Letters to the Editor
taken this into account due to lack of well-designed trials to prove such benefits. By virtue of Indian culture, women enjoy a strategic position in household. The family practice of common kitchen gives her control for diet modification of family. Family history of diabetes, means additional family members from her parent’s side afflicted with diabetes. Her offspring stands at high risk for obesity, diabetes, and cardiovascular disease in future. If she is imparted diabetic education about lifestyle modifications, empowered with other health promotion education and motivated regarding her important role in primary/secondary prevention of diabetes for the entire family; it will not only reduce risk of diabetes for her, but will also help in reducing risk for others. This will change her position from a socially stigmatized one to a role model in society and will mark the new dawn of diabetes care in India. Yashdeep Gupta, Bharti Kalra1 Department of Medicine, Government Medical College and Hospital, Chandigarh,1Department of Obstetrics and Gynaecology, Bharti Hospital, Karnal, Haryana, India
Diabetes mellitus management in the Greek financial crisis as an opportunity to steer recovery Sir, Greece has recently been in the spotlight for its finances. Diabetes prevention and management could tip the scale toward success or disaster. A projection of the cost of diabetes management is approximately 2.3 billion Euros or 12% of the annual budget for health.[1] It is of the utmost importance, especially in the current context of the fiscal crisis, to develop solid, applicable and integrated policies that will facilitate a reduction in expenditures for diabetes. Currently, there is lack of formal policies, guidelines and large scale trials on diabetes in Greece. Development of such tools is fundamental and the pertinent stake-holders should collaborate toward mapping the current status. However, given the burden of the disease and the time needed for such tools to be developed, it is reasonable that appropriate action is taken using existing resources.
Corresponding Author: Dr. Bharti Kalra, Department of Obstetrics and Gynaecology, Bharti Hospital, Kunjpura Road, Karnal - 132 001, Haryana, India. E-mail: [email protected]
REFERENCES 1.
Veeraswamy S, Vijayam B, Gupta VK, Kapur A. Gestational diabetes: The public health relevanceand approach. Diabetes Res Clin Pract 2012;97:350-8.
2.
Ramachandran A, Ma RC, Snehalatha C. Diabetes in Asia. Lancet 2010;375:408-18.
3.
Marseille E, Lohse N, Jiwani A, Hod M, Seshiah V, Yajnik CS, et al. The cost-effectiveness of gestational diabetes screening including prevention of type 2 diabetes: Application of a new model in India and Israel. J Matern Fetal Neonatal Med 2013;26:802-10. Access this article online Quick Response Code: Website: www.ijem.in DOI: 10.4103/2230-8210.126595
The role of central Government is crucial. In the current climate of economic crisis and gargantuan unemployment rates, it is an opportunity to focus on promotion of healthier eating habits. The Mediterranean diet has been proven to be of value in diabetes prevention[2] and has been associated with reduced overall mortality. Greece could invest in “healthy lifestyle” tourism and exports of healthy food products as a means to exit the crisis (via reduction of unemployment, improvement in the balance of payments, reduction in health costs for diabetes). Local communities can have a leading role in diabetes prevention. Raising awareness through campaigns in local settings, mass media and the dynamically spreading new media and social networks is but one option. It is vital that exercise is encouraged in the community either by urban planning, transportation policies or by promoting a “sports for the masses” culture. The Olympic heritage can be employed in this cause, as Greeks first identified the value of a healthy body and with the stadia infrastructure that was developed for the recent Olympic Games mostly abandoned it is a huge opportunity to engage the population in sports activities.
Indian Journal of Endocrinology and Metabolism / Jan-Feb 2014 / Vol 18 | Issue 1
121
Letters to the Editor
Risk assessment tools have been designed, shown to be able to detect high risk individuals for type 2 diabetes (T2DM) and validated for use in the Greek population.[3] Appropriate action should then be taken for those individuals or those diagnosed with T2DM. Large studies have proven that T2DM is preventable with sustainable results. Implementation of such interventions in Greece[4] has been successful and holds a promise for the future. It is well-documented that a key factor in prevention programs is effective behavioural modification. The employment of lay health educators and peer led support[5] has been promising in that field and should be considered, especially in the current context of limited resources. If appropriate action is not taken it is inevitable that Greek National Health System will face tremendous pressure from diabetes in the future. At the same time, the economic setting calls for limited, reasonable and cost-effective expenditures. This context asks for strategies that can facilitate a future where Greece will act as a paradigm in diabetes prevention, confirming that a crisis can be seen as an opportunity and steer development.
ACKNOWLEDGMENTS The diploma is funded for by SAS Fund from East Midlands Deanery. Pavlos Zafeiris United Lincolshire Hospitals, NHS Trust, UK Corresponding Author: Dr. Pavlos Zafeiris, Flat 10, Bolingbroke House, Boston, PE21 9QQ, Lincs, UK. E-mail: [email protected]
REFERENCES 1.
2.
3.
4.
5.
122
Athanasakis K, Ollandezos M, Angeli A, Gregoriou A, Geitona M, Kyriopoulos J. Estimating the direct cost of type 2 diabetes in Greece: The effects of blood glucose regulation on patient cost. Diabet Med 2010;27:679-84. Martínez-González MA, de la Fuente-Arrillaga C, Nunez-Cordoba JM, Basterra-Gortari FJ, Beunza JJ, Vazquez Z, et al. Adherence to Mediterranean diet and risk of developing diabetes: Prospective cohort study. BMJ 2008;336:1348-51. Makrilakis K, Liatis S, Grammatikou S, Perrea D, Stathi C, Tsiligros P, et al. Validation of the Finnish diabetes risk score (FINDRISC) questionnaire for screening for undiagnosed type 2 diabetes, dysglycaemia and the metabolic syndrome in Greece. Diabetes Metab 2011;37:144-51. Makrilakis K, Liatis S, Grammatikou S, Perrea D, Katsilambros N. Implementation and effectiveness of the first community lifestyle intervention programme to prevent type 2 diabetes in Greece. The DE-PLAN study. Diabet Med 2010;27:459-65. Aswathy S, Unnikrishnan AG, Kalra S, Leelamoni K. Peer support as a strategy for effective management of diabetes in India. Indian J Endocrinol Metab 2013;17:5-7.
Access this article online Quick Response Code: Website: www.ijem.in DOI: 10.4103/2230-8210.126596
Subclinical pituitary apoplexy with preserved pituitary functions Sir, The word “apoplexy” means accumulation of blood or fluid within any organ in Greek. Pituitary apoplexy was firstly described by Brougham et al., in 1950.[1] Pituitary apoplexy is a medical emergency and clinically manifest as a sudden onset of severe headache, visual deterioration, ophthalmoplegia, and partial or complete pituitary failure, with or without altered consciousness. However, the presentation varies from asymptomatic presentation to life-threatening subarachnoid hemorrhage.[2] Asymptomatic pituitary hemorrhage is often termed subacute or subclinical pituitary apoplexy, which occurs in about 14-22% of cases with pituitary macroadenoma.[2,3] A 22-year-old male presented with progressive diminution of vision in both eye for 1 month to an eye department. There was no history of headache, vomiting, seizure, motor, sensory, altered sensorium, and bowel or bladder symptoms. He had no symptoms suggestive of endocrine dysfunction. He was of average built and his general examination was unremarkable including vital parameters. He had no clinical evidence of endocrine hyper or hypofunction. His visual field examination showed bitemporal hemianopia [Figure 1]. There was no evidence of any neurological deficit, including cranial nerves. He had normal hematological and biochemical parameters (hemoglobin 13.0 g/dl, P. glucose fasting 76 mg/dl, PP 76 mg/dl, B urea 26 mg/dl, S creatinine 0.7 mg/dl, S sodium 138 meq/L, potassium 4.8 meq/L, S bilirubin 0.6 mg/dl, ALT 11 IU/L, AST 17 IU/L, urine specific gravity 1020, spot sodium 11.5 meq/dl), His magnetic resonance imaging (MRI) showed hemorrhagic pituitary macroadenoma (2.9 × 4.3 × 4.6 cm) with suprasellar extension with solid and cystic component within tumor. It also extended into cavernous sinus, displacing both the cavernous internal carotid arteries laterally [Figure 2].
Indian Journal of Endocrinology and Metabolism / Jan-Feb 2014 / Vol 18 | Issue 1
Copyright of Indian Journal of Endocrinology & Metabolism is the property of Medknow Publications & Media Pvt. Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
taken this into account due to lack of well-designed trials to prove such benefits. By virtue of Indian culture, women enjoy a strategic position in household. The family practice of common kitchen gives her control for diet modification of family. Family history of diabetes, means additional family members from her parent’s side afflicted with diabetes. Her offspring stands at high risk for obesity, diabetes, and cardiovascular disease in future. If she is imparted diabetic education about lifestyle modifications, empowered with other health promotion education and motivated regarding her important role in primary/secondary prevention of diabetes for the entire family; it will not only reduce risk of diabetes for her, but will also help in reducing risk for others. This will change her position from a socially stigmatized one to a role model in society and will mark the new dawn of diabetes care in India. Yashdeep Gupta, Bharti Kalra1 Department of Medicine, Government Medical College and Hospital, Chandigarh,1Department of Obstetrics and Gynaecology, Bharti Hospital, Karnal, Haryana, India
Diabetes mellitus management in the Greek financial crisis as an opportunity to steer recovery Sir, Greece has recently been in the spotlight for its finances. Diabetes prevention and management could tip the scale toward success or disaster. A projection of the cost of diabetes management is approximately 2.3 billion Euros or 12% of the annual budget for health.[1] It is of the utmost importance, especially in the current context of the fiscal crisis, to develop solid, applicable and integrated policies that will facilitate a reduction in expenditures for diabetes. Currently, there is lack of formal policies, guidelines and large scale trials on diabetes in Greece. Development of such tools is fundamental and the pertinent stake-holders should collaborate toward mapping the current status. However, given the burden of the disease and the time needed for such tools to be developed, it is reasonable that appropriate action is taken using existing resources.
Corresponding Author: Dr. Bharti Kalra, Department of Obstetrics and Gynaecology, Bharti Hospital, Kunjpura Road, Karnal - 132 001, Haryana, India. E-mail: [email protected]
REFERENCES 1.
Veeraswamy S, Vijayam B, Gupta VK, Kapur A. Gestational diabetes: The public health relevanceand approach. Diabetes Res Clin Pract 2012;97:350-8.
2.
Ramachandran A, Ma RC, Snehalatha C. Diabetes in Asia. Lancet 2010;375:408-18.
3.
Marseille E, Lohse N, Jiwani A, Hod M, Seshiah V, Yajnik CS, et al. The cost-effectiveness of gestational diabetes screening including prevention of type 2 diabetes: Application of a new model in India and Israel. J Matern Fetal Neonatal Med 2013;26:802-10. Access this article online Quick Response Code: Website: www.ijem.in DOI: 10.4103/2230-8210.126595
The role of central Government is crucial. In the current climate of economic crisis and gargantuan unemployment rates, it is an opportunity to focus on promotion of healthier eating habits. The Mediterranean diet has been proven to be of value in diabetes prevention[2] and has been associated with reduced overall mortality. Greece could invest in “healthy lifestyle” tourism and exports of healthy food products as a means to exit the crisis (via reduction of unemployment, improvement in the balance of payments, reduction in health costs for diabetes). Local communities can have a leading role in diabetes prevention. Raising awareness through campaigns in local settings, mass media and the dynamically spreading new media and social networks is but one option. It is vital that exercise is encouraged in the community either by urban planning, transportation policies or by promoting a “sports for the masses” culture. The Olympic heritage can be employed in this cause, as Greeks first identified the value of a healthy body and with the stadia infrastructure that was developed for the recent Olympic Games mostly abandoned it is a huge opportunity to engage the population in sports activities.
Indian Journal of Endocrinology and Metabolism / Jan-Feb 2014 / Vol 18 | Issue 1
121
Letters to the Editor
Risk assessment tools have been designed, shown to be able to detect high risk individuals for type 2 diabetes (T2DM) and validated for use in the Greek population.[3] Appropriate action should then be taken for those individuals or those diagnosed with T2DM. Large studies have proven that T2DM is preventable with sustainable results. Implementation of such interventions in Greece[4] has been successful and holds a promise for the future. It is well-documented that a key factor in prevention programs is effective behavioural modification. The employment of lay health educators and peer led support[5] has been promising in that field and should be considered, especially in the current context of limited resources. If appropriate action is not taken it is inevitable that Greek National Health System will face tremendous pressure from diabetes in the future. At the same time, the economic setting calls for limited, reasonable and cost-effective expenditures. This context asks for strategies that can facilitate a future where Greece will act as a paradigm in diabetes prevention, confirming that a crisis can be seen as an opportunity and steer development.
ACKNOWLEDGMENTS The diploma is funded for by SAS Fund from East Midlands Deanery. Pavlos Zafeiris United Lincolshire Hospitals, NHS Trust, UK Corresponding Author: Dr. Pavlos Zafeiris, Flat 10, Bolingbroke House, Boston, PE21 9QQ, Lincs, UK. E-mail: [email protected]
REFERENCES 1.
2.
3.
4.
5.
122
Athanasakis K, Ollandezos M, Angeli A, Gregoriou A, Geitona M, Kyriopoulos J. Estimating the direct cost of type 2 diabetes in Greece: The effects of blood glucose regulation on patient cost. Diabet Med 2010;27:679-84. Martínez-González MA, de la Fuente-Arrillaga C, Nunez-Cordoba JM, Basterra-Gortari FJ, Beunza JJ, Vazquez Z, et al. Adherence to Mediterranean diet and risk of developing diabetes: Prospective cohort study. BMJ 2008;336:1348-51. Makrilakis K, Liatis S, Grammatikou S, Perrea D, Stathi C, Tsiligros P, et al. Validation of the Finnish diabetes risk score (FINDRISC) questionnaire for screening for undiagnosed type 2 diabetes, dysglycaemia and the metabolic syndrome in Greece. Diabetes Metab 2011;37:144-51. Makrilakis K, Liatis S, Grammatikou S, Perrea D, Katsilambros N. Implementation and effectiveness of the first community lifestyle intervention programme to prevent type 2 diabetes in Greece. The DE-PLAN study. Diabet Med 2010;27:459-65. Aswathy S, Unnikrishnan AG, Kalra S, Leelamoni K. Peer support as a strategy for effective management of diabetes in India. Indian J Endocrinol Metab 2013;17:5-7.
Access this article online Quick Response Code: Website: www.ijem.in DOI: 10.4103/2230-8210.126596
Subclinical pituitary apoplexy with preserved pituitary functions Sir, The word “apoplexy” means accumulation of blood or fluid within any organ in Greek. Pituitary apoplexy was firstly described by Brougham et al., in 1950.[1] Pituitary apoplexy is a medical emergency and clinically manifest as a sudden onset of severe headache, visual deterioration, ophthalmoplegia, and partial or complete pituitary failure, with or without altered consciousness. However, the presentation varies from asymptomatic presentation to life-threatening subarachnoid hemorrhage.[2] Asymptomatic pituitary hemorrhage is often termed subacute or subclinical pituitary apoplexy, which occurs in about 14-22% of cases with pituitary macroadenoma.[2,3] A 22-year-old male presented with progressive diminution of vision in both eye for 1 month to an eye department. There was no history of headache, vomiting, seizure, motor, sensory, altered sensorium, and bowel or bladder symptoms. He had no symptoms suggestive of endocrine dysfunction. He was of average built and his general examination was unremarkable including vital parameters. He had no clinical evidence of endocrine hyper or hypofunction. His visual field examination showed bitemporal hemianopia [Figure 1]. There was no evidence of any neurological deficit, including cranial nerves. He had normal hematological and biochemical parameters (hemoglobin 13.0 g/dl, P. glucose fasting 76 mg/dl, PP 76 mg/dl, B urea 26 mg/dl, S creatinine 0.7 mg/dl, S sodium 138 meq/L, potassium 4.8 meq/L, S bilirubin 0.6 mg/dl, ALT 11 IU/L, AST 17 IU/L, urine specific gravity 1020, spot sodium 11.5 meq/dl), His magnetic resonance imaging (MRI) showed hemorrhagic pituitary macroadenoma (2.9 × 4.3 × 4.6 cm) with suprasellar extension with solid and cystic component within tumor. It also extended into cavernous sinus, displacing both the cavernous internal carotid arteries laterally [Figure 2].
Indian Journal of Endocrinology and Metabolism / Jan-Feb 2014 / Vol 18 | Issue 1
Copyright of Indian Journal of Endocrinology & Metabolism is the property of Medknow Publications & Media Pvt. Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
