined by genetics. The present research aims to validate the Ayurvedic concept of Prakriti from a modern molecular perspective to strengthen the personalized and precise treatment approach. A study was conducted to investigate the role of the KCNJ11gene in the susceptibility of individuals to type 2 diabetes mellitus (T2DM) with their metabolic status. The research involved allele mining on three major Prakriti groups - Vata, Pitta, and Kapha - in 112 patients with T2DM and 112 healthy individuals. The KCNJ11 gene, responsible for insulin secretion membrane pore formation, was analyzed to determine the susceptibility of different Prakriti types to T2DM. The MutPred tool predicted the molecular cause of disease-related amino acid substitution. According to the study, only Pitta and Kapha Prakriti were diagnosed with diabetes, while all three Prakriti types were present in the control group of healthy individuals. A protein model was prepared, and the changes resulting from mutations were observed for each group in their protein sequence, both as synonymous and non-synonymous mutations. Ultimately, these changes contributed to the manifestation of T2DM. Based on the findings, it appears that Prakriti groups may experience changes in protein function due to nonsynonymous mutations and differences in amino acids at the protein level. © 2024 Center for Food and Biomolecules, National Taiwan University
Outcome of Diabetic Pregnancies in a Tertiary Referral Centre, Varanasi
(Federation of Obstetric and Gynecologycal Societies of India, 2016) Uma Pandey; Neeraj Kumar Agrawal; Shilpa Agrawal; Shuchita Batra
Aim: The study was done to determine the maternal and fetal outcome of pregnancies complicated by maternal diabetes either Gestational Diabetes Mellitus (GDM) or preexisting (type 1 or type 2) diabetes over a period from March 2011 to Feb 2013 in a tertiary care hospital, Varanasi. Methods: This is a retrospective audit of the maternal and fetal outcome of women who presented to the Sir Sundar Lal Hospital, Department of Obstetrics and Gynaecology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India from March 2011 to Feb 2013, with GDM or pre-existing type 1 or type 2 Diabetes with pregnancy. The audit group comprised 65 pregnancies (67 babies), of whom 27 had preexisting diabetes and 38 cases developed gestational diabetes. Pregnant women who were found to be diabetic preconceptionally or in the first trimester were classified as ‘pre-existing diabetes’. Results: There were total of 65 diabetic women in this retrospective study, 39 women were GDM (60 %) while 26 women (40 %) were having pre-existing diabetes (24 type 1 diabetes and 2 women were in type 2 diabetes group). There were 35 multigravid women (53.85 %) and 30 primigravid women (46.15 %). There were 39 (60 %) women on Insulin. There were 42 Lower Segment Caesarean Section (64.62 %) and 23 Spontaneous Vaginal Delivery (35.38 %). In fetal and neonatal complications, there were three still births, one case of intrapartum death, and one case of shoulder dystocia. Fetal anomalies were less frequent, one case of Gastroschisis with Hydrocephalus associated with Menigomyelocoele, there was one case of isolated Hydrocephalus, and there was also one case of Truncus arteriosus. Conclusions: The study analyses maternal and fetal complication in the GDM group and also preexisting diabetes group. In our centre, the 60 % women were GDM while 40 % were having pre-existing diabetes. Total rate of fetal/neonatal complication rate was 7.69 % and of congenital anomaly rate it was 9.23 %. Proportion of still birth, Intrauterine death, and congenital malformations was higher in the pre-existing diabetes group although the data are not large enough to draw a statistically significant conclusion. LSCS rate was little higher in the GDM group (69.23 %) in comparison to the preexisting diabetes group where it was 57.69 %. SVD (Spontaneous Vaginal Delivery) rate was 30.77 % in GDM and 42.31 % in the pre-existing diabetes group. HbA1c was within normal range 84.62 % of GDM group while in 15.38 % it was raised >6 %. In the pre-existing diabetes group, only 19.23 % of women had HbA1c within acceptable range and 80.77 % had it >6. The aim of St Vincent Declaration is to ‘achieve pregnancy outcome in the diabetic woman that is similar to that of the non-diabetic woman.’ But, so far we have not been able to achieve this. Our HbA1c level is remarkably high in the pre-existing diabetes group. Only 3 out of 65 patients’ women took Folic Acid periconceptionally. We need to work to achieve it our best. It is well known that insulin treatment during pregnancy results in reduction in the rate of macrosomia, fetal/neonatal, and maternal complications. Therefore, we need to use insulin judiciously and advocate its usage in the situations where it is needed. © 2015, Federation of Obstetric & Gynecological Societies of India.
Patterns and outcomes of late onset thyroid disturbances after COVID-19 vaccination: A report of 75 cases
(John Wiley and Sons Inc, 2024) Upinder Kaur; Noti Taruni Srija Reddy; Jaideep Reddy; Dondapati Venkata Vamshi Krishna; Amol Dehade; Neeraj Kumar Agrawal
Isolated cases of subacute thyroiditis exist in the early period of COVID-19 vaccination, largely after mRNA vaccines. Here we report late onset thyroid disturbances and persistent health issues in patients of thyroid disorders after COVID-19 vaccination. Seventy-five patients with post COVID-19 vaccination thyroid disturbances were identified. Among these, 41 had flare of underlying thyroid illness, majority occurring at a median time lag of 28.4 weeks since 2nd dose. Thirty-one cases of new onset hypothyroidism and three of new onset hyperthyroidism were reported, with a median time lag respectively of 17.2 and 22.6 weeks since 2nd dose. Most cases occurred after ChAdOx1-nCoV-19, which was the commonest vaccine employed in mass roll out in India. Significant improvement was observed in majority, after a median follow up of 22–26 weeks. New onset health issues persisting for ≥4 weeks were reported in 37.3% and were common in individuals with history of COVID-19 before vaccine. New onset metabolic, musculoskeletal, and reproductive disorders were the common health complaints. Active monitoring is warranted for late onset adverse events after COVID-19 vaccines of all types. Larger studies with involvement of unvaccinated individuals are required to understand the incidence and causality of late onset thyroid disturbances after COVID-19 vaccines. © 2023 John Wiley & Sons Ltd.
Prevalence of autoantibodies and HLA DR, DQ in type 1 diabetes mellitus
(Journal of Clinical and Diagnostic Research, 2016) Shailja Singh; Usha; Gyanendra Singh; Neeraj Kumar Agrawal; Rana Gopal Singh; Shashi Bhushan Kumar
Introduction: Type I diabetes Mellitus (T1DM) is caused by autoimmune destruction of β-cells of pancreas. Two forms of T1DM are known called as 1A (autoimmune) and 1B (idiopathic). Aim: Aim was to study the prevalence of Anti-TTG IgA, Anti-TPO, GADA, ZnT8 and IA-2 autoantibodies and HLA DR and DQ genes and its diagnostic value in T1DM.Materials and Methods: Thirty four T1DM patients, 59 type 2 diabetes mellitus (T2DM) patients and 28 healthy controls were included in study. Antibodies levels were estimated by ELISA and HLA typing was performed by SSP-PCR method.Result: The prevalence of various autoantibodies in T1DM were Anti-TTG 14.7%, Anti-TPO 17.65%, GADA 38.23%, ZnT8 11.76% and IA-2 5.88%. Only GADA and ZnT8 were significantly positive in T1DM. GADA (66.67%) and ZnT8 (33.33%) positivity was more in patients below 15 years age while levels of other antibodies were higher after 15 years age. All autoantibodies were detected in higher frequency in T1DM than in T2DM and controls.HLA DR and DQ typing showed highly significant increase in DRB1*0301 (61.76%, p=0.00) and DQB1*0201 (64.71%, p=0.00) in T1DM. Subjects with HLA DRB1*0301 and DQB1*0201 had 80-100% positive prevalence of GADA, ZnT8, IA-2, Anti-TTG and Anti-TPO autoantibodies.Conclusion: Combination of GADA antibody with DRB1 and DQB1 estimation improved diagnosis of T1A than insulin antigen specific antibodies alone. © 2016, Journal of Clinical and Diagnostic Research. All rights reserved.
Prevalence of osteoporosis in otherwise healthy Indian males aged 50 years and above
(Springer London, 2013) Neeraj Kumar Agrawal; Balram Sharma
Bone mineral density was studied in 200 healthy Indian men above 50 years age, without fractures or osteoporosis. Mean vitamin D was 18.96 ng/ml; other biochemical evaluations were normal. Bone density (femur neck) decreased with age; there was osteoporosis in 8.5 %, osteopenia in 42 %, while 49.5 % were normal. Vitamin D deficiency may have caused osteoporosis. Purpose: Osteoporosis is recognized as the disease of females; however, males are also affected and have serious consequences thereof. The present study aimed at studying the prevalence of osteoporosis in otherwise healthy Indian males aged 50 years or more and studying the factors affecting bone mineral density (BMD). Methods: With informed consent, 200 healthy males aged 50 years or more without the history of fractures or diseases affecting the BMD were evaluated clinically (including anthropometry) and biochemically (serum calcium, phosphate, alkaline phosphatase, creatinine, albumin, 25-OH Vitamin D, intact parathyroid hormone (iPTH), and testosterone). The BMD was measured by single observer on Lunar DPX-NT at right proximal femur for least effects of artifacts. Calculation of T score and categorization as osteoporosis, osteopenia, and normal BMD was done as per WHO classification. Results: The mean age was 62.61 ± 7.64 years, and BMI was 23.90 ± 3.73 kg/m2. The testosterone levels were normal in 84 % subjects. The mean 25-OH vitamin D level was 18.96 ± 10.23 ng/ml; only 13.5 % subjects had normal levels. The mean iPTH level was 72.60 ± 43.77 pg/ml; 57 % subjects had normal iPTH (12-72 pg/ml). The other parameters studied were normal. The osteoporosis and osteopenia were more prevalent when BMD was evaluated at neck of femur (osteoporosis 8.5 vs 8 % at trochanter and 7.5 % at total right hip; osteopenia 42 vs 37 % at trochanter and 41 % at total right hip). The BMD deteriorated with age. Conclusion: The osteoporosis affects 8.5 % of otherwise healthy males aged 50 years and above. Vitamin D deficiency is common in such group and maybe responsible for osteoporosis. © 2013 International Osteoporosis Foundation and National Osteoporosis Foundation.
Recurrent femoral neck fractures: keep an eye out for Cushing’s syndrome
(BMJ Publishing Group, 2024) Ahmad Alam; Shinjan Patra; Neeraj Kumar Agrawal; Surya K. Singh
Prolonged glucocorticoid overexposure leads to Cushing’s syndrome (CS). It is characterised by diverse metabolic, cardiovascular and bone mineral manifestations. A middle-aged woman presented for a preoperative evaluation of a pathological fracture of the left neck of the femur. She had a history of a hip fracture on the opposite side 3 years back. She exhibited several features specific to CS and was subsequently diagnosed with Cushing’s disease. She underwent transsphenoidal adenoma resection and achieved remission. Glucocorticoids primarily affect the trabecular bone compared with cortical bones, and vertebral fractures are common in CS. The femoral neck consists of both trabecular and cortical bone and can be involved in CS. Our patient was not diagnosed as C at the first pathological fracture and was subsequently diagnosed only after the second fracture. This case report underscores the importance of a diligent search for a possible endocrinological aetiology in any case of pathological fractures. Copyright 2023 BMJ Publishing Group. All rights reserved.
Roles of sodium-glucose cotransporter 2 inhibitors and glucagon-like peptide-1 agonists in neuroprotection in diabetics
(Elsevier, 2025) Neeraj Kumar Agrawal; Y. H. Phirke
Sodium-glucose cotransporter 2 (SGLT2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists are emerging as neuroprotective agents in diabetic patients, with potential benefits in mitigating neurodegeneration and enhancing cognitive function. SGLT2 inhibitors, primarily used for managing type 2 diabetes, exhibit neuroprotective effects by reducing inflammation, oxidative stress, and mitochondrial dysfunction while improving endothelial function and cerebral blood flow. These agents can effectively cross the blood-brain barrier, directly influencing central nervous system mechanisms. Notably, their selectivity for SGLT2 over SGLT1 minimizes gastrointestinal side effects and enhances neuroprotective outcomes, particularly in cognitive function and seizure activity. GLP-1 receptor agonists, traditionally used for glycemic control, also demonstrate significant neuroprotective properties. Research indicates that they promote neurogenesis, reduce neuroinflammation, and enhance cognition. Studies have shown that GLP-1 receptor activation can lower amyloid-beta plaque deposition in Alzheimer’s disease models and protect dopaminergic neurons in Parkinson’s disease. These agonists are associated with improved memory and synaptic plasticity and may protect neurons from ischemic injury, indicating their potential role in acute neurological events like stroke. The dual action of SGLT2 inhibitors and GLP-1 receptor agonists emphasizes the connection between metabolic regulation and neuroprotection, presenting promising therapeutic avenues beyond diabetes management. Their roles in enhancing neuronal survival, reducing oxidative stress, and improving cognitive function provide a compelling basis for further investigation into their use for neurodegenerative diseases. Ongoing research is essential to fully elucidate their mechanisms and efficacy, suggesting that these agents may significantly benefit neuronal health and cognitive function in diabetic patients facing neurodegeneration. © 2026 Elsevier Inc. All rights reserved..