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   Table of Contents - Current issue
November-December 2020
Volume 24 | Issue 6
Page Nos. 507-558

Online since Tuesday, January 12, 2021

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Structural and Functional Consequences of Hypercortisolism on Brain: Are the Brain and Psycho-neuro-cognitive Manifestations Reversible? p. 507

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Endocrinology and “Humpty-Dumpty” Highly accessed article p. 509

Nursery rhymes represent the simplest and most innocent form of performance art. 'Humpty-Dumpty' is a popular character of a nursery rhyme. This character denotes a humanized egg. In medicine, the term 'Humpty-Dumpty syndrome' has been used in many specialities. In neurology, “Humpty-Dumpty” syndrome is used to denote prosopagnosia and in rehabilitation medicine and psychiatry it is used to denote failure of a patient to recover from the psychological trauma of a stressful event in childhood. We believe that the character of “Humpty-Dumpty” potentially represents a patient with Cushing syndrome. In this article we have elaborated the scientific reasons for the same.
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Hypovitaminosis D and Its Relationship with Diabetes Mellitus among the Postmenopausal Women in Jashore, Bangladesh p. 512
Goutam Kumar Acherjya, Mohammad Ali, Keya Tarafder, Shamima Yeasmin
Background and Objectives: Vitamin D has diversity of functions including diabetes mellitus by its anti-inflammatory and immuno-modulatory effects. With the scarcity of the regarding data in Bangladesh, the aim of this study was to assess the relationship between hypovitaminosis D and diabetes mellitus among the postmenopausal women. Methods: An observational study conducted from 1st July to 31st December, 2018 in Jashore, Bangladesh that recruited 152 eligible apparently healthy natural postmenopausal women above 45 years without having any chronic diseases and drugs interfering vitamin D metabolism. Data was taken by face to face interview through self-administered questionnaires. Independent t-test, one-way analysis of variance (ANOVA) were used to extract P value and Hochberg's post-hoc test used as equal variance assumed in homogeneous sample to evaluate deference between different groups. Results: Among 152 study subjects, the frequency of diabetes and prediabetes were 28.3% and 31.6%, respectively, among the postmenopausal women by fasting blood sugar level according to the ADA guideline. The study revealed 86 (52.58%) deficient, 56 (36.84%) insufficient, and only 10 (6.58%) sufficient Vitamin D level. Illiterate subjects had less hypovitaminosis D than literate subjects. Urban subjects had more in deficiency state of Vitamin D than rural subjects' on the other hand rural subjects had more insufficiency of Vitamin D. Obese individuals suffered more in hypovitaminosis D than others. There was no significant statically relationship found between FBS and 25(OH)D Level in this study. Conclusion: With high frequency of diabetes and hypovitaminosis D among the postmenopausal women but there is no statically significant relationship found between diabetes and hypovitaminosis D in this study.
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The Effect of Hypomagnesemia on Refractory Hypocalcemia after Total Thyroidectomy: A Single-Center Prospective Cohort Study p. 518

Background: Hypomagnesemia is known to impede hypocalcemia correction. This prospective observational study aimed to evaluate the impact of serum magnesium levels on the development of refractory hypocalcemia, which remains a concerning problem after total thyroidectomy (TT). Subjects and Methods: Consecutive subjects (n = 312; mean age = 38.4 [range: 13–83] years; M:F = 62:250) undergoing TT for benign or malignant thyroid diseases were evaluated for serum corrected-calcium (8.4–10.4 mg/dL), magnesium (1.7–2.4 mg/dL), intact parathormone (iPTH), and 25-hydroxycholecalciferol (25OHD) levels preoperatively, at 48-h and 6-month post-TT. Results: Postoperatively, 98 subjects (31.4%) exhibited transient hypocalcemia, 96 (30.8%) had hypomagnesemia, and 52 (16.7%) had refractory hypocalcemia. Preoperatively, 38 subjects (12.2%) had asymptomatic hypocalcemia and 77 (24.7%) had hypomagnesemia. In multivariate logistic regression analysis, independent risk factors of transient hypocalcemia were hyperthyroidism (odd's ratio [OR]: 5.6), 48-h iPTH (OR: 3.2), 48-h magnesium (OR: 2.7), preoperative 25OHD (OR: 0.96), and preoperative calcium (OR: 0.5; each P < 0.01). In receiver-operating characteristic analysis, percent calcium decline and 48-h magnesium reliably predicted transient hypocalcemia with a threshold of 10.5% and 1.9 mg/dL, respectively. Area under curve, sensitivity, and specificity were 0.822, 82.7%, and 72.9%; and 0.649 (each P < 0.001), 68.4%, and 63.1%, respectively. Conclusion: Serum magnesium below 1.9 mg/dL had 2.7 times higher odds of developing transient hypocalcemia post-TT. Hypomagnesemia and percent calcium decline >10.5% within 48-h post-TT are associated with refractory hypocalcemia, which necessitates correction of both the deficiencies for prompt resolution of symptoms.
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Lives of Gender Incongruent Community: An Indian Subset Chants “All is Well” p. 525

Context: Gender incongruent individuals are exposed to unique stressors as a result of their minority social position. Poor social support has a further adverse impact on the lives and wellbeing of gender incongruent individuals. There is a paucity of scientific data from India on the socioeconomic status (SES) of gender incongruent community. Aims: Aim of the study is to understand and estimate the social support, wellbeing, and SES of gender incongruent individuals in Eastern India. Subjects and Methods: Data of 120 gender incongruent patients from the endocrinology outpatient department of a tertiary care hospital in eastern India were collected. We looked at demographic characteristics, social support, underlying psychiatric comorbidities, and SES. SES was calculated by the Kuppuswamy's socioeconomic status (KSS) scale based on occupation, education, and income. Statistical Analysis Used: Microsoft Word and Excel were used to generate tables. Results: Most of the gender incongruent individuals were transfeminine. Almost half of them had no history of addiction. Most of them had good support from family and friends and very few (only 3%) had mental health problems. Calculation by KSS scale showed most of the study population lay in the upper middle or lower middle socioeconomic class. Conclusions: Strong support from friends and family appears a key factor for protection against psychiatric comorbidities and an all-round impact on the lives and wellbeing of the study population.
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Thyroid Function Test in COVID-19 Patients: A Cross-Sectional Study in a Tertiary Care Hospital p. 532
Kaushik Sen, Sandip Chakraborty, Arijit Sinha, Sirsendu Sen, Md Sayeef Alam
Context: There is scarcity of data on thyroid function abnormality in COVID-19 patients in world literature. Aims: The objective of this study was to assess thyroid function tests in hospitalized patients of COVID-19. Settings and Design: Sixty (60) patients with COVID-19 detected by RT-PCR admitted in General Medicine isolation ward and COVID block of a tertiary care teaching hospital were selected by semi-purposive sampling. Materials and Methods: These patients were assessed for thyroid function tests, including total T3, free T3, total T4, free T4, TSH and anti-TPO antibody along with other baseline investigations. Patients with pre-existing thyroid–related ailments, those on levothyroxine or anti-thyroid drugs or other drugs known to interfere with the results were excluded. Results: There were 43.3% patients in mild, 26.7% in moderate, and 30% in severe category, according to local COVID-19 severity classification protocol. 35% patients had one or more abnormality in the thyroid function, low TSH being the most common (18.33%). 9.1% patients had characteristic pattern of thyroiditis. In most of the others thyroid function did not match any typical pattern. There was no significant difference in any of the parameters of the thyroid function test between mild, moderate, and severe groups. Conclusion: Thyroid function may be abnormal in all categories of patients during COVID-19 infection, even in absence of pre-existing thyroid ailments. Although low TSH is the commonest abnormality and typical pattern of thyroiditis can be seen in a subsection of patients, in majority of the patients, thyroid function abnormality does not follow any characteristic pattern and likely represents a combination of thyroiditis and sick euthyroid syndrome in different points of its spectrum.
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Comparison of Multimodal Ultrasound Imaging with Conventional Ultrasound Risk Stratification Systems in Presurgical Risk Stratification of Thyroid Nodules p. 537
M Shreyamsa, Anand Mishra, Pooja Ramakant, Anit Parihar, Kul R Singh, Chanchal Rana, Sasi Mouli
Background: Ultrasonography (US) is an indispensable tool in the management of thyroid nodules, not only for assessing tumor characteristics but also to assign risk of malignancy and guide in management. Various guidelines and US-based risk stratification systems have been proposed for this purpose. This study aims to compare the diagnostic performances of multimodal US-based risk scores (French TIRADS, TMC-RSS) with conventional US-based scoring systems (Korean TIRADS, ACR-TIRADS, ATA risk stratification). Material and Methods: A total of 168 nodules from 139 patients were studied and categorized in each of the risk stratification systems. Sensitivity, specificity, positive and negative predictive values, and accuracy of each system were computed. ROC curves were plotted and area under curve (AUC) for each scoring system noted. Results: Thirty five (21%) of the 168 nodules were malignant on final histopathological examination. TMC-RSS fared the best in predicting malignant nodules with a sensitivity of 96.2% and specificity of 88.6%, while the PPV and NPV were 97% and 86.1%, respectively. The AUC for TMC-RSS was 0.924 (95% CI, 0.860–0.988; P < 0.001). Conclusion: Multimodal US-based risk stratification incorporating non-grayscale characteristics in addition to conventional systems like the TMC-RSS improves the diagnostic performance of ultrasound imaging of thyroid nodules.
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Radiofrequency Ablation of Parathyroid Adenomas: Safety and Efficacy in a Study of 10 Patients p. 543

Purpose: To evaluate safety and effectiveness of ultrasound-guided percutaneous radiofrequency ablation of parathyroid adenoma in surgically unfit patients with hypercalcemia because of hyperparathyroidism. Materials and Methods: A retrospective review of hospital records from Jan 2012 to Dec 2018 revealed 10 patients, who had undergone ablation for solitary parathyroid adenoma. All 10 patients suffered from hyperparathyroidism because of parathyroid adenoma, resulting in hypercalcemia. These patients were surgically unfit because of comorbidities. Pre-ablation serum calcium and serum parathormone levels were measured and compared with the levels after the ablation. Results: Mean serum calcium level decreased significantly from 2.81 ± 0.17 mmol/L pre-ablation to 2.42 ± 0.17 mmol/L 72 h after ablation and parathyroid hormone levels became normal in all patients within 7 days. Seven patients remained normo-calcaemic at 6 months follow-up with no signs and symptoms of hyperparathyroidism. One patient with pancreatitis died after 15 days because of pre-existing multi-organ failure. Two patients were lost to follow-up before 6 months. Conclusion: Radiofrequency ablation of parathyroid adenoma is a safe and effective alternate treatment method for symptomatic hypercalcemia in surgically unfit patients suffering from primary hyperparathyroidism because of parathyroid adenoma.
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Giant Bilateral Adrenal Myelolipoma: Case Report p. 551

Adrenal myelolipomas are nonfunctional tumors that are usually asymptomatic; however, they have been known to coexist with other endocrine disorders, such as Cushing's syndrome, congenital adrenal hyperplasia (CAH), Conn's syndrome, and pheochromocytoma. We report a case of a 49-year-old man with hypertension and diabetes mellitus who complained of chronic abdominal pain, vomiting, and early satiety. Preoperative contrast-enhanced computerized tomography (CECT) was performed, and adrenal myelolipoma was considered, lab investigations revealed a nonfunctional tumor. CECT also revealed bilateral renal cortical cyst, right renal calculi, and hepatic cyst. A left open cortical sparing adrenalectomy was performed, pathological examination confirmed the diagnosis, and a radiological surveillance was planned for the right tumor. Four years following this, the patient came back with a similar presentation. Right adrenalectomy was performed after preoperative workup, and subsequently steroid replacement therapy was initiated. We suggest adequate follow-up of a patient presenting with adrenal myelolipoma and to explore the possibility of establishing a syndromic diagnosis such as autosomal dominant polycystic kidney disease (ADPKD).
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Pagets Disease, is it Common in the South India p. 554
S Parthasarathy
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Is Paget Disease of Bone a Predominant Disease of South India? Clinical Characteristics, Therapeutic Outcome and Follow Up of 66 Patients from Tamil Nadu and Brief Review of Epidemiology p. 554
Adlyne R Asirvatham, Subramanian Kannan, Shriraam Mahadevan, Karthik Balachandran, Geethalakshmi Sampathkumar, Dhalapathy Sadacharan, Satish K Balasubramanian
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Neonatal Hypoglycaemia due to ABCC8 Gene Mutation p. 555
Ashok Kumar, Subhodip Pramanik, Sujoy Ghosh, Bijan Saha
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