Correlation of serum androgen and gonadotropin with anti-mullerian hormone in polycystic ovarian syndrome in Eastern Indian population

Background: Ovarian steroidogenesis requires gonadotropin stimulation, Luteinizing Hormone (LH) is a key factor in the hyperandrogenaemia of the polycystic ovary syndrome. Progesterone is the primary regulator of Gonadotropin-Releasing Hormone (GnRH) pulse frequency; however, in the polycystic ovary syndrome, the GnRH pulse generator is relatively resistant to the negative feedback effects of progesterone.  Study aims to evaluate the association of Anti-mullerian hormone with serum androgen and gonadotropin level in adolescents and young women of Polycystic Ovary Syndrome (PCOS).Methods: This was a single centre observational Cross-sectional study carried out in the department of Endocrinology and metabolism, Medical College, Kolkata from March 2017 to January 2019. Total number of study subjects were 207 out of which 138 were cases.Results: The AMH had strong positive correlation with serum testosterone in both case and control groups (r 0.542, p<0.001 and r 0.57, p<0.001) respectively .After the adjustment of age and BMI , the AMH moderately positive  but extremely significant correlation with serum testosterone as compare to control.Conclusions: Hyperandrogenaemia and higher ratio of LH and FSH associated with higher serum AMH level is associated with the higher serum AMH in polycystic ovarian syndrome.

Evaluation of the Role of Circumcision in Reducing Symptomatic Urinary Tract Infection Following Vale Ablation

Aim: The aim of this single center short-term prospective study is to determine the effects of circumcision in reducing the risksof symptomatic urinary tract infection (UTI) in post posterior urethral valve (PUV) ablated patients and to compare them withtheir non-circumcised counterparts.Objective: The specific objective of this study in the group includes: a. To identify patients with PUV who develop UTI with subsequentrenal damage. b. Proportion of children with symptomatic UTI in each group. c. Relative risks of presenting with symptomatic UTIafter PUV ablution and. d. To analyze statistically when circumcision really reduces the incidence of UTI in valve ablated patients.Materials and Methods: A single institutional prospective study of patients who were admitted with PUV between April 2016and September 2017 Institutional Ethics Committee Clearance and informed consent of the parents were taken. Boys withcongenital anomalies along with hypospadias and epispadias or any other condition rendering circumcision impossible wereexcluded from the study.Results: We identified 38 patients in all of whom 23 underwent circumcision at the time of valve ablation. The mean age ofthese patients was 41.22 days on a mean follow-up period of 1 year. Only one patient (4.35%) in the circumcised group hadtwo episodes of UTI, whereas three patients (20%) who had not undergone circumcision had five episodes of UTI.Conclusion: Circumcision along with PUV ablation does protect these patients from post-ablation symptomatic UTI and thusis protective against ongoing renal damage.

Migratory polyarthritis in familial hypercholesterolemia (type iIa hyperlipoproteinemia).

Metabolic disorders are often encountered in clinical practice. Some of these diseases are associated with dermatological and musculoskeletal manifestations. Familial hypercholesterolemia is a disorder of lipoprotein metabolism characterized by elevated cholesterol, low-density lipoprotein cholesterol, xanthomas and early onset atherosclerosis. Tendinitis and arthritis have been rarely reported in patients with familial hypercholesterolemia. Here is presented a case of a young girl with migratory polyarthritis, who was diagnosed as probable homozygote familial hypercholesterolemia with hypercholesterolemic arthritis. A proper knowledge of cutaneous manifestations helps to identify patients at risk, establish the underlying diagnosis, and start early and effective therapy.

Multiorgan involvement due to cytomegalovirus infection in AIDS

Cytomegalovirus (CMV) infection is a relatively late complication of AIDS. Like other viruses contributing to co-morbidity of HIV infection, cytomegalovirus has the propensity to cause multiorgan involvement. We report the case of a 34-year-old seropositive man who presented with bilateral lower limb weakness and symptomatic pallor. He was already on antiretroviral drugs for a month prior to presentation. Detailed clinical examination and laboratory investigations revealed cytomegalovirus polyradiculoneuropathy associated with bone marrow dysplasia. Dysplasia of haematopoeitic cell lines occurs in 30 percent to 70 percent of HIV infected patients, and is often indistinguishable from myelodysplastic syndrome. However, in our case, the bone marrow picture reverted back to normal with treatment of the CMV infection, pointing to a possible role of CMV as the causative agent of bone marrow dysplasia. Moreover, CMV has been incriminated as a pathogen producing the immune reconstitution inflammatory syndrome. The onset of the disease in our case one month after initiation of HAART strongly raises the possibility of this being a case of CMV related IRIS. This is the first reported case where IRIS has presented with CMV polyradiculoneuropathy and bone marrow dysplasia. We would like to highlight that in today's era of HIV care, clinicians should be aware of the possibility of multiorgan involvement by CMV, for appropriate management of this disease in the background of AIDS.

Recurrent limb weakness as initial presentation of Wilson's disease.

A 28-year-old normotensive euthyroid man presented with recurrent lower motor neuron type of weakness without sensory or autonomic involvement, with preserved reflexes. Systemic examination was significant for mild hepatosplenomegaly. Investigations revealed persistent hypokalemic, hyperchloremic, normal-anion-gap metabolic acidosis with deranged liver functions. Urine pH was 6.0 even after oral ammonium-chloride loading test. Type I renal tubular acidosis was diagnosed. A search for the etiology revealed bilateral Kayser-Fleischer ring, with low serum ceruloplasmin levels and high urinary copper, confirming it to be Wilson's disease.

Sertoli Leydig cell tumour of ovary with heterologous element--a case report.

A 16 years old female who presented with abdominal swelling and secondary amenorrhoea was subsequently diagnosed as Sertoli Leydig cell tumour of ovary revealing intermediate differentiation with heterologous element. The case is reported in view of its rarity.