The predictability of triglyceride glucose index (TyG index) as a biomarker for identification of insulin resistance (IR) is being extensively studied in various ethnic populations. TyG index could be a beneficial tool for identification of IR and populations at high risk for developing diabetes in future. However, more studies are required to standardize optimal cut-off values in different ethnicities and populations. The present review describes existing literature, and identifies merits and demerits of TyG index as a surrogate marker for IR. Keywords: Triglyceride Glucose Index, Insulin resistance, Type 2 Diabetes Mellitus.

OBJECTIVE -Increased pulse pressure has been associated with increased cardiovascular risk in individuals with diabetes. Changes in central aortic properties can increase central pulse pressure and may adversely affect microvascular perfusion and cardiac performance. This study was performed to define early changes in central arterial properties in a group of young individuals with type 1 diabetes. RESEARCH AND DESIGN METHODS -Seventeen individuals with type 1 diabetesand their nondiabetic control subjects who were participating in the Cardio-Diab Study had arterial stiffness and pulsatile hemodynamics measured with calibrated tonometry and pulsed Doppler. Aortic characteristic impedance (Z c ) was calculated from the ratio of change in carotid pressure and aortic flow in early systole. Pulse wave velocity (PWV) was assessed from tonometry and body surface measurements.RESULTS -Duration of type 1 diabetes was 15.3 Ϯ 0.7 (mean Ϯ SD) years. In type 1 diabetic subjects, central pulse pressure was elevated (45 Ϯ 11 vs. 36 Ϯ 10 mmHg in control subjects, P ϭ 0.02), as was peripheral pulse pressure (54 Ϯ 13 vs. 43 Ϯ 10 mmHg, P ϭ 0.002). Z c was elevated in type 1 diabetes (179 Ϯ 57 vs. 136 Ϯ 42 dynes ϫ s/cm 5 in control subjects, P ϭ 0.004), whereas PWV was not different (5.9 Ϯ 0.9 vs. 5.9 Ϯ 0.7 m/s in type 1 diabetic vs. control subjects, respectively; NS). There was a moderate correlation between Z c and urinary albumin excretion (coefficient 0.39, P ϭ 0.02). CONCLUSIONS-Z c appears to be increased early in type 1 diabetes, before elevation of PWV and is associated with higher pulse pressure, which may contribute to renal microvascular damage in diabetes.

Background: In view of COVID-19 lockdown in India, many colleges started online classes. This study aimed to evaluate the attitude of and the factors affecting medical students attending online classes during lockdown. Methods: We designed an online questionnaire with open-ended, close-ended, and Linkert scale questions. Links to the questionnaires were shared with the medical undergraduate students who have attended at least one online class during the COVID-19 lockdown period. Respondents were 1061 participants from 30 medical colleges from the states of Kerala and Tamil Nadu in India. Results: The majority of students – 94 % (955/1016) – used smartphones to attend online classes. ZOOM/ Skype – by 57.1 % (580/1016) – and Google platforms – by 54.4 % (553/1016) – were commonly used. Learning at leisure – 44.5 % (452/1016) – was the top reason why students liked online classes, whereas network problems – 85.8 % (872/1016) – was the top reason why students disliked them. Lack of sufficient interaction – 61.1% (621/1016) and more than half the participants – 51.7% (526/1016) – did not want to continue online classes after COVID-19 lockdown. More students – 55% (558/1016) – favored regular classes than online classes. Conclusion: Students in our survey did not seem favorably disposed to online classes. Network problems experienced by students should be addressed. Furthermore, teachers should try to make the classes more interactive and educational institutions should address the problem pointed out by the students in order to make online classes more effective in the future.

A 30-year-old male with cerebral palsy and motor impairment presented with right femur fracture. He had gradually worsening mobility and contractures of all extremities for the preceding 5 years. Evaluation showed multiple vertebral and femoral fractures, severe osteoporosis, a large parathyroid adenoma, and parathormone (PTH) exceeding 2500 pg/mL. Because of poor general health and high anesthetic risk, parathyroidectomy was deemed impractical. Ultrasound-guided radiofrequency ablation (RFA) helped achieve 50% size reduction and PTH levels with better control of hypercalcemia. Later, as calcium and PTH remained elevated, percutaneous ethanol ablation was performed with resultant normalization of PTH and substantial symptomatic improvement. Two years later, he still remains normocalcaemic with normal PTH levels. We propose that RFA and percutaneous ethanol ablation be considered as effective short-term options for surgically difficult cases, which could even help achieve long-term remission. Although not previously reported, our case illustrates that both RFA and percutaneous ethanol ablation could be safely performed successively achieving long-term remission.

Background: Necrotizing enterocolitis (NEC) is a neonatal emergency that affects preterm newborns during the 1st weeks of life. Diagnosis is made mainly by clinical criteria since no specific diagnostic tests are available. Objective: The objective was to evaluate fecal calprotectin (fCal) as a biomarker of gut inflammation to predict NEC in preterm neonates. Methods: Design: Diagnostic test evaluation. Inclusion criteria: 102 preterm neonates <36 weeks gestation and within 7 days of birth admitted in Level III neonatal intensive care unit (NICU) were recruited from January 2010 to May 2011. Exclusion criteria: Congenital anomalies and overt infection. Paired stool samples at day 3 and 7 were analyzed by lateral quantum blue rapid calprotectin assay. Cut-off values of fCal were determined among 30 term healthy infants. A structured questionnaire which included gestational age, symptoms at admission, and modified Bell’s staging was used to record NEC episodes on day 3 and 7 of admission. Septic screen and radiological tools were done as per NICU protocol. Results: 48% were above 34 weeks gestation; 31.3% were of very low birth weight. As per modified Bell’s staging on day 3 and 7, 22 and 11 neonates had 1a or above stage, respectively. 15 had features of NEC; of these, 12 were managed appropriately and discharged and 3 died. In the receiver-operated curve with fCal >279 ?g/g as cutoff, the area under the curve was 0.652 (95% confidence interval: 0.516-0.789). Day 3 fCal levels were high in 65.7% neonates. Using NEC as outcome, sensitivity of the test was 93.3%; specificity was 39%; positive predictive value was 20.8% and negative predictive value was 97.14%. Conclusion: fCal has high sensitivity for diagnosing NEC in preterm neonates. However, further research is needed to establish its clinical usefulness.