ABSTRACT
Background: Polycystic ovary syndrome (PCOS) is a common disorder in women of reproductive age. Although PCOS patients have a high prevalence of obstructive sleep apnea (OSA), there is limited data on sleep quality and abnormalities in sleep architecture among this patient population. We conducted a study to assess the frequency of OSA and poor sleep quality in women with PCOS and to assess any association between these sleep disorders and metabolic abnormalities. Materials and methods: An observational study of adults with PCOS (by revised Rotterdam criteria) from May 2015 to June 2017 was conducted. Patients with thyroid disorders, pre-existing depression, current pregnancy, and recent drug use (benzodiazepines, antidiabetics, antiepileptics, steroids, and androgens) were excluded. The evaluations included the following: overnight polysomnography (PSG), lipid profile, testosterone, fasting insulin, fasting glucose levels, free androgen index (FAI), and homeostatic model assessment for insulin resistance (HOMA-IR); sleep quality [Pittsburgh Sleep Quality Index (PSQI), Jenkins Sleep Scale (JSS)], daytime sleepiness and possible depression were assessed by standard questionnaires. Descriptive statistics, t-test/Mann朩hitney test, Chi-squared test/Fischer's test were used as appropriate; p <0.05 was considered statistically significant. Results: A total of 65 patients, mean age 24.3 � 4.0 years; mean body mass index (BMI) 26.4 � 5.3 kg/m2 were included. Frequencies of sleep disorders were evaluated as follows: Obstructive sleep apnea 10.9% (7/64) [95% confidence interval (CI): 5.4�.9%], poor sleep quality 35.0% (21/60) (95% CI: 24.2�.6%) by JSS, 54.2% (32/59) (95% CI: 41.6�.3%) by PSQI. The PSG indicators of sleep quality were abnormal in arousal index, 96.8% (62); %wake time, 62.5% (40); sleep latency, 40.6% (26); and sleep efficiency, 12.5% (8). Anthropometric indicators of obesity were higher in OSA vs non-OSA patients (p <0.05). The OSA patients had lower total sleep time and %N2 stage, and higher desaturation index than non-OSA patients. When patients with good and poor sleep quality were compared, poor sleepers (by JSS and PSQI) had higher depression scores; poor sleepers by JSS had a lower waist杊ip ratio (p <0.05). Daytime sleepiness scores were similar in OSA and non-OSA patients, and in good and poor sleepers. Conclusion: Sleep disorders, particularly poor sleep quality, are frequent in women with PCOS. Patients should be screened for these disorders using specific questionnaires. Further research into the metabolic consequences of these sleep disorders is mandated.
ABSTRACT
In view of the high burden of latency of tuberculosis (TB) in India, tackling latent TB in the right way is a menace. All latent TB’s infection (LTBI) are treated in countries having low burden such as the United States. However, this approach cannot be implemented in high burden countries like India until concrete evidence or consensus by experts on this subject is made. There are very specific risk groups where these patients are to be treated as far as current evidence-based medicine is concerned. Hence, the need to develop a document was felt, through which the treatment of LTBI becomes homogeneous by each and every physician who is practicing and treating TB. The last attempt to review the topic was made in 2015, after which there have been many changes and update in this subject.
ABSTRACT
Background: Hypocalcaemia is one of the acute and most feared complication following thyroidectomy. Depending upon the extent of parathyroid damage, post-operative hypocalcaemia may be temporary or permanent requiring lifelong calcium supplements. Aims and objectives: This study aims to prospectively study and analyse the demographics and possible causes of hypocalcaemia post thyroidectomy.Methods: This is a prospective study of 150 patients undergoing thyroidectomy surgery from January 2015 to December 2015 in Victoria hospital, Bangalore medical college and research institute, Bangalore. Patients demographics, intra operative and pathological aspects were correlated to our hypocalcaemic findings.Results: Out of 150 patients, 18 patients developed temporary hypocalcaemia (12%), none of them developed permanent hypocalcaemia. Mean age of patients developing hypocalcaemia was 45.16 years. 15 (83.33%) of them were females and 3 (16.66%) were male. Hypocalcaemia was found in 9% in multinodular goitre (9 out of 99 patients), 20% in papillary carcinoma (3 out of 15 patients) and 40 % in follicular neoplasm (6 out of 15 patients). Near total thyroidectomy was the procedure in 105(70%) patients, 3 from them (2.86%) developed hypocalcaemia and the other 15 out of 45 cases (30%) were after total thyroidectomy. Mean duration of surgery was 101 mins. Average no of parathyroid glands identified was 2. Conclusion: Risk factor for development of hypocalcaemia is multifactorial. The recommended surgical strategy is meticulous dissection and preservation of at least one parathyroid gland and their blood supply to prevent permanent hypocalcaemia.