Background/Aims: Association of sarcopenia with disease severity in ulcerative colitis (UC) is not clearly defined. We planned to estimate the prevalence of sarcopenia in patients with UC as per the revised definition and its relation with the disease severity. Methods: A cross-sectional assessment of sarcopenia in patients with UC was performed. Disease activity was graded according to complete Mayo score. Hand grip strength was assessed with Jamar hand dynamometer, muscle mass using a dual energy X-ray absorptiometry scan, and physical performance with 4-m walk test. Sarcopenia was defined as a reduction of both muscle mass and strength. Severe sarcopenia was defined as reduced gait speed in presence of sarcopenia. Results: Of 114 patients (62 males, mean age: 36.49±12.41 years), 32 (28%) were in remission, 46 (40.4%) had mild-moderate activity, and 36 (31.6%) had severe UC. Forty-three patients (37.7%) had probable sarcopenia, 25 (21.9%) had sarcopenia, and 14 (12.2%) had severe sarcopenia. Prevalence of sarcopenia was higher in active disease (2 in remission, 6 in active, and 17 in severe, P<0.001). Of 14 with severe sarcopenia, 13 had severe UC while 1 had moderate UC. On multivariate analysis, lower body mass index and higher Mayo score were associated with sarcopenia. Of 37 patients with acute severe colitis, 16 had sarcopenia. Requirement of second-line therapy was similar between patients with and without sarcopenia. On follow-up (median: 18 months), there was a non-significant higher rate of major adverse events in those with sarcopenia (47.4% vs. 33.8%, P=0.273). Conclusions Sarcopenia and severe sarcopenia in UC correlate with the disease activity.

Background/Aims: The pathogenesis of gastrointestinal (GI) symptoms in patients with type 2 diabetes mellitus (T2DM) is yet to be delineated clearly.Serotonin, a monoamine neurotransmitter, resides primarily in the gut and plays a vital role in GI system. However, no study has been documented the role of serotonin and serotonin transporter gene (SLC6A4) polymorphism in the development of GI symptoms in T2DM patients. Methods: Three hundred diabetes patients attending diabetes clinic at Postgraduate Institute of Medical Education and Research, Chandigarh, and matched healthy controls were enrolled for this study. Plasma from collected blood sample was used for serotonin measurement by enzyme-linked immunosorbent assay method and buffy coat was used for isolation of DNA by phenol chloroform method.Serotonin transporter gene polymorphism was analyzed by polymerase chain reaction method. Results: The frequency of short allele (S) and SS genotype was significantly higher in patients with T2DM than controls and was associated with increased risk of T2DM. The frequency of LS genotype showed an association with protection from the disease. Regarding GI symptoms, 78.2% of patients with constipation showed LL and LS genotypes, and 97.7% of patients with diarrhea had SS genotype. The patients without GI symptoms did not show any association of gut motility with genotype. Furthermore, serotonin was significantly higher in diabetic patients who belonged to SS genotype compared to LS or LL genotype and who presented with diarrhea. Conclusion SS genotypes are prone to develop diarrhea because of faster gut motility resulting from higher serotonin levels as compared to LS and LL genotype in T2DM patients.

Objectives: To determine the prevalence of sarcopenia obesity (SO) in healthy Indian adults and delineate the relative impact of the 3 indices of obesity [body mass index (BMI), waist circumference (WC), fat mass percent (FM%)] with regards to inter-definitional agreement and their relationship with usual gait speed (GS). Methods: Apparently healthy adults (aged ≥ 20 years) with no background history of comorbidities were enrolled from the community by door-to-door survey. Following blood investigations, individuals with biochemical abnormalities were excluded. Enrolled participants underwent dual-energy X-ray absorptiometry (DXA). Sarcopenia was defined according to EWGSOP2 consensus based on indigenous cut-offs obtained from the Sarcopenia-Chandigarh Urban Bone Epidemiological Study (Sarco-CUBES). Obesity was defined based on BMI (≥ 25.0 kg/m2) or WC (> 90 cm in men, > 80 cm in women) or DXA-derived FM% (> 32% in men, > 40% in women). Results: Data of 804 participants were analyzed after exclusion. The mean ± SD for BMI, WC, and FM% were 26.5 ± 2.7 kg/m2, 86.8 ± 9.6, and 34.7 ± 7.3%, respectively. Prevalence of sarcopenia was 3.2%. Based on BMI, WC, and FM%, the prevalence of SO in elderly subjects (≥65 years) was 5.4%, 5.4%, and 6.3%, respectively. Using Cohen’s kappa, inter-definitional agreement between the 3 groups was ‘almost perfect’. FM%, and not BMI/WC, emerged as a significant predictor of GS on multiple linear regression analysis. Conclusions The prevalence of SO in healthy elderly Indian adults is 5.4%–6.3%. Either BMI/WC/FM% can be used to correctly identify individuals with SO.

Background/Aims: The pathogenesis of gastrointestinal (GI) symptoms in patients with type 2 diabetes mellitus (T2DM) is yet to be delineated clearly.Serotonin, a monoamine neurotransmitter, resides primarily in the gut and plays a vital role in GI system. However, no study has been documented the role of serotonin and serotonin transporter gene (SLC6A4) polymorphism in the development of GI symptoms in T2DM patients. Methods: Three hundred diabetes patients attending diabetes clinic at Postgraduate Institute of Medical Education and Research, Chandigarh, and matched healthy controls were enrolled for this study. Plasma from collected blood sample was used for serotonin measurement by enzyme-linked immunosorbent assay method and buffy coat was used for isolation of DNA by phenol chloroform method.Serotonin transporter gene polymorphism was analyzed by polymerase chain reaction method. Results: The frequency of short allele (S) and SS genotype was significantly higher in patients with T2DM than controls and was associated with increased risk of T2DM. The frequency of LS genotype showed an association with protection from the disease. Regarding GI symptoms, 78.2% of patients with constipation showed LL and LS genotypes, and 97.7% of patients with diarrhea had SS genotype. The patients without GI symptoms did not show any association of gut motility with genotype. Furthermore, serotonin was significantly higher in diabetic patients who belonged to SS genotype compared to LS or LL genotype and who presented with diarrhea. Conclusion SS genotypes are prone to develop diarrhea because of faster gut motility resulting from higher serotonin levels as compared to LS and LL genotype in T2DM patients.

Objectives: To determine the prevalence of sarcopenia obesity (SO) in healthy Indian adults and delineate the relative impact of the 3 indices of obesity [body mass index (BMI), waist circumference (WC), fat mass percent (FM%)] with regards to inter-definitional agreement and their relationship with usual gait speed (GS). Methods: Apparently healthy adults (aged ≥ 20 years) with no background history of comorbidities were enrolled from the community by door-to-door survey. Following blood investigations, individuals with biochemical abnormalities were excluded. Enrolled participants underwent dual-energy X-ray absorptiometry (DXA). Sarcopenia was defined according to EWGSOP2 consensus based on indigenous cut-offs obtained from the Sarcopenia-Chandigarh Urban Bone Epidemiological Study (Sarco-CUBES). Obesity was defined based on BMI (≥ 25.0 kg/m2) or WC (> 90 cm in men, > 80 cm in women) or DXA-derived FM% (> 32% in men, > 40% in women). Results: Data of 804 participants were analyzed after exclusion. The mean ± SD for BMI, WC, and FM% were 26.5 ± 2.7 kg/m2, 86.8 ± 9.6, and 34.7 ± 7.3%, respectively. Prevalence of sarcopenia was 3.2%. Based on BMI, WC, and FM%, the prevalence of SO in elderly subjects (≥65 years) was 5.4%, 5.4%, and 6.3%, respectively. Using Cohen’s kappa, inter-definitional agreement between the 3 groups was ‘almost perfect’. FM%, and not BMI/WC, emerged as a significant predictor of GS on multiple linear regression analysis. Conclusions The prevalence of SO in healthy elderly Indian adults is 5.4%–6.3%. Either BMI/WC/FM% can be used to correctly identify individuals with SO.

A 32-year-old lady presented to us at 6 months of gestation with acute pancreatitis due to parathyroid hormone-dependent hypercalcemia and with insulin-dependent hypoglycemia, owing to parathyroid adenoma and possibly insulinoma, respectively. The parathyroid adenoma was localized on the magnetic resonance imaging of the neck; however, imaging for the insulinoma could not be done due to the gravid state. Due to the simultaneous occurrence of tumours in two endocrine glands, namely, parathyroid gland and pancreatic islet cells, a diagnosis of MEN-1 (multiple endocrine neoplasia) was considered, which is very rarely seen in pregnancy. Her hypercalcemia was effectively managed with cinacalcet and alcohol ablation of the parathyroid adenoma while her hypoglycemic episodes were managed with short and long-acting octreotide injections during the antenatal period. She had a full-term cesarean delivery, with no maternal or neonatal complications, except for transient neonatal hypoglycemia. The patient was followed up for 1 year after her delivery with no further episodes of hypercalcemia and hypoglycemia, on medical management. Tc99m sestamibi scan was done after delivery which confirmed the presence of a left inferior parathyroid adenoma. MEN-1 with pregnancy thus poses a diagnostic and therapeutic challenge and our case highlights the role of multimodal medical therapy for successful management.

A 32-year-old lady presented to us at 6 months of gestation with acute pancreatitis due to parathyroid hormone-dependent hypercalcemia and with insulin-dependent hypoglycemia, owing to parathyroid adenoma and possibly insulinoma, respectively. The parathyroid adenoma was localized on the magnetic resonance imaging of the neck; however, imaging for the insulinoma could not be done due to the gravid state. Due to the simultaneous occurrence of tumours in two endocrine glands, namely, parathyroid gland and pancreatic islet cells, a diagnosis of MEN-1 (multiple endocrine neoplasia) was considered, which is very rarely seen in pregnancy. Her hypercalcemia was effectively managed with cinacalcet and alcohol ablation of the parathyroid adenoma while her hypoglycemic episodes were managed with short and long-acting octreotide injections during the antenatal period. She had a full-term cesarean delivery, with no maternal or neonatal complications, except for transient neonatal hypoglycemia. The patient was followed up for 1 year after her delivery with no further episodes of hypercalcemia and hypoglycemia, on medical management. Tc99m sestamibi scan was done after delivery which confirmed the presence of a left inferior parathyroid adenoma. MEN-1 with pregnancy thus poses a diagnostic and therapeutic challenge and our case highlights the role of multimodal medical therapy for successful management.

Owing to an oversight in manuscript preparation, the name of the fifth author was rendered incorrectly. The correct spelling is Divya Dahiya.

¹⁸F-Fluorocholine (FCH) PET/CT is evolving as a functional imaging modality for the preoperative imaging of abnormal parathyroid tissue(s) helping to localize eutopic and ectopic parathyroid tissue and limit the extent of surgery. FCH PET/CT may show incidental uptake in various thyroid lesions necessitating further evaluation, whereas the role of ¹⁸F-fluorodeoxyglucose (FDG) PET/CT in the detection of incidental thyroid nodules is well documented. The case of a middle-aged woman with dual pathology of parathyroid adenoma and papillary thyroid cancer detected on FCH and FDG PET/CT is presented.

Owing to an oversight in manuscript preparation, the name of the fifth author was rendered incorrectly. The correct spelling is Divya Dahiya.