30 results on '"Usha, Sriram"'
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2. Use of capillary blood glucose for screening for gestational diabetes mellitus in resource-constrained settings
- Author
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Bhavadharini, Balaji, Mahalakshmi, Manni Mohanraj, Maheswari, Kumar, Kalaiyarasi, Gunasekaran, Anjana, Ranjit Mohan, Deepa, Mohan, Ranjani, Harish, Priya, Miranda, Uma, Ram, Usha, Sriram, Pastakia, Sonak D., Malanda, Belma, Belton, Anne, Unnikrishnan, Ranjit, Kayal, Arivudainambi, and Mohan, Viswanathan
- Published
- 2016
- Full Text
- View/download PDF
3. Comparison of screening for gestational diabetes mellitus by oral glucose tolerance tests done in the non-fasting (random) and fasting states
- Author
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Mohan, Viswanathan, Mahalakshmi, Manni Mohanraj, Bhavadharini, Balaji, Maheswari, Kumar, Kalaiyarasi, Gunasekaran, Anjana, Ranjit Mohan, Uma, Ram, Usha, Sriram, Deepa, Mohan, Unnikrishnan, Ranjit, Pastakia, Sonak D., Malanda, Belma, Belton, Anne, and Kayal, Arivudainambi
- Published
- 2014
- Full Text
- View/download PDF
4. Gender differences in the incidence of Covid 19 among young men and women with and without diabetes in Chennai, India
- Author
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Akshara Rajendhran, Usha Sriram, and AMALA FLORIDA
- Published
- 2021
5. Liraglutide: A review of its therapeutic use as a once daily GLP-1 analog for the management of type 2 diabetes mellitus
- Author
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Mala Dharmalingam, Usha Sriram, and Manash P Baruah
- Subjects
Diabetes ,GLP-1 analog ,liraglutide ,Diseases of the endocrine glands. Clinical endocrinology ,RC648-665 ,Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Type 2 diabetes mellitus (T2DM) is a progressive disease associated with significant morbidity and mortality. Even though progress have been accomplished in the management of type 2 diabetes, current treatment preferences for patients with this disease still fall short to address disease progression. With the present therapy, glycaemic control remains suboptimal and are often associated with weight gain and hypoglycaemia. Glucagon like peptide-1 (GLP-1) is an incretin hormone secreted from the small intestine that lowers fasting and postprandial glucose through multiple mechanisms including glucose-dependent insulin secretion, reduction of glucagon secretion, delaying gastric emptying and increased satiety. Liraglutide, a human glucagon-like peptide 1 (GLP-1) analogue is a treatment for T2DM that is administered as a once-daily subcutaneous injection. The efficacy and tolerability of liraglutide at doses of 0.6, 1.2, and 1.8 mg for T2DM, in combination with, and compared with, other T2DM treatments were investigated in the Liraglutide Effect and Action in Diabetes (LEAD) Phase III clinical trial program. In the LEAD trial, treatment with liraglutide was associated with substantial improvements in glycaemic control and low risk of hypoglycaemia. In addition liraglutide significantly improved β-cell function, reduced systolic blood pressure (BP) and induced weight loss. Overall, liraglutide was well tolerated. Recent data on safety and efficacy of liraglutide from real-life clinical practice settings also reiterate the better therapeutic profile of this molecule. Based on results from the LEAD programme, and real-life clinical experience, liraglutide has been demonstrated as an effective therapeutic intervention even at the early stage of diabetes regardless of with what, it has been used.
- Published
- 2011
- Full Text
- View/download PDF
6. The Indian Society for Bone and Mineral Research (ISBMR) position statement for the diagnosis and treatment of osteoporosis in adults
- Author
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Shriraam Mahadevan, Sanjay Kumar Bhadada, Nikhil Tandon, Narendra Kotwal, Thomas V Paul, Usha Sriram, Satinath Mukhopadhyay, Ameya Joshi, Soham Mukherjee, Rajesh Khadgawat, Beena Bansal, Sushil Gupta, Anshita Aggarwal, Ambrish Mithal, Mahendra Kumar Garg, Nitin Kapoor, Manoj Chadha, Subhash C. Kukreja, Sudhaker D Rao, and Rimesh Pal
- Subjects
Adult ,0301 basic medicine ,medicine.medical_specialty ,FRAX ,Osteoporosis ,Population ,030209 endocrinology & metabolism ,03 medical and health sciences ,Absorptiometry, Photon ,0302 clinical medicine ,Pharmacotherapy ,Bone Density ,Risk Factors ,medicine ,Humans ,Orthopedics and Sports Medicine ,Intensive care medicine ,education ,Bone mineral ,Estimation ,Minerals ,education.field_of_study ,business.industry ,Public health ,medicine.disease ,Orthopedic surgery ,030101 anatomy & morphology ,business ,Osteoporotic Fractures - Abstract
The Indian Society for Bone and Mineral Research (ISBMR) has herein drafted clinical practice guidelines for the diagnosis and management of osteoporosis for the people of India. Implementation of the position statement in clinical practice is expected to improve the overall care of patients with osteoporosis in India. In India, osteoporosis is a major public health problem. However, in the absence of any robust regional guidelines, the screening, treatment, and follow-up of patients with osteoporosis are lagging behind in the country. The Indian Society for Bone and Mineral Research (ISBMR), which is a multidisciplinary group of physicians, researchers, dietitians, and epidemiologists and who study bone and related tissues, in their annual meeting, drafted the guidelines for the diagnosis and management of osteoporosis that would be appropriate in a resource constraint setting like India. Diagnosis of osteoporosis can be made in a patient with minimal trauma fracture without the aid of any other diagnostic tools. In others, bone mineral density measured by dual-energy X-ray absorptiometry remains the modality of choice. Data indicates that osteoporotic fractures occur at an earlier age in Indians than in the West; hence, screening for osteoporosis should begin at an earlier age. FRAX can be used for fracture risk estimation; however, it may underestimate the risk of future fractures in our population and still needs validation. Maintaining optimum serum 25-hydroxyvitamin D levels is essential, which, in most cases, would require regular vitamin D supplementation. Pharmacotherapy should be guided by the presence/absence of vertebral/hip fractures or the severity of risk based on clinical factors, although bisphosphonates remain the first choice in most cases. Regular follow-up is essential to ensure adherence and response to therapy. Implementation of the position statement in clinical practice is expected to improve the overall care of patients with osteoporosis in India.
- Published
- 2021
7. Evidence-Based Consensus on Positioning of SGLT2i in Type 2 Diabetes Mellitus in Indians
- Author
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Binayak Sinha, Pradeep G Talwalkar, Banshi Saboo, Awadhesh Kumar Singh, Shashank Joshi, Viswanathan Mohan, Ambika Gopalakrishnan Unnikrishnan, Sanjay Kalra, Kalyan Kumar Gangopadhyay, Samit Ghosal, Surendra K. Sharma, Ajay Kumar, Usha Sriram, Ashok Kumar Das, and Abdul Hamid Zargar
- Subjects
Indian population ,medicine.medical_specialty ,Diabetic ketoacidosis ,Endocrinology, Diabetes and Metabolism ,030209 endocrinology & metabolism ,Type 2 diabetes ,Review ,030204 cardiovascular system & hematology ,Cochrane Library ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Insulin resistance ,Diabetes management ,Diabetes mellitus ,Internal Medicine ,Medicine ,SGLT2i ,Dapagliflozin ,Intensive care medicine ,business.industry ,Type 2 Diabetes Mellitus ,medicine.disease ,Glycaemic efficacy ,chemistry ,business - Abstract
The current diabetes management strategies not only aim at controlling glycaemic parameters but also necessitate continuous medical care along with multifactorial risk reduction through a comprehensive management concept. The sodium-glucose cotransporter 2 inhibitors (SGLT2i) are a group of evolving antidiabetic agents that have the potential to play a pivotal role in the comprehensive management of patients with diabetes due to their diverse beneficial effects. SGLT2i provide moderate glycaemic control, considerable body weight and blood pressure reduction, and thus have the ability to lower the risk of macrovascular and microvascular complications. Some of the unique characteristics associated with SGLT2i, such as reduction in body weight (more visceral fat mass loss than subcutaneous fat loss), reduction in insulin resistance and improvement in β-cell function, as measured by homeostatic model assessment-β (HOMA-β) could be potentially beneficial and help in overcoming some of the challenges faced by Indian patients with diabetes. In addition, a patient-centric approach with individualised treatment during SGLT2i therapy is inevitable in order to reduce diabetic complications and improve quality of life. Despite their broad benefits profile, the risk of genital tract infections, volume depletion, amputations and diabetic ketoacidosis associated with SGLT2i should be carefully monitored. In this compendium, we systematically reviewed the literature from Medline, Cochrane Library, and other relevant databases and attempted to provide evidence-based recommendations for the positioning of SGLT2i in the management of diabetes in the Indian population. Funding: AstraZeneca Pharma India Limited.
- Published
- 2019
8. Preconception Care
- Author
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Usha Sriram
- Published
- 2018
9. Efficacy and safety of fixed dose combination of atorvastatin and hydroxychloroquine: a randomized, double-blind comparison with atorvastatin alone among Indian patients with dyslipidemia
- Author
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H. R. Salkar, Rajesh Khyalappa, Mahendra Parmar, Anil Pareek, Manish Agarwal, R. Legha, Urman Dhruv, Navneet Agrawal, Nitin Chandurkar, N. K. Thulaseedharan, Vikas Pai, Usha Sriram, S. Mathur, Subhash Saxena, and Sangeeta Pednekar
- Subjects
Adult ,Male ,medicine.medical_specialty ,Atorvastatin ,Fixed-dose combination ,Pharmacology ,Gastroenterology ,Double blind ,chemistry.chemical_compound ,Double-Blind Method ,Internal medicine ,medicine ,Humans ,Triglycerides ,Dyslipidemias ,Glycated Hemoglobin ,biology ,Cholesterol ,business.industry ,Anticholesteremic Agents ,Cholesterol, HDL ,C-reactive protein ,nutritional and metabolic diseases ,Hydroxychloroquine ,Cholesterol, LDL ,General Medicine ,Middle Aged ,medicine.disease ,Lipids ,Drug Combinations ,C-Reactive Protein ,chemistry ,biology.protein ,Female ,lipids (amino acids, peptides, and proteins) ,Glycated hemoglobin ,Hydroxymethylglutaryl-CoA Reductase Inhibitors ,business ,Dyslipidemia ,medicine.drug - Abstract
To evaluate the efficacy and safety of atorvastatin + hydroxychloroquine fixed-dose combination tablets in comparison with atorvastatin alone in treatment of dyslipidemia.This double-blind, randomized, out-patient study was conducted in 328 patients with primary dyslipidemia having low-density lipoprotein cholesterol (LDL-C) ≥ 130 mg/dL (3.37 mmol/L) to ≤ 250 mg/dL (6.48 mmol/L) and triglycerides ≤ 400 mg/dL (4.52 mmol/L). Eligible patients were randomized to receive either atorvastatin 10 mg (n = 167) or atorvastatin 10 mg + hydroxychloroquine 200 mg (n = 161) for 24 weeks.CTRI/2010/091/006138.To compare percentage change in LDL-C, total cholesterol (TC), triglycerides, high-density lipoprotein cholesterol (HDL-C) and non-high-density lipoprotein cholesterol (non-HDL-C) from baseline to Week 12 and Week 24 between groups. To compare mean change in glycated hemoglobin (HbA1c), fasting blood glucose (FBG), high-sensitivity C-reactive protein (Hs-CRP), and percentage of patients achieving lipid goals at Week 12 and Week 24.At Week 24, percentage reduction in LDL-C (-32.52 [-36.13 to -28.91] vs -39.54 [-43.25 to -35.83]; p = 0.008), TC (-24.41 [-27.10 to -21.72] vs -29.30 [-32.07 to -26.54]; p = 0.013), and non-HDL-C (-30.37 [-33.71 to -27.04] vs -36.76 [-40.18 to -33.33]; p = 0.009) was significantly greater in combination treated patients. Both the treatments showed a significant reduction in triglycerides at Week 24 from baseline, however, this reduction was not statistically significantly different between treatment groups. No significant change in HDL-C was observed in patients from both the treatment groups. At Week 24, change in HbA1c (0.22 [0.07 to 0.37] vs -0.13 [-0.28 to 0.03]; p = 0.002) and FBG was also statistically significant in favor of combination therapy (0.37 [0.07 to 0.67] vs -0.29 [-0.59 to 0.03]; p = 0.003), whereas no statistically significant difference was observed in change in Hs-CRP (p = 0.310). Significantly more patients from the combination group achieved LDL-C and TC goals. Exploratory analysis in patients with pre-diabetes showed development of diabetes in 8 patients (15.09%) from the monotherapy group and 1 patient (1.96%) from the combination group (p = 0.034). Study medications were generally safe and well tolerated.Based on study results and widely reported pleiotropic benefits, hydroxychloroquine could emerge as a potential drug for combination with statins for treatment of dyslipidemia. Long duration studies with larger sample sizes are required to further explore the role of hydroxychloroquine as adjunct to statins in reducing risk of cardiovascular events and prevention of statin-induced diabetes.
- Published
- 2015
10. Lipid Association of India Expert Consensus Statement on Management of Dyslipidemia in Indians 2016: Part 1
- Author
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S S, Iyengar, Raman, Puri, S N, Narasingan, S K, Wangnoo, V, Mohan, J C, Mohan, Anoop, Misra, Usha, Sriram, Jamshed J, Dalal, Rajeev, Gupta, D, Prabhakar, Prafulla, Kerkar, Abdul Hamid, Zargar, Ravi R, Kasliwal, Rahul, Mehrotra, Soumitra, Kumar, Rabin, Chakraborty, Manoj, Chadha, Mradul Kumar, Daga, Krishna, Seshadri, Justin, Paul, Narasaraju, Kavalipati, Dheeraj, Kapoor, V S, Narain, Ashu, Rastogi, A, Muruganathan, Ajay, Gupta, S, Murthy, Neil, Bordoloi, Prasant Kumar, Sahoo, Rajesh Kumar, Agarwal, Milan, Chag, Rajesh, Rajput, and Rashida Patanwala, Melinkeri
- Published
- 2017
11. Liraglutide: A review of its therapeutic use as a once daily GLP-1 analog for the management of type 2 diabetes mellitus
- Author
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Manash P Baruah, Usha Sriram, and Mala Dharmalingam
- Subjects
liraglutide ,lcsh:RC648-665 ,Gastric emptying ,Liraglutide ,business.industry ,Endocrinology, Diabetes and Metabolism ,Diabetes ,Glucagon secretion ,Type 2 Diabetes Mellitus ,Review Article ,Type 2 diabetes ,Pharmacology ,medicine.disease ,lcsh:Diseases of the endocrine glands. Clinical endocrinology ,GLP-1 analog ,Endocrinology ,Tolerability ,Weight loss ,Diabetes mellitus ,medicine ,lcsh:Diseases of the digestive system. Gastroenterology ,medicine.symptom ,lcsh:RC799-869 ,business ,medicine.drug - Abstract
Type 2 diabetes mellitus (T2DM) is a progressive disease associated with significant morbidity and mortality. Even though progress have been accomplished in the management of type 2 diabetes, current treatment preferences for patients with this disease still fall short to address disease progression. With the present therapy, glycaemic control remains suboptimal and are often associated with weight gain and hypoglycaemia. Glucagon like peptide-1 (GLP-1) is an incretin hormone secreted from the small intestine that lowers fasting and postprandial glucose through multiple mechanisms including glucose-dependent insulin secretion, reduction of glucagon secretion, delaying gastric emptying and increased satiety. Liraglutide, a human glucagon-like peptide 1 (GLP-1) analogue is a treatment for T2DM that is administered as a once-daily subcutaneous injection. The efficacy and tolerability of liraglutide at doses of 0.6, 1.2, and 1.8 mg for T2DM, in combination with, and compared with, other T2DM treatments were investigated in the Liraglutide Effect and Action in Diabetes (LEAD) Phase III clinical trial program. In the LEAD trial, treatment with liraglutide was associated with substantial improvements in glycaemic control and low risk of hypoglycaemia. In addition liraglutide significantly improved β-cell function, reduced systolic blood pressure (BP) and induced weight loss. Overall, liraglutide was well tolerated. Recent data on safety and efficacy of liraglutide from real-life clinical practice settings also reiterate the better therapeutic profile of this molecule. Based on results from the LEAD programme, and real-life clinical experience, liraglutide has been demonstrated as an effective therapeutic intervention even at the early stage of diabetes regardless of with what, it has been used.
- Published
- 2011
12. BMD Reference Standards Among South Asians in the United States
- Author
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Alexander Melamed, Usha Sriram, Ann V. Schwartz, Eric Vittinghoff, and Alka M. Kanaya
- Subjects
Male ,musculoskeletal diseases ,medicine.medical_specialty ,South asia ,Endocrinology, Diabetes and Metabolism ,Population ,Osteoporosis ,Pilot Projects ,Statistics, Nonparametric ,White People ,Article ,Absorptiometry, Photon ,Bone Density ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Orthopedics and Sports Medicine ,education ,Reference standards ,Asia, Southeastern ,Dual-energy X-ray absorptiometry ,Aged ,Bone mineral ,education.field_of_study ,Asian ,medicine.diagnostic_test ,business.industry ,Middle Aged ,Reference Standards ,medicine.disease ,United States ,Confidence interval ,Cross-Sectional Studies ,Indians, North American ,Physical therapy ,Female ,Lumbar spine ,business ,Demography - Abstract
The relationship between bone mineral density (BMD) and fracture risk is not well established for non-white populations. There is no established BMD reference standard for South Asians. Dual-energy X-ray absorptiometry (DXA) was used to measure BMD at total hip and lumbar spine in 150 US-based South-Asian Indians. For each subject, T-scores were calculated using BMD reference values based on US white, North Indian, and South Indian populations, and the resulting WHO BMD category assignments were compared. Reference standards derived from Indian populations classified a larger proportion of US-based Indians as normal than did US white-based standards. The percentage of individuals reclassified when changing between reference standards varied by skeletal site and reference population origin, ranging from 13% (95% confidence interval [CI]: 7–18%), when switching from US white- to North Indian-based standard for total hip, to 40% (95% CI: 32–48%), when switching from US white to South Indian reference values for lumbar spine. These findings illustrate that choice of reference standard has a significant effect on the diagnosis of osteoporosis in South Asians, and underscore the importance of future research to quantify the relationship between BMD and fracture risk in this population.
- Published
- 2010
13. Hyperglycaemia in pregnancy and the effect of diabetes on cardiovascular risk
- Author
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Usha Sriram, Anil Kapur, Chandrika N Wijeyaratne, Moshe Hod, and Ravi Retnakaran
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Adult ,Male ,medicine.medical_specialty ,Endocrinology, Diabetes and Metabolism ,030209 endocrinology & metabolism ,Article ,03 medical and health sciences ,0302 clinical medicine ,Endocrinology ,Text mining ,Pregnancy ,Risk Factors ,Diabetes mellitus ,Internal Medicine ,medicine ,Humans ,Prospective Studies ,030212 general & internal medicine ,Intensive care medicine ,business.industry ,medicine.disease ,Diabetes Mellitus, Type 2 ,Cardiovascular Diseases ,Hyperglycemia ,Female ,business - Abstract
Summary Background Several studies have shown that diabetes confers a higher relative risk of vascular mortality among women than among men, but whether this increased relative risk in women exists across age groups and within defined levels of other risk factors is uncertain. We aimed to determine whether differences in established risk factors, such as blood pressure, BMI, smoking, and cholesterol, explain the higher relative risks of vascular mortality among women than among men. Methods In our meta-analysis, we obtained individual participant-level data from studies included in the Prospective Studies Collaboration and the Asia Pacific Cohort Studies Collaboration that had obtained baseline information on age, sex, diabetes, total cholesterol, blood pressure, tobacco use, height, and weight. Data on causes of death were obtained from medical death certificates. We used Cox regression models to assess the relevance of diabetes (any type) to occlusive vascular mortality (ischaemic heart disease, ischaemic stroke, or other atherosclerotic deaths) by age, sex, and other major vascular risk factors, and to assess whether the associations of blood pressure, total cholesterol, and body-mass index (BMI) to occlusive vascular mortality are modified by diabetes. Results Individual participant-level data were analysed from 980 793 adults. During 9·8 million person-years of follow-up, among participants aged between 35 and 89 years, 19 686 (25·6%) of 76 965 deaths were attributed to occlusive vascular disease. After controlling for major vascular risk factors, diabetes roughly doubled occlusive vascular mortality risk among men (death rate ratio [RR] 2·10, 95% CI 1·97–2·24) and tripled risk among women (3·00, 2·71–3·33; χ2 test for heterogeneity p
- Published
- 2018
14. Tumoral calcinosis with vitamin D deficiency
- Author
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Subramanian, Kannan, Latha, Ravikumar, Shiraam, Mahadevan, Mayilvahanan, Natarajan, Anjali, Satya, Rekha, Bhat, and Usha, Sriram
- Subjects
Tumoral calcinosis ,Vitamin D deficiency ,Nerve Compression Syndromes ,lcsh:R ,Calcinosis ,lcsh:Medicine ,Lactose ,Comorbidity ,Middle Aged ,Phosphates ,Hyperphosphatemia ,Kidney Tubules ,Homeostasis ,Humans ,Osteoporosis ,Female ,Amino Acids ,Sciatic Neuropathy - Abstract
A 50-year-old woman presented with recurrent calcified mass in the left gluteal region. The clinical, radiological, and biochemical profile confirmed the diagnosis of tumoral calcinosis. She also had associated vitamin D deficiency. The patient underwent surgical removal of the mass to relieve the sciatic nerve compression and was managed with acetazolamide, calcium carbonate, and aluminium hydroxide gel with which she showed significant improve-ment. The management implications and effect of vitamin D deficiency on phosphate metabolism in the setting of tumoral calcinosis is discussed.
- Published
- 2008
15. Assessment of knowledge, attitudes and practices about tight glycemic control in the critically ill among endocrinologists and intensivists practicing in Chennai
- Author
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Latha Ravikumar, Vijayaprasad Gopichandran, Gomathy Parasuraman, Anjali Sathya, Bhuma Srinivasan, Shriraam Mahadevan, and Usha Sriram
- Subjects
medicine.medical_specialty ,Critically ill ,business.industry ,Cut off value ,Insulin ,medicine.medical_treatment ,Control (management) ,Hypoglycemia ,Critical Care and Intensive Care Medicine ,medicine.disease ,Intensive care unit ,law.invention ,law ,medicine ,Regular insulin ,Intensive care medicine ,business ,Glycemic - Abstract
Background: Tight glycemic control in the critically ill is known to reduce both the morbidity and the mortality. It is essential that intensivists and endocrinologists involved in the care of these patients have a good understanding of the concepts related to this condition. Objectives: To assess the knowledge, attitudes and practices about achieving tight glycemic control in the critically ill among the endocrinologists and intensivists practicing in the city of Chennai. Materials and Methods: Questionnaires containing ten questions pertaining to clinical outcomes, drawbacks, target levels of glycemic control and insulin regimen in achieving tight glycemia in the critically ill were sent to a total of six endocrinologists and 52 intensivists practicing in Chennai. Results: All those who were administered the questionnaires responded. Majority of the responders (88%) believed in tight glycemic control in the critically ill because of better outcomes from hospitalization. A minority did not for fear of hypoglycemia. Fifty percent agreed on the cut off value of 110 mg/dL as followed in the Van den Berghe study. Seventy percent used glucometer for monitoring sugar levels. Most preferred using regular insulin as infusion. Conclusions: There seems to be a good understanding and standard practices among the endocrinologists and intensivists in achieving strict glycemic control in the critically ill. Setting up of standard intensive care unit glycemic control protocols will settle all the methodological differences and make the practices more uniform.
- Published
- 2007
16. Women's Health and Diabetes
- Author
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Rakesh Sahay, Usha Sriram, Sanjay Kalra, and G. Sridhar
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Gerontology ,business.industry ,Diabetes mellitus ,medicine ,medicine.disease ,business - Published
- 2015
17. Assessment of knowledge, attitudes and practices about adrenal insufficiency in the critically ill among endocrinologists and intensivists practicing in Chennai
- Author
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Anjali Sathya, Usha Sriram, B Srinivasan, Vijayaprasad Gopichandran, Latha Ravikumar, Shriraam Mahadevan, and Gomathy Parasuraman
- Subjects
medicine.medical_specialty ,business.industry ,Critically ill ,Concordance ,education ,Critical Care and Intensive Care Medicine ,medicine.disease ,Intensive care unit ,law.invention ,law ,Critical illness ,Adrenal insufficiency ,Medicine ,Adrenal function ,business ,Intensive care medicine ,Serum cortisol - Abstract
Background: Adrenal insufficiency is a common occurrence in the critically ill and it is essential that intensivists and endocrinologists involved in the care of these patients have a good understanding of the concepts related to this condition. Objectives: To assess the knowledge, attitudes and practices about adrenal insufficiency in the critically ill among the endocrinologists and intensivists practicing in the city of Chennai. Materials and Methods: Questionnaires containing ten questions pertaining to adrenal insufficiency in the critically ill were sent to a total of six endocrinologists and 52 intensivists practicing in Chennai. Results: About 77% of all the respondents agreed to the fact that adrenal insufficiency is a frequent occurrence in critical illness. But 57% of them felt that there is no need for routine evaluation of critically ill patients for adrenal insufficiency. Random serum cortisol was selected by 62% of the responders as the method for evaluating adrenal function in the critically ill. There is clearly no agreement among the endocrinologists or the intensivists on the various cut off levels for diagnosis. Neither is there a clear consensus on the method followed for treatment of patients with adrenal insufficiency in the critical care unit. Conclusion: There is no concordance in the knowledge, attitudes or practices on adrenal insufficiency in the critically ill among the endocrinologists and intensivists in Chennai. There is a need for developing standard diagnostic and treatment guidelines and making it available for all the practicing endocrinologists and intensivists.
- Published
- 2006
18. Thyroid nodule
- Author
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Usha, Sriram and Lydia Marie, Patacsil
- Subjects
Diagnostic Imaging ,Male ,Neoplasms, Radiation-Induced ,Cysts ,Biopsy, Needle ,Thyroid Gland ,Receptors, Thyrotropin ,General Medicine ,Thyroglossal Cyst ,Diagnosis, Differential ,Pregnancy ,Mutation ,Humans ,Female ,Thyroid Neoplasms ,Thyroid Nodule ,Child ,Pregnancy Complications, Neoplastic ,Algorithms ,Goiter, Nodular - Published
- 2004
19. Clinical and Endocrinological Evaluation of the Infertile Male
- Author
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Usha Sriram
- Published
- 2014
20. Glucose tolerance status of Asian Indian women with gestational diabetes at 6weeks to 1year postpartum (WINGS-7)
- Author
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Bhavadharini, Balaji, primary, Anjana, Ranjit Mohan, additional, Mahalakshmi, Manni Mohanraj, additional, Maheswari, Kumar, additional, Kayal, Arivudainambi, additional, Unnikrishnan, Ranjit, additional, Ranjani, Harish, additional, Ninov, Lyudmil, additional, Pastakia, Sonak D., additional, Usha, Sriram, additional, Malanda, Belma, additional, Belton, Anne, additional, Uma, Ram, additional, and Mohan, Viswanathan, additional
- Published
- 2016
- Full Text
- View/download PDF
21. Postmenopausal Evaluation and Risk Reduction With Lasofoxifene (PEARL) trial: 5-year gynecological outcomes
- Author
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Dalibor Krpan, David M. Thompson, Steven R. Goldstein, Usha Sriram, John F. Thompson, Steven R. Cummings, Carolyn D Runowicz, Patrick Neven, James Proulx, Margot Johnson, and Terence J. Colgan
- Subjects
Selective Estrogen Receptor Modulators ,medicine.medical_specialty ,Pyrrolidines ,Tetrahydronaphthalenes ,Urology ,Urinary incontinence ,Placebo ,Polyps ,Double-Blind Method ,medicine ,Humans ,Vaginal bleeding ,Osteoporosis, Postmenopausal ,Femoral neck ,Aged ,Proportional Hazards Models ,Ultrasonography ,Gynecology ,Aged, 80 and over ,Ovarian Neoplasms ,Uterine Diseases ,business.industry ,Endometrial cancer ,Uterus ,Obstetrics and Gynecology ,Lasofoxifene ,Middle Aged ,medicine.disease ,Endometrial hyperplasia ,Postmenopause ,Ovarian Cysts ,medicine.anatomical_structure ,Urinary Incontinence ,Selective estrogen receptor modulator ,Female ,medicine.symptom ,business ,medicine.drug - Abstract
OBJECTIVE The aim of this study was to establish the gynecological effects of 5 years of treatment with lasofoxifene versus placebo in postmenopausal osteoporotic women. METHODS A total of 8,556 women aged 59 to 80 years with femoral neck or spine bone mineral density T scores of -2.5 or lower were randomized to receive lasofoxifene 0.25 mg/day, or lasofoxifene 0.5 mg/day, or placebo, for 5 years. RESULTS Endometrial cancer was confirmed for two women in each lasofoxifene group and for three women in the placebo group. Endometrial hyperplasia occurred in three, two, and zero women in the lasofoxifene 0.25 mg/day, lasofoxifene 0.5 mg/day, and placebo groups, respectively. Vaginal bleeding occurred in 2.2% (P = 0.012 vs placebo), 2.6% (P = 0.001 vs placebo), and 1.3% of women treated with 0.25 mg/day lasofoxifene, 0.5 mg/day lasofoxifene, and placebo, respectively. Lasofoxifene treatment resulted in a small increase in endometrial thickness versus placebo (least-squares mean change from baseline 1.19 mm [P = 0.001], 1.43 mm [P < 0.001], and -0.72 mm for 0.25 mg/day lasofoxifene, 0.5 mg/day lasofoxifene, and placebo). Similar numbers of women required surgery for pelvic organ prolapse or urinary incontinence in the placebo and 0.5 mg/day lasofoxifene groups (1.2% vs 1.6%, P = 0.224; 0.25 mg/day group: 1.9%, P = 0.036). The absolute incidence rates of endometrial polyps were 8.8%, 5.5%, and 3.3% for lasofoxifene 0.25 mg/day (P = 0.003 vs placebo), lasofoxifene 0.5 mg/day (P = 0.163 vs placebo), and placebo groups, respectively. CONCLUSION These findings indicate that 5 years of lasofoxifene treatment result in benign endometrial changes that do not increase the risk for endometrial cancer or hyperplasia in postmenopausal women.
- Published
- 2010
22. Use of capillary blood glucose for screening for gestational diabetes mellitus in resource-constrained settings
- Author
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Bhavadharini, Balaji, primary, Mahalakshmi, Manni Mohanraj, additional, Maheswari, Kumar, additional, Kalaiyarasi, Gunasekaran, additional, Anjana, Ranjit Mohan, additional, Deepa, Mohan, additional, Ranjani, Harish, additional, Priya, Miranda, additional, Uma, Ram, additional, Usha, Sriram, additional, Pastakia, Sonak D., additional, Malanda, Belma, additional, Belton, Anne, additional, Unnikrishnan, Ranjit, additional, Kayal, Arivudainambi, additional, and Mohan, Viswanathan, additional
- Published
- 2015
- Full Text
- View/download PDF
23. Primary Amenorrhea
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Usha Sriram
- Subjects
Pediatrics ,medicine.medical_specialty ,business.industry ,Medicine ,business ,Primary amenorrhea - Published
- 2010
24. Efficacy of teriparatide in increasing bone mineral density in postmenopausal women with osteoporosis--an Indian experience
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B K, Sethi, M, Chadha, K D, Modi, K M Prasanna, Kumar, R, Mehrotra, and Usha, Sriram
- Subjects
Bone Density Conservation Agents ,Injections, Subcutaneous ,Middle Aged ,Treatment Outcome ,Double-Blind Method ,Bone Density ,Osteogenesis ,Teriparatide ,Humans ,Calcium ,Female ,Prospective Studies ,Bone Resorption ,Vitamin D ,Osteoporosis, Postmenopausal ,Aged ,Follow-Up Studies - Abstract
Osteoporosis is emerging as a leading cause of substantial morbidity in India, particularly in postmenopausal women. Teriparatide (recombinant human parathyroid hormone [1-34]) increases bone formation and improves bone microarchitecture, thereby reducing the risk of fractures. This study was conducted to evaluate the efficacy of teriparatide in increasing bone mineral density (BMD) in postmenopausal women with osteoporosis.A randomised, prospective, multicentre, open-label, controlled study was conducted on 82 postmenopausal women with established osteoporosis. Patients were randomly divided into control and teriparatide groups, each group consisting of 41 patients. All the patients were supplemented with 1000 mg of elemental calcium and 500 IU of vitamin D throughout the study period of 180 days. Besides, teriparatide group patients were administered teriparatide 20 microg daily subcutaneously. Lumbar spine, femoral neck and total hip BMD, bone mineral content (BMC) and bone area were measured by dual energy x-ray absorptiometry (DXA) at baseline and at the end of 6 months of treatment. Bone biomarkers, such as serum bone specific alkaline phosphatase (BSAP) and serum osteocalcin (OC), representing bone formation, and urinary deoxypyridinoline (DPD), representing bone resorption were assessed at baseline, and at 3 and 6 months of treatment.During the study period, 9 patients (11%) were lost to follow-up--6 in control group (7.3%) and 3 in teriparatide group (3.7%). There was an excellent compliance to both oral and injectable medication. The investigational product teriparatide was well tolerated and there were no serious adverse events. In addition, there were no significant differences between the groups in the incidence of adverse events. The percentage of increase in lumbar spine BMD, which is the primary endpoint, was significantly (P0.001) higher in teriparatide group compared to that in control group (6.58% vs. 1.06%). Further, teriparatide significantly increased percentage of change in lumbar spine T-score (P0.001), BMC (P0.001) and bone area (P0.028) compared to control group at 6 months. Administration of teriparatide resulted in a significant percentage of increase in all the bone biomarkers in teriparatide group compared to control group patients at 3 and 6 months over baseline, thereby showing that there was a significant increase in bone turnover in teriparatide group of patients.These results show that teriparatide is an effective and safe drug in increasing the BMD and therefore, teriparatide provides yet another new therapeutic option for reducing the risk management of osteoporosis in postmenopausal women (clinicaltrials.gov number, NCT00500409).
- Published
- 2008
25. Management of Hyperprolactinemia
- Author
-
Usha Sriram
- Published
- 2005
26. Efficacy and safety of raloxifene 60 milligrams/day in postmenopausal Asian women
- Author
-
Abid Farooqi, Florante Gonzaga, Allan G. Need, Daniel Thiebaud, Foo-Hoe Loh, Hsiang-Tai Chao, Usha Sriram, Ichramsjah A Rachman, Annie W.C. Kung, Nik Mohd Nasri Ismail, Mayme Wong, Ko-En Huang, Gerald G. Crans, and Nimit Taechakraichana
- Subjects
medicine.medical_specialty ,Endocrinology, Diabetes and Metabolism ,Clinical Biochemistry ,Blood lipids ,Placebo ,Biochemistry ,Bone remodeling ,chemistry.chemical_compound ,Endocrinology ,Asian People ,Bone Density ,Internal medicine ,medicine ,Humans ,Raloxifene ,Triglycerides ,Bone mineral ,Lumbar Vertebrae ,biology ,Cholesterol ,business.industry ,Biochemistry (medical) ,Cholesterol, HDL ,Estrogen Antagonists ,Cholesterol, LDL ,Middle Aged ,Postmenopause ,chemistry ,Raloxifene Hydrochloride ,Osteocalcin ,biology.protein ,Osteoporosis ,lipids (amino acids, peptides, and proteins) ,Female ,business ,medicine.drug ,Lipoprotein - Abstract
In healthy Caucasian postmenopausal women, raloxifene increases bone mineral density (BMD), decreases biochemical markers of bone turnover, and lowers low-density lipoprotein (LDL) cholesterol, without effects on high-density lipoprotein (HDL) cholesterol and triglycerides. This randomized, double-blind study examines the effects of raloxifene 60 mg/d (n = 483) or placebo (n = 485) in healthy postmenopausal Asian women (mean age 57 yr) from Australia, Hong Kong, India, Indonesia, Malaysia, Pakistan, Philippines, Singapore, Taiwan, and Thailand. Serum osteocalcin, serum N-telopeptide, total cholesterol, HDL cholesterol, LDL cholesterol, and triglycerides were assessed at baseline and 6 months. Lumbar spine BMD was measured at baseline and 1 yr in 309 women from 4 countries. Clinical adverse events were recorded at each interim visit. At 6 months, raloxifene 60 mg/d significantly decreased osteocalcin, N-telopeptide, total cholesterol, and LDL cholesterol by medians of 15.9%, 14.6%, 5.3%, and 7.7%, respectively, from placebo. Changes in HDL cholesterol and triglycerides were similar between raloxifene and placebo. Raloxifene 60 mg/d increased mean lumbar spine BMD (1.9%) from placebo at 1 yr (P = 0.0003). The incidences of hot flashes (placebo 3.5%, raloxifene 5.6%, P = 0.12), and leg cramps (placebo 2.7%, raloxifene 4.3%, P = 0.16) were not different between groups. No case of venous thromboembolism was reported. The effects of raloxifene 60 mg/d on bone turnover, BMD, and serum lipids in healthy postmenopausal Asian women were similar to that previously reported in Caucasian women.
- Published
- 2003
27. Prolactin and alternative medicines: a word of caution
- Author
-
Usha Sriram, Shriraam Mahadevan, Subramanian Kannan, and Anjali Sathya
- Subjects
medicine.medical_specialty ,Infectious Diseases ,Endocrinology ,business.industry ,Internal medicine ,Public Health, Environmental and Occupational Health ,medicine ,business ,Linguistics ,Word (computer architecture) ,Prolactin - Published
- 2008
28. Postpartum thyroid dysfunction
- Author
-
Usha Sriram
- Subjects
Thyroid dysfunction ,business.industry ,Medicine ,Physiology ,business - Published
- 2013
29. Inherited 11q partial trisomy
- Author
-
Gazala Jabeen, Prema Lakshminarayana, Indrani Suresh, Usha Sriram, and Sudarshan Suresh
- Subjects
Male ,Pediatrics ,medicine.medical_specialty ,Partial Trisomy ,Heterozygote ,Chromosomes, Human, Pair 12 ,business.industry ,Chromosomes, Human, Pair 11 ,Infant, Newborn ,11q Partial Trisomy ,Trisomy ,Translocation, Genetic ,Pedigree ,Pediatrics, Perinatology and Child Health ,medicine ,Humans ,Abnormalities, Multiple ,business - Published
- 1995
30. POSTMENOPAUSAL EVALUATION AND RISK-REDUCTION WITH LASOFOXIFENE (THE PEARL TRIAL): GYNAECOLOGICAL OUTCOMES AT FIVE-YEARS
- Author
-
T. Colgan, Usha Sriram, D. Krpan, Patrick Neven, John R. Thompson, S. Cumming, J. Proulx, M. Johnson, Steven R. Goldstein, C. Runowicz, D.D. Thompson, and Z. Giljevic
- Subjects
Gynecology ,medicine.medical_specialty ,business.industry ,Obstetrics ,medicine.medical_treatment ,Obstetrics and Gynecology ,Lasofoxifene ,engineering.material ,General Biochemistry, Genetics and Molecular Biology ,engineering ,Medicine ,business ,Pearl ,Reduction (orthopedic surgery) ,medicine.drug - Published
- 2009
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