This document provides information about Fibrocalculous Pancreatic Diabetes (FCPD). It discusses the historical background and definitions of FCPD. FCPD is characterized by severe diabetes associated with chronic pancreatitis and pancreatic stones. It predominantly affects poor populations in tropical developing countries. The document outlines the diagnostic criteria and clinical manifestations of FCPD. It also discusses the genetic factors, various theories about the etiopathogenesis, and principles of management including treatment of diabetes and abdominal pain. FCPD shows heterogeneity in its presentation and natural history.
Diabetes mellitus (DM) refers to a group of common metabolic disorders that share the phenotype of hyperglycemia, due to defect in insulin secretion, insulin action or both .
Diabetes mellitus (DM) refers to a group of common metabolic disorders that share the phenotype of hyperglycemia, due to defect in insulin secretion, insulin action or both .
NAFLD is a vast topic and recently gaining a lot of importance. Fatty liver, NASH, are other topics discussed here. sleissenger, sheila sherlock and Harrisons are used for reference
NAFLD is a vast topic and recently gaining a lot of importance. Fatty liver, NASH, are other topics discussed here. sleissenger, sheila sherlock and Harrisons are used for reference
Digital Strategy Guides for Healthcare Marketers.
How digital can help speed up buying decisions,
turning prospects into customers more quickly,
and more efficiently.
Is Abstraction the Key to Artificial Intelligence? - Lorenza SaittaWithTheBest
With this comprehensive breakdown of abstraction's multiple layers and components, we can understand and answer the question if abstraction is essential to artificial intelligence.
Lorenza Saitta, Università del Piemonte Orientale
NYAI #8 - HOLIDAY PARTY + NYC AI OVERVIEW with NYC's Chief Digital Officer Sr...Rizwan Habib
Sree Sreenivasan is the Cheif Digital Officer for the City of New York, where he works to promote access to City government through technology and support of the city's tech ecosystem.
Prior to his work at City Hall, Sreenivasan served for three years as the first Chief Digital Officer at the Metropolitan Museum of Art, where he led a 70-person team to increase the museum’s digital presence. In October 2015, he was appointed by Mayor de Blasio to the Commission on Public Information and Communication (COPIC), where he worked to increase access to, and education about, City information online.
Before his work at the Met, he spent 20 years as a member of faculty of the Columbia Journalism School and a year as Columbia University's first Chief Digital Officer. For four years, he taught an entrepreneurship class with Ken Lerer, co-founder and chairman of the Huffington Post and now head of Lerer Ventures. He has also taught media marketing classes at Columbia Business School. Because of his interest in startups, he has served as a mentor and adviser to dozens of new ventures, including many by his former students. At the same time, he teaches about intrapreneurship - how to foster innovation and create change within big organizations.
Prior to the Met, Sree was a founding member and contributing editor at neighborhood news site DNAinfo, and throughout his career, he has written for various publications, including the New York Times, and was a popular technology reporter on WABC-TV, WNBC-TV and WCBS-TV.
Normalization of Tumor Microenvironment in Hepatocellular Carcinoma
Oral presentation made at the 2016 World Gastrointestinal Cancer Symposium in Barcelona by Eric Raymond MD, PhD at Saint-Joseph Hospital. This presentation comprehensively updates drugs targeting the microenvironment such as antiangiogenic agents such as VEGF/VEGFR inhibitors, stromal signaling inhibitors such as HGF/c-MET, FGF19/FGFR4, TGF-beta targeting agents and immunotherapy such as PD1/PDL1 and CTLA4 inhibitors in hepatocellular carcinoma. This presentation is aimed at targeting physicians, scientists, students, and experts in pharmas who are interested in drug development in this area of oncology.
Hepatocellular carcinoma—role of interventional radiologist Dr. Muhammad Bin ...Dr. Muhammad Bin Zulfiqar
In these presentation we will discuss the merits, demrits and outcomes of various interventional radiology modalities for the treatment of hepatocellular carcinoma
Many people don't participate in clinical trials because of common misunderstandings, but trials are critical to the development of new cancer drugs and therapies. Learn about 5 basic myths involving clinical trials .
Glucagon like peptide-1 (GLP-1) is an incretin secretory molecule. GLP-1 receptor agonists (GLP-1RAs) are widely used in the treatment of type 2 diabetes (T2DM) due to their attributes such as body weight loss, protection of islet β cells, promotion of islet β cell proliferation and minimal side effects. Studies have found that GLP-1R is widely distributed on pancreatic and other tissues and has multiple biological effects, such as reducing neuroinflammation, promoting nerve growth, improving heart function, suppressing appetite, delaying gastric emptying, regulating blood lipid metabolism and reducing fat deposition. Moreover, GLP-1RAs have neuroprotective, anti-infectious, cardiovascular protective, and metabolic regulatory effects, exhibiting good application prospects. Growing attention has been paid to the relationship between GLP-1RAs and tumorigenesis, development and prognosis in patient with T2DM. Here, we reviewed the therapeutic effects and possible mechanisms of action of GLP-1RAs in the nervous, cardiovascular, and endocrine systems and their correlation with metabolism, tumours and other diseases.
The worldwide explosion of obesity has resulted in an ever-increasing prevalence of type 2 diabetes. The importance of insulin resistance and β-cell dysfunction to the pathogenesis of type 2 diabetes was debated for a long time; many thought that insulin resistance was the main abnormality in type 2 diabetes, and that inability to secrete insulin was a late manifestation. This notion is now challenged. This presentation deals with the important contributing factors in the development of type 2 diabetes mellitus.
Shashikiran Umakanth made this presentation at the "First Endocrine Update Program” – ENDO EGYPT 2015, from 17-20 December 2015 in the Historic City of Luxor, Egypt. This endocrine update was organised by the Egyptian Association of Endocrinology , Diabetes and Atherosclerosis (EAEDA) in collaboration with the Endocrine Society, USA.
Infertility is defined as the inability of a couple to conceive after at least one year of regular unprotected intercourse.
Male infertility refers to a male's inability to cause pregnancy in a fertile female.
IDD situation in our country has improved
A good number of thyroid disorder patients are either undiagnosed and or untreated
Thyroid disorder in pregnancy- Rate high
As a sound thyroid functioning status is crucial for growth, development in children; reproduction, psychological and general wellbeing in adults, we must be proactive in screening, diagnosing and treating our patients.
Over the past several years it has been proved that maternal thyroid disorder influence the outcome of mother and fetus, during and also after pregnancy. The most frequent thyroid disorder in pregnancy is maternal hypothyroidism. It is associated with fetal loss, placental abruptions, pre-eclampsia, preterm delivery and reduced intellectual function in the offspring.1 In pregnancy, overt hypothyroidism is seen in 0.2% cases2 and sub clinical hypothyroidism in 2.3% cases3. Fetal loss, fetal growth restriction, pre-eclampsia and preterm delivery are the usual complications of overt hyperthyroidism (low TSH and high T3, T4) seen in 2 of 1000 pregnancies whereas mild or sub clinical hyperthyroidism (suppressed TSH alone) is seen in
1.7% of pregnancies and not associated with adverse outcomes4. Autoimmune positive euthyroid pregnancy shows doubling of incidence of miscarriage and preterm delivery. Worldwide more than 20 million people develop neurological sequel due to intra uterine, iodine deprivation5. Other problems of thyroid disorders in pregnancy are post partum thyroiditis, thyroid nodules and cancer, hyper emesis gravidarum etc. Debates and disputes persist regarding several protocol and management plan in this specific spectrum of diseases.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
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Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
1. Dr Shahjada Selim
Assistant Professor
Department of Endocrinology
Bangabandhu Sheikh Mujib Medical University, Dhaka
Email: selimshahjada@gmail.com
Fibrocalculous Pancreatic
Diabetes (FCPD)
1
2. Etiologic classification of diabetes mellitus
(ADA Expert Committee (1997)
resistance with relative insulin deficiency
Type 1 diabetes (β cell destruction, usually leading
to absolute insulin deficiency)
a. Immune mediated
b. Idiopathic
Type 2 diabetes (may range from predominantly insulin
to a predominantly secretory defect with
insulin resistance)
2
3. Etiologic classification of diabetes mellitus
contd….
Other specific types
Genetic defects of β cell function
Genetic defects in insulin action
Diseases of the exocrine pancreas e.g. FCPD
Endocrinopathies
Drug - or chemical induced
Infections
Uncommon forms of immune-mediated diabetes
Other genetic syndromes sometimes associated with diabetes
Gestational diabetes mellitus (GDM)
3
4. HISTORICAL BACKGROUND OF FCPD
1959 Zudeima’s first description from Indonesia
1960 Shaper’s report from Uganda
Geevarghese’s first study from Kerala,
1962 world’s largest series around 1700 patients
cases - considered to be the Father of TCP
1962 Existence of FCPD confirmed in Brazil, Kenya,
- 1981 Nigeria and several countries in
Asia eg. Thailand, Bangladesh, Sri Lanka
4
5. FCPD - INTERNATIONAL STATUS
This entity was not given due recognition
1985
Till
1985 WHO study group report introduced the term
Malnutrition Related Diabetes Mellitus (MRDM)
where the term Fibrocalculous Pancreatic
Diabetes (FCPD) was introduced
1997 ADA expert committee deleted MRDM. FCPD now
classified as a subtype under other specific types
as diseases of the Exocrine Pancreas
1998 Provisional report of WHO consulting group
ratified ADA recommendation
5
6. FCPD DEFINITION (Mohan et al, 1985)
Diabetes secondary
to non- alcoholic chronic
pancreatitis of uncertain
etiology predominantly
seen in tropical
developing countries
6
7. FCPD DEFINITION
Severe diabetes
Associated with undernutrition
Usually non ketotic
Presence of pancreatic calculi on X-ray abdomen
or evidence of
chronic pancreatitis on ultrasound or CT
Usually requires insulin for control
Usually seen in poor people
7
8. WORLDWIDE DISTRIBUTION OF MRDM (FCPD) AND PDDM
Reproduced from WHO study Group on Diabetes Mellitus (1985) with permission
8
9. DIAGNOSTIC CRITERIA FOR FCPD
(MOHAN et al, 1985)
Mohan V. Diabetologia. 1985;28:229-232.
Occurrence in tropical country
Diabetes (WHO criteria)
Evidence of chronic pancreatitis
Pancreatic calculi
OR
ERCP evidence of CP
OR
Ultrasound/CT features
Plus h/o abd. Pain / steatorrhoea
Plus abnormal pancreatic function
Absence of other causes of CP (eg. alcoholism)
9
19. Prevalences of Microvascular and Macrovascular diabetic
complications in subjects with FCPD compared with
NIDDM patients
* p = 0.04 compared to Type 2 diabetes
Mohan V et al. Journal of Diabetes and its Complications. 2004;18:264-270.
Percentage of subjects with complications
Type 2 Diabetes (n = 277) FCPD(n =277)
Retinopathy
Non-proliferative
Proliferative
Nephropathy
Peripheral neuropathy
Macrovascular disease
Infarction
Ischaemia
37.2
31.4
5.8
15.0
25.3
5.4
6.5
36.1
32.9
3.6
10.1
20.9
2.2
2.5*
19
20. FCPD WITHO
NATURAL HISTORY OF FCPD
Mohan V et al, International Journal of Diabetes. 1995;3:71-82.
UT FCPD WITH
TCP (PRE- FCPD) TCP- IGT COMPLICATIONS COMPLICATIONS
NORMAL GTT IGT CLINICAL DIABETES
20
24. Prevalence
ACP
of
at
FCPD and diabetes secondary to
our centre from 1991-2010
diabetes
ACP**
0.155
*p for trend < 0.001; **p for trend =0.155
Papita R, Nazir A, Anbalagan VP, Anjana RM, Pitchumoni C, Chari S, Mohan V.
Journal of Pancreas. 2012 ;13:205-9.
Period of
study
Total diabetes
patients
registered at the
centre
No.
Prevalence of
FCPD*
No./ Prevalence of
secondary to
1991-1995 23,788 371 (1.6%) 12 (0.1%)
1996-2000 35,368 226 (0.6%) 25 (0.1%)
2001-2005 48,192 179 (0.4%) 40 (0.1%)
2006-2010 70,394 122 (0.2%) 57 (0.1%)
Total cases
P for trend* 177,742
898 (0.5%)
<0.001
134 (0.1%)
24
25. Change in mean age at diagnosis of patients with FCPD and
diabetes secondary to ACP during the years 1991 to 2010
Papita R, Nazir A, Anbalagan VP, Anjana RM, Pitchumoni C, Chari S,
Journal of Pancreas. 2012 ;13:205-9.
Mohan V.
25
26. ETIOPATHOGENESIS
CASSAVA
LIMITED EXPERIMENTAL EVIDENCE
NO DIRECT PROOF FOR CASSAVAAS A
PANCREATIC TOXIN
MOST OF THE STUDIES ARE SHORT-TERM
Malnutrition - ? Overt
- ? Micronutrient
Cassava (Tapioca)
26
27. Genetic studies on FCPD
TYPE 2 DM FCPD TYPE 1 DM
Kambo PK, Hitman GA, Mohan V. et al. Diabetologia. 1989;32:45-51
Mohan V and Hitman GA, Diabetes / Metabolism Research and Reviews. 2000;16:454-457
Trypsinogen gene - No association
REG gene - No association
INSULIN GENE
HLA-DQβ
HLA-DQα
HLA-DRα
27
28. GENE MUTATIONS ASSOCIATED WITH FCPD
Genetic alterations in the trypsinogen pathway
Serum protease inhibitor Kazal type 1 (SPINK1)
Cationic trypsinogen (PRSS1)
Anionic trypsinogen (PRSS2)
Chymotrypsinogen C (CTRC)
28
29. GENE MUTATIONS ASSOCIATED WITH FCPD
Alteration in other genes
Cystic fibrosis transmembrane conductance
regulator
(CFTR)
Regenerating islet-derived genes 1α (REG1A &
REG1B)
Cathepsin B (CTSB)
Angiotensin converting enzyme (ACE)
Calcium-sensing receptor (CASR)
29
30. ASSOCIATION OF SPINK GENE WITH FCPD
o Pfützer RH, Barmada MM, Brunskill AP, Finch R, Hart PS,
Neoptolemos J, Furey WF, Whitcomb DC. SPINK1/PSTI
polymorphisms act as disease modifiers in familial and idiopathic
chronic pancreatitis. Gastroenterology. 2000.
o Witt H, Luck W, Hennies HC et al. Mutations in the gene encoding
the serine protease inhibitor, Kazal type 1 are associated with
chronic pancreatitis. Nature Genetics. 2000.
o Hassan Z, Mohan V, Ali L et al, SPINK1 is a susceptibility gene for
fibrocalculous pancreatic diabetes in subjects from the Indian
subcontinent. American Journal of Human Genetics. 2002.
30
31. ASSOCIATION OF SPINK GENE WITH FCPD
o Schneider A, et al. SPINK1/PSTI mutations are associated with tropical
pancreatitis and type II diabetes mellitus in Bangladesh
Gastroenterology. 2002.
o Chandak G.R., Idris M.M., Reddy D.N., Bhaskar S., Sriram P.V. and Singh
L. Mutations in the pancreatic secretory trypsin inhibitor gene
(PSTI/SPINK1) rather than the cationic trypsinogen gene (PRSS1) are
significantly associated with tropical calcific pancreatitis, J Med
Genet.,2002.
o Noone P.G., Zhou Z., Silverman L.M., Jowell P.S., Knowles M.R., Cohn
J.A., Cystic fibrosis gene mutations and pancreatitis risk: relation to
epithelial ion transport and trypsin inhibitor gene mutations,
Gastroenterology. 2001
31
32. Current Theories About The
Aetiopathogenesis of FCPD
formation
Factors
FCPDSteatorrhea
Impaired
Glucose
Tolerance
Pancreatic
exocrine
deficiency
Environmental
Malnutrition
Excessive dietary
oxidants and / or
antioxidants
Dietary toxins
Acinar and B cell
damage
Duct obstruction
Calcite stoneDefective B cell
growth and repair
Genetic Factors
Association SPINK
gene and other
genes
32
33. MANAGEMENT OF FCPD –
PRINCIPLES
Treatment of abdominal pain
Use of pancreatic enzymes
Management of diabetes
33
34. Management of Diabetes
Diet
Principles similar to that of other types of
diabetes
More liberal calorie Intake
High protein intake
34
35. Management of Diabetes
Pharmacotherapy
Oral Antidiabetic Drugs
Sulphonyureas can be used if β cell function is good
Biguanides usually not used as the FCPD
patients are lean
Insulin
Would be needed in majority of the cases to
achieve
blood sugar control in FCPD patients
35
36. Heterogeneity in FCPD
Mohan V et al, Diabetologia. 1985;28:229-232.
1. Symptoms Asymptomatic
Marked symptoms
2. Carbohydrate intolerance Normal glucose tolerance
IGT
Overt diabetes
3. B - cell reserve Good
Poor
Negligible
4. Response to therapy Diet alone
Oral agents
Insulin
5. Proneness to ketosis Ketosis - resistant
Ketosis – prone
6. Exocrine dysfunction Only after provocative tests
Clinical steatorrhoea
7. ERCP Absent to mild ductal changes
Marked ductal changes
8. Histopathology Mild changes : calculi
absent or small
Marked changes : extensive
fibrosis, ductal dilatation,
multiple calculi
36