This review describes the epidemiology of childhood diabetes in India. It focuses on the incidence and prevalence of type 1 diabetes and its complications and comorbid conditions. The review also covers data related to type 2 diabetes, glucose intolerance, and monogenic diabetes from India. A brief discussion regarding unique contributions from India to the world literature is included. The topics discussed include use of camel milk as adjuvant therapy in type 1 diabetes, relevance of the A1/A2 hypothesis, and comprehensive clinico-etiopathological classification of type 1 diabetes.
Camels ; Child ; Classification ; Diabetes Mellitus, Type 1 ; Diabetes Mellitus, Type 2 ; Epidemiology ; Glucose Intolerance ; Humans ; Incidence ; India* ; Milk ; Prevalence

OBJECTIVE: To assess effects of off-centering, automatic exposure control, and padding on attenuation values, noise, and radiation dose when using in-plane bismuth-based shields for CT scanning. MATERIALS AND METHODS: A 30 cm anthropomorphic chest phantom was scanned on a 64-multidetector CT, with the center of the phantom aligned to the gantry isocenter. Scanning was repeated after placing a bismuth breast shield on the anterior surface with no gap and with 1, 2, and 6 cm of padding between the shield and the phantom surface. The "shielded" phantom was also scanned with combined modulation and off-centering of the phantom at 2 cm, 4 cm and 6 cm below the gantry isocenter. CT numbers, noise, and surface radiation dose were measured. The data were analyzed using an analysis of variance. RESULTS: The in-plane shield was not associated with any significant increment for the surface dose or CT dose index volume, which was achieved by comparing the radiation dose measured by combined modulation technique to the fixed mAs (p > 0.05). Irrespective of the gap or the surface CT numbers, surface noise increased to a larger extent compared to Hounsfield unit (HU) (0-6 cm, 26-55%) and noise (0-6 cm, 30-40%) in the center. With off-centering, in-plane shielding devices are associated with less dose savings, although dose reduction was still higher than in the absence of shielding (0 cm off-center, 90% dose reduction; 2 cm, 61%) (p < 0.0001). Streak artifacts were noted at 0 cm and 1 cm gaps but not at 2 cm and 6 cm gaps of shielding to the surface distances. CONCLUSION: In-plane shields are associated with greater image noise, artifactually increased attenuation values, and streak artifacts. However, shields reduce radiation dose regardless of the extent of off-centering. Automatic exposure control did not increase radiation dose when using a shield.
Analysis of Variance ; Artifacts ; Phantoms, Imaging ; Radiation Dosage ; Radiation Protection/*methods ; *Tomography, X-Ray Computed

This review article comprehensively discusses multidetector CT urography protocols and their role in imaging of the urinary tract in patients with hematuria.
Hematuria/etiology/*radiography ; Human ; Incidental Findings ; Sensitivity and Specificity ; Tomography, X-Ray Computed/*methods/standards ; Urinary Tract/abnormalities ; Urography/methods/standards ; Urologic Diseases/complications/congenital/radiography

OBJECTIVE: We evaluated the association between patients' weight and abdominal cross-sectional dimensions and CT image quality. MATERIALS AND METHODS: We prospectively evaluated 39 cancer patients aged more than 65 years with multislice CT scan of abdomen. All patients underwent equilibrium phase contrast-enhanced abdominal CT with 4 slices (from top of the right kidney) obtained at standard tube current (240 280 mA). All other scanning parameters were held constant. Patients' weight was measured just prior to the study. Cross-sectional abdominal dimensions such as circumference, area, average anterior abdominal wall fat thickness and, anteroposterior and transverse diameters were measured in all patients. Two subspecialty radiologists reviewed randomized images for overall image quality of abdominal structures using 5-point scale. Non-parametric correlation analysis was performed to determine the association of image quality with patients' weight and cross-sectional abdominal dimensions. RESULTS: A statistically significant negative linear correlation of 0.46, 0.47, 0.47, 0.58, 0.56, 0.54, and 0.56 between patient weight, anterior abdominal fat thickness, anteroposterior and transverse diameter, circumference, cross-sectional area and image quality at standard scanning parameters was found (p< 0.01). CONCLUSION: There is a significant association between image quality, patients' weight and cross-sectional abdominal dimensions. Maximum transverse diameter of the abdomen has the strongest association with subjective image quality.
Aged ; Aged, 80 and over ; Body Weight/*physiology ; Body Weights and Measures/*statistics & numerical data ; Contrast Media/administration & dosage ; Female ; Human ; Male ; Observer Variation ; Prospective Studies ; Radiation Dosage ; Radiography, Abdominal/*methods ; Statistics, Nonparametric ; Tomography, X-Ray Computed/*methods

Enhanced z-axis coverage with thin overlapping slices in breath-hold acquisitions with multidetector CT (MDCT) has considerably enhanced the quality of multiplanar 3D reconstruction. This pictorial essay describes the improvements in 3D reconstruction and technical aspects of 3D reconstruction and rendering techniques available for abdominal imaging. Clinical applications of 3D imaging in abdomen including liver, pancreaticobiliary system, urinary and gastrointestinal tracts and imaging before and after transplantation are discussed. In addition, this article briefly discusses the disadvantages of thin-slice acquisitions including increasing numbers of transverse images, which must be reviewed by the radiologist.
Adult ; Aged ; Biliary Tract/radiography ; Female ; Gastrointestinal Tract/radiography ; Human ; Image Processing, Computer-Assisted/*methods ; Imaging, Three-Dimensional ; Liver/radiography ; Liver Transplantation/radiography ; Male ; Middle Aged ; Pancreas/radiography ; Radiography, Abdominal/*methods ; Tomography, X-Ray Computed/*methods ; Urography/methods

Objectives: Type 2 Diabetics have elevated risk for acute coronary syndrome (ACS). The current management algorithm focuses on atherosclerotic cardiovascular (ASCVD) risk score to stratify this risk. However, in medically managed subjects, this algorithm may not be accurate. This study compares the ASCVD risk score in an Indian population with T2DM under medical supervision and the actual incidence of ACS. It also compared the ASCVD risk scores in cases with T2DM who developed ACS to controls and tried to estimate whether the ASCVD risk score is different in the two subsets, evaluating the utility of the ASCVD risk score in predicting ACS. Methodology: This is an electronic medical record (EMR) based case-control study. Only records of subjects with T2DM where details of age, sex, body mass index, blood pressure, duration of diabetes, family history of ACS, lipid profile, renal and liver function tests were included. The incidence of ACS was calculated in the selected records, and the records of subjects with ACS were compared with age and sex-matched subjects without ACS. Data are summarized as median and interquartile range (IQR). Wilcoxon rank-sum test was used for checking differences in continuous variables and Pearson’s Chi-squared test for categorical data. Univariate and multivariate logistic regression analyses were used to check the effect of ASCVD scores and other variables on the occurrence of ACS. Statistical data analyses were performed using JASP, version 0.16.4 (JASP Team [2022]) for MS Windows. Results: Of the 1226 EMRs included in the analysis, 207 had ACS. The actual incidence of ACS was 16.85% in 6 years, higher than the mean predicted 10-year incidence of 14.56 percent (p <0.05). The cases were age and sex-matched with controls and the ASCVD incidence was estimated in the two groups. The mean ASCVD score in the cases was 14.565 ± 8.709 (Min: 1.5, Max: 38.3) and controls 13.114 ± 8.247 (Min: 1.4, Max: 45). The chance of development of ACS increases with elevated systolic blood pressure (per mmHg rise OR: 1.04, 95% CI: 1.03, 1.06; p <0.001), positive family history (OR: 5.70, 95% CI: 3.41, 9.77; p <0.001), statin use (OR: 2.26, 95% CI: 1.46, 3.52; p <0.001), and longer duration of diabetes (for every year increase OR: 1.19, 95% CI: 1.13, 1.25; p <0.001) Conclusion The ASCVD risk score underestimates the ACS risk in subjects with T2DM under medical supervision and may not differ in those who developed and did not develop ACS. We also conclude that factors like a negative family history (30% less risk), longer duration of diabetes, and higher SBP are relevant in those who developed ACS.
Acute Coronary Syndrome

The South Asian population is rapidly ageing and sarcopenia is likely to become a huge burden in this region if proper action is not taken in time. Several sarcopenia guidelines are available, from the western world and from East Asia. However, these guidelines are not fully relevant for the South Asian healthcare ecosystem. South Asia is ethnically, culturally, and phenotypically unique. Additionally, the region is seeing an increase in non-communicable lifestyle disease and obesity. Both these conditions can lead to sarcopenia. However, secondary sarcopenia and sarcopenic obesity are either not dealt with in detail or are missing in other guidelines. Hence, we present a consensus on the screening, diagnosis and management of sarcopenia, which addresses the gaps in the current guidelines. This South Asian consensus gives equal importance to muscle function, muscle strength, and muscle mass; provides cost-effective clinical and easy to implement solutions; highlights secondary sarcopenia and sarcopenic obesity; lists commonly used biomarkers; reminds us that osteo-arthro-muscular triad should be seen as a single entity to address sarcopenia; stresses on prevention over treatment; and prioritizes nonpharmacological over pharmacological management. As literature is scarce from this region, the authors call for more South Asian research guided interventions.