ABSTRACT
Addison’s disease is chronic adrenocortical insufficiency. Adrenocortical insufficiency (AI) could be due to congenital or acquiredcauses. Congenital causes include inborn defects of steroidogenesis, adrenal hypoplasia congenita, adrenoleukodystrophy,and familial glucocorticoid deficiency. Acquired causes include autoimmunity (Type 1 and 2 autoimmune polyendocrinopathy),infections such as tuberculosis and meningococcemia, drugs such as ketoconazole, rifampicin, phenytoin, and phenobarbitone,and hemorrhage into adrenals as a consequence of difficult labor, metastasis, amyloidosis, and surgical excision. Althoughautoimmunity is the major cause of AI in developed countries, infections like tuberculosis still remain an important cause indeveloping countries like India. Addison’s disease can be easily missed due to its presentation with non-specific symptoms. Serumcortisol levels can also be misleading due to variations in circadian rhythm and increase during stressful situations. Hence, strongclinical suspicion is the key to early diagnosis and treatment. We report here a case Addison’s disease secondary to tuberculosis.
ABSTRACT
Introduction: The association of type 2 diabetes mellitus and thyroid dysfunction is well known. Thyroid dysfunction especially subclinical hypothyroidism has been reported to be a risk factor for sight threateningdiabetic retinopathy. Therefore, it is of importance to investigate the determinants of clinical and subclinicalhypothyroidism in patients with diabetic retinopathy. This study was aimed to investigate the effect of hypothyroidism on diabetic retinopathy and the determinants of hypothyroidism.Aims: To study the association of hypothyroidism and diabetic retinopathy and its effect on severity of retinopathy in type 2 diabetes and investigate the determinants of hypothyroidism in patients with diabetic retinopathy.Subjects and methods: A cross sectional study conducted on one hundred patients of type 2 diabetes withdiabetic retinopathy. They were evaluated for status of diabetes control, thyroid function, lipid profile andretinopathy grade. Those found to have clinical and subclinical hypothyroidism were analyzed for variousclinical and biochemical parameters for possible determinants of thyroid dysfunction.Results: There were seventy-four euthyroid patients and eighteen with subclinical hypothyroidism and five withclinical hypothyroidism. Patients with subclinical hypothyroidism had severe form of retinopathy (61.11%versus 32.43%). The odds of having a subclinical hypothyroidism in patients with severe form of diabeticretinopathy was found to be significant (OR 3.23; p=.048 CI=1.10-9.88). High HBA1c was an independent determinant of abnormal thyroid function.Conclusions: About one fourth of type II diabetes patients with retinopathy have thyroid dysfunction. Thesepatients are also likely to have severe form of the retinopathy especially those having subclinical hypothyroidism. Thus, we recommend thyroid function test should be done in all patients with type II diabetes mellitus withretinopathy. Those identified as having subclinical hypothyroidism should be closely followed so as, to detectand prevent vision threatening complications
ABSTRACT
Aims and Objectives: Carcinoma (Ca) esophagus is a life-threatening malignancy in Indian scenario, due to late-stagepresentation and limited treatment options. Rampant tobacco and alcohol use have seen a rise in the incidence of squamous cellCa esophagus. Accurate identification and description of risk factors are critical to the implementation of preventive measures.The data in this regard are lacking in our country.Materials and Methods: This was a retrospective study conducted at a tertiary care center in Southern India. 103 patients withbiopsy-proven esophageal Ca presenting over a period of 22 months were studied. The data regarding smoking and alcoholconsumption, history of gastroesophageal reflux disease (GERD), Helicobacter pylori infections as assessed by rapid ureasetest during endoscopy and documentation suggestive of tylosis were collected by means of a questionnaire and analysis ofexisting medical documents. No therapeutic or diagnostic interventions were made based on the data collected.Results: Smokers were more likely to develop squamous cell Ca (82.1%, P = 0.04, Z = 1.74) as well as adenocarcinoma (41%,P = 0.01, Z = 5.18). Alcohol consumption was more likely to develop both squamous cell Ca (39%, P = 0.01, Z = 1.73) andadenocarcinoma. Smoking, GERD, and H. pylori infection had a significantly higher association with adenocarcinoma than withthe squamous cell Ca while alcohol use and caustic injury had a higher association with squamous cell Ca.Conclusion: A systematic analysis of risk factors shows that smoking and alcohol are strongly associated with bothhistopathological subtypes of this malignancy. Other risk factors were H. pylori infection, GERD, caustic injury, and tylosis.
ABSTRACT
Hanging is the suspension of a person by a noose or ligature around the neck and has been a common method of capital punishment since medieval times. Hanging is also a common method of suicide/homicide worldwide as also in India. We report a case of attempted suicidal hanging admitted in our intensive care unit. The patient, a 32-year old male, presented with poor clinical status, in gasping condition, hypoxemic and required immediate intubation, resuscitation, assisted ventilation and intensive care treatment. He received standard supportive intensive care and made a full clinical recovery without any neurological deficit. The purpose of the case report is to emphasize that the cases of near-hanging need to be aggressively resuscitated and managed irrespective of dismal initial presentation.