Letters to the Editor
2. Ecological or etiological hypothesis formulation and testing: Based on the region and geographical/ environmental factors/incidents, one can deduce the cause of the distribution, which can be further proven with statistical tests. Conclusively, GIS and its software could be of great utility in diabetes research in that it supplements and helps in better spatial data analyses and interpretations as discussed above.
ACKNOWLEDGEMENTS We acknowledge the Cambridge University Press, and the authors of article entitled “Prevalence and risk factors for self-reported diabetes among adult men and women in India: findings from a national cross-sectional survey” published in 2012 in Public Health Nutrition.” Arun Kumar, Anjali Grover1 Department of Community Medicine, Shaheed Hasan Khan Mewati Government Medical College Nalhar, Mewat, Haryana, 1 Department of Geographical Information System and Remote Sensing, RMS India, Noida, Uttar Pradesh, India Corresponding Author: Dr. Arun Kumar, Department of Community Medicine, Shaheed Hasan Khan Mewati Government Medical College Nalhar, Mewat, Haryana, India. E-mail: [email protected]
REFERENCES 1.
2. 3.
4.
Anjana RM, Pradeepa R, Deepa M, Datta M, Sudha V, Unnikrishnan R, et al. Prevalence of diabetes and prediabetes (impaired fasting glucose and/or impaired glucose tolerance) in urban and rural India: Phase I results of the Indian Council of Medical Research-INdia DIABetes (ICMR-INDIAB) study. Diabetologia 2011;54:3022-7. Chrisman NR. What does ‘GIS’ mean? Transactions in GIS 1999;3:175-86. Agrawal S, Ebrahim S. Prevalence and risk factors for self-reported diabetes among adult men and women in India: Findings from a national cross-sectional survey. Public Health Nutr 2012;15:1065-77. Kalra S, Kalra B, Sharma A. Prevalence of type 1 diabetes mellitus in Karnal district, Haryana state, India. Diabetol Metab Syndr 2010;2:14. Access this article online Quick Response Code: Website: www.ijem.in DOI: 10.4103/2230-8210.126598
Neonatal thyroid screening: Relationship between cord blood thyroid stimulating hormone levels and thyroid stimulating hormone in heel prick sample on 4th to 7th day-of-life Sir, Neonatal thyroid screening is considered one of the best cost-effective tool to prevent mental retardation in population. Different strategies are suggested for thyroid hormone estimation in the sample obtained at birth using cord blood or later in the neonatal period.[1-4] The study estimates the correlation between the serially monitored levels of thyroid stimulating hormone in serum obtained from cord blood (TSH-CB) and heel prick (TSH-HP) at 4th to 7th day-of-life. This cross-sectional observational study was performed between November 2001 and March 2003. Live newborns >28 weeks of gestation at birth were enrolled after taking informed consent from parent. The presented data was from a subset of newborns that were undergoing thyroid screening using cord blood TSH under a separate research project.[5] A total volume of 5 ml of cord blood was drawn, centrifuged and serum refrigerated. Another sample was collected at the 4th to 7th day-of-life by heel prick on a labeled filter paper (Schleicher and Schuell #903). Estimation of TSH was performed using immunoradiometric assay. The study was approved by the Ethics Committee of the Institute. Difference between the results obtained by 2 strategies was compared using paired t-test and the correlation estimated using statistical package for the social sciences version 16 (SPSS Inc, Chicago). Over the study period, 130 neonates were enrolled. The mean (range) gestational age and birth weight was 38.16 weeks (28-42 weeks) and 2600 g (800-4500 g), respectively. Almost half were males, 15 were delivered
Indian Journal of Endocrinology and Metabolism / Jan-Feb 2014 / Vol 18 | Issue 1
125
Letters to the Editor
by cesarean section, 14 were preterm, 57 were low birth weight and 24 were small for gestational age.
Table 1: Value of TSH among newborns (n=130) as estimated on CB and HP sample on 4th to 7th day-of-life
The comparison between TSH-CB and TSH-HP is given in the Table 1. There was no statistically significant difference observed in mean TSH values. However, in one baby with cord blood TSH 29.4 μU/ml, the TSH-HP was 60.4 μU/ml and FT4 was in normal range. The TSH-HP increased with increasing TSH-CB with a positive correlation coefficient of 0.87.
Mean±SD (μU/ml) Median (μU/ml) Range (μU/ml) Number of newborns with TSH (μU/ml) between 1-10 10.1-20 20.1-30 >30
A comparison reported from Portugal showed technical superiority of cord blood TSH over heel prick T4 based screening.[2] Similar results, with lower recall rate associated with primary TSH screening, were also reported from India.[3] Hardy et al. reported better sensitivity of TSH-HP compared with TSH-CB which, in turn, was found to be more sensitive than cord blood FT4 based screening.[4] Sample drawn at the 4th to 7th day-of-life is less likely to be affected by the surge in thyroid hormones secondary to the event of birth and the strategy can be applied in the newborns missed during cord blood screening. On the other hand, using cord blood offers advantages of availability in abundance, ethical appropriateness and ensured compliance since it can be collected in all newborns before the discharge in hospital. The observed positive correlation between TSH-CB and TSH-HP appears to be independent of perinatal factors such as birth weight, gestational age and mode of delivery, which are known to interfere with the thyroid status in newborns.[5] Our observations indicate that same cut-off value for recall can be used for TSH-CB and TSH-HP for screening of congenital hypothyroidism.
TSH-CB
TSH-HP
8.28±5.47 6.6 1.4-29.4
8.83±7.27 8 0-60.4
89 35 6 0
90 34 5 1
CB: Cord blood, HP: Heel prick, TSH: Thyroid stimulating hormone, SD: Standard deviation
Bhagat Singh Marg, New Delhi, India. E-mail: [email protected]
REFERENCES 1.
2.
3.
4.
5.
Kempers MJ, Lanting CI, van Heijst AF, van Trotsenburg AS, Wiedijk BM, de Vijlder JJ, et al. Neonatal screening for congenital hypothyroidism based on thyroxine, thyrotropin, and thyroxine-binding globulin measurement: Potentials and pitfalls. J Clin Endocrinol Metab 2006;91:3370-6. Ward LS, Maciel RM, Magalhães RF, Kunii IS, Kurazawa GK, Matsumura LK, et al. Comparison of two strategies for the early detection of congenital hypothyroidism. Rev Assoc Med Bras 1998;44:81-6. Desai MP, Colaco MP, Ajgaonkar AR, Mahadik CV, Vas FE, Rege C, et al. Neonatal screening for congenital hypothyroidism in a developing country: Problems and strategies. Indian J Pediatr 1987;54:571-81. Hardy JD, Zayed R, Doss I, Dhatt GS. Cord blood thyroxine and thyroid stimulating hormone screening for congenital hypothyroidism: How useful are they? J Pediatr Endocrinol Metab 2008;21:245-9. Rashmi, Seth A, Sekhri T, Agarwal A. Effect of perinatal factors on cord blood thyroid stimulating hormone levels. J Pediatr Endocrinol Metab 2007;20:59-64. Access this article online
Anju Seth, M. Rashmi, Bhanu Kiran Bhakhri, Tarun Sekri1 Department of Pediatrics, Lady Hardinge Medical College, Shaheed Bhagat Singh Marg, 1Thyroid Research Centre, Institute of Nuclear Medicine and Allied Sciences, Timarpur, New Delhi, India Corresponding Author: Dr. Bhanu Kiran Bhakhri, Department of Pediatrics, Lady Hardinge Medical College, Shaheed
126
Quick Response Code: Website: www.ijem.in DOI: 10.4103/2230-8210.126599
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.
2. Ecological or etiological hypothesis formulation and testing: Based on the region and geographical/ environmental factors/incidents, one can deduce the cause of the distribution, which can be further proven with statistical tests. Conclusively, GIS and its software could be of great utility in diabetes research in that it supplements and helps in better spatial data analyses and interpretations as discussed above.
ACKNOWLEDGEMENTS We acknowledge the Cambridge University Press, and the authors of article entitled “Prevalence and risk factors for self-reported diabetes among adult men and women in India: findings from a national cross-sectional survey” published in 2012 in Public Health Nutrition.” Arun Kumar, Anjali Grover1 Department of Community Medicine, Shaheed Hasan Khan Mewati Government Medical College Nalhar, Mewat, Haryana, 1 Department of Geographical Information System and Remote Sensing, RMS India, Noida, Uttar Pradesh, India Corresponding Author: Dr. Arun Kumar, Department of Community Medicine, Shaheed Hasan Khan Mewati Government Medical College Nalhar, Mewat, Haryana, India. E-mail: [email protected]
REFERENCES 1.
2. 3.
4.
Anjana RM, Pradeepa R, Deepa M, Datta M, Sudha V, Unnikrishnan R, et al. Prevalence of diabetes and prediabetes (impaired fasting glucose and/or impaired glucose tolerance) in urban and rural India: Phase I results of the Indian Council of Medical Research-INdia DIABetes (ICMR-INDIAB) study. Diabetologia 2011;54:3022-7. Chrisman NR. What does ‘GIS’ mean? Transactions in GIS 1999;3:175-86. Agrawal S, Ebrahim S. Prevalence and risk factors for self-reported diabetes among adult men and women in India: Findings from a national cross-sectional survey. Public Health Nutr 2012;15:1065-77. Kalra S, Kalra B, Sharma A. Prevalence of type 1 diabetes mellitus in Karnal district, Haryana state, India. Diabetol Metab Syndr 2010;2:14. Access this article online Quick Response Code: Website: www.ijem.in DOI: 10.4103/2230-8210.126598
Neonatal thyroid screening: Relationship between cord blood thyroid stimulating hormone levels and thyroid stimulating hormone in heel prick sample on 4th to 7th day-of-life Sir, Neonatal thyroid screening is considered one of the best cost-effective tool to prevent mental retardation in population. Different strategies are suggested for thyroid hormone estimation in the sample obtained at birth using cord blood or later in the neonatal period.[1-4] The study estimates the correlation between the serially monitored levels of thyroid stimulating hormone in serum obtained from cord blood (TSH-CB) and heel prick (TSH-HP) at 4th to 7th day-of-life. This cross-sectional observational study was performed between November 2001 and March 2003. Live newborns >28 weeks of gestation at birth were enrolled after taking informed consent from parent. The presented data was from a subset of newborns that were undergoing thyroid screening using cord blood TSH under a separate research project.[5] A total volume of 5 ml of cord blood was drawn, centrifuged and serum refrigerated. Another sample was collected at the 4th to 7th day-of-life by heel prick on a labeled filter paper (Schleicher and Schuell #903). Estimation of TSH was performed using immunoradiometric assay. The study was approved by the Ethics Committee of the Institute. Difference between the results obtained by 2 strategies was compared using paired t-test and the correlation estimated using statistical package for the social sciences version 16 (SPSS Inc, Chicago). Over the study period, 130 neonates were enrolled. The mean (range) gestational age and birth weight was 38.16 weeks (28-42 weeks) and 2600 g (800-4500 g), respectively. Almost half were males, 15 were delivered
Indian Journal of Endocrinology and Metabolism / Jan-Feb 2014 / Vol 18 | Issue 1
125
Letters to the Editor
by cesarean section, 14 were preterm, 57 were low birth weight and 24 were small for gestational age.
Table 1: Value of TSH among newborns (n=130) as estimated on CB and HP sample on 4th to 7th day-of-life
The comparison between TSH-CB and TSH-HP is given in the Table 1. There was no statistically significant difference observed in mean TSH values. However, in one baby with cord blood TSH 29.4 μU/ml, the TSH-HP was 60.4 μU/ml and FT4 was in normal range. The TSH-HP increased with increasing TSH-CB with a positive correlation coefficient of 0.87.
Mean±SD (μU/ml) Median (μU/ml) Range (μU/ml) Number of newborns with TSH (μU/ml) between 1-10 10.1-20 20.1-30 >30
A comparison reported from Portugal showed technical superiority of cord blood TSH over heel prick T4 based screening.[2] Similar results, with lower recall rate associated with primary TSH screening, were also reported from India.[3] Hardy et al. reported better sensitivity of TSH-HP compared with TSH-CB which, in turn, was found to be more sensitive than cord blood FT4 based screening.[4] Sample drawn at the 4th to 7th day-of-life is less likely to be affected by the surge in thyroid hormones secondary to the event of birth and the strategy can be applied in the newborns missed during cord blood screening. On the other hand, using cord blood offers advantages of availability in abundance, ethical appropriateness and ensured compliance since it can be collected in all newborns before the discharge in hospital. The observed positive correlation between TSH-CB and TSH-HP appears to be independent of perinatal factors such as birth weight, gestational age and mode of delivery, which are known to interfere with the thyroid status in newborns.[5] Our observations indicate that same cut-off value for recall can be used for TSH-CB and TSH-HP for screening of congenital hypothyroidism.
TSH-CB
TSH-HP
8.28±5.47 6.6 1.4-29.4
8.83±7.27 8 0-60.4
89 35 6 0
90 34 5 1
CB: Cord blood, HP: Heel prick, TSH: Thyroid stimulating hormone, SD: Standard deviation
Bhagat Singh Marg, New Delhi, India. E-mail: [email protected]
REFERENCES 1.
2.
3.
4.
5.
Kempers MJ, Lanting CI, van Heijst AF, van Trotsenburg AS, Wiedijk BM, de Vijlder JJ, et al. Neonatal screening for congenital hypothyroidism based on thyroxine, thyrotropin, and thyroxine-binding globulin measurement: Potentials and pitfalls. J Clin Endocrinol Metab 2006;91:3370-6. Ward LS, Maciel RM, Magalhães RF, Kunii IS, Kurazawa GK, Matsumura LK, et al. Comparison of two strategies for the early detection of congenital hypothyroidism. Rev Assoc Med Bras 1998;44:81-6. Desai MP, Colaco MP, Ajgaonkar AR, Mahadik CV, Vas FE, Rege C, et al. Neonatal screening for congenital hypothyroidism in a developing country: Problems and strategies. Indian J Pediatr 1987;54:571-81. Hardy JD, Zayed R, Doss I, Dhatt GS. Cord blood thyroxine and thyroid stimulating hormone screening for congenital hypothyroidism: How useful are they? J Pediatr Endocrinol Metab 2008;21:245-9. Rashmi, Seth A, Sekhri T, Agarwal A. Effect of perinatal factors on cord blood thyroid stimulating hormone levels. J Pediatr Endocrinol Metab 2007;20:59-64. Access this article online
Anju Seth, M. Rashmi, Bhanu Kiran Bhakhri, Tarun Sekri1 Department of Pediatrics, Lady Hardinge Medical College, Shaheed Bhagat Singh Marg, 1Thyroid Research Centre, Institute of Nuclear Medicine and Allied Sciences, Timarpur, New Delhi, India Corresponding Author: Dr. Bhanu Kiran Bhakhri, Department of Pediatrics, Lady Hardinge Medical College, Shaheed
126
Quick Response Code: Website: www.ijem.in DOI: 10.4103/2230-8210.126599
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.
