Weekly versus daily Levothyroxine Tablet Replacement in Adults with Hypothyroidism: A meta-analysis / Journal of the ASEAN Federation of Endocrine Societies

Objectives@#Daily levothyroxine is the treatment of choice and standard of care in hypothyroidism, sufficient to restore thyroid stimulating hormone (TSH) to normal range. For many patients, daily lifelong therapy is required, making adherence a major issue. In such cases, weekly replacement may be a suitable alternative to improve adherence. In this study, we aimed to determine the efficacy and safety of weekly levothyroxine replacement among adults with hypothyroidism.@*Methodology@#Electronic databases were searched. Two reviewers (HCC and RBL) independently screened the abstracts, reviewed full-text papers, critically appraised the quality of included studies using PRISMA guidelines. Meta-analysis was performed using the random-effects model. The primary outcome is the difference in serum TSH levels between weekly and daily administration, while secondary outcomes included adverse events and symptoms of hypothyroidism.@*Results@#The primary outcome is the difference in serum TSH levels between weekly and daily administration. Secondary outcomes included adverse events and clinical symptoms. The study included two randomized trials (n=109) in the primary analysis. The difference in TSH levels was 1.78 mIU/mL higher [(95% confidence interval (CI): 1.28 to 2.28, p<0.00001] at 6 weeks and 1.22 mIU/mL higher (95% CI: 0.76 to 1.67, p<0.00001) at 12 weeks for the weekly regimen. There was no significant heterogeneity between the two groups. There was no significant difference in hypothyroid symptoms and adverse events before and after levothyroxine treatment within each group.@*Conclusions@#Weekly levothyroxine resulted in less suppression and higher mean serum TSH levels, while still remaining within the normal reference range. It may be a suitable alternative for non-adherent patients. However, larger randomized trials with longer duration of follow-up are needed to firmly establish its role.

An exploration of knowledge and themes on Diabetes during outpatient consultation in a tertiary referral hospital / Journal of the ASEAN Federation of Endocrine Societies

Objectives@#Effective communication has been correlated with improved outcomes in diabetes mellitus. Patient comprehension bears an effect on understanding, improving healthcare access and utilization, interaction with healthcare providers, caring for one’s own health, and shared decision making. Currently, there is a gamut of information on diabetes-related terms from various sources. However, no material has yet been available for clinical use in the third world setting. Hence, we explored the most common themes discussed during an outpatient diabetes consult in our hospital.@*Methodology@#Consultation audio recordings (N = 96) and focus group discussions (N = 32) were conducted among adults with diabetes. Transcribed results underwent qualitative content and thematic analyses to develop the conceptual framework.@*Results@#The study generated the following themes: diabetes mellitus diagnosis, lifestyle modification, treatment targets, hypoglycemia precautions, diabetes complications, and medication safety. There was a good understanding of these themes among patients with a higher educational attainment, however, among those with lower educational attainment, the attitude of patients toward diabetes care is paternalistic.@*Conclusion@#The themes discussed in outpatient diabetes consult reflects the dimensions of diabetes care mainly influenced by socio-cultural factors, patient-doctor relationships and adaptability to limitations of resources. The results will be used to develop and validate a culturally appropriate diabetes health literacy tool.

Dermatomyositis Presenting as Life-threatening Hypercalcemia

Dermatomyositis is a rare disease characterized by classic skin lesions and muscle weakness. In rare cases, life-threatening hypercalcemia may develop caused by regression of dystrophic calcifications. Here we report a 36-year-old man who presented with progressive proximal weakness, difficulty in ambulation, and weight loss. He had the V-sign, Gottron’s papules, and hard, chalky nodules on both antecubital, thigh, and hip areas. Laboratory examinations revealed hypercalcemia (3.47 mmol/L) and shortened QT interval. Workup for malignancy and tuberculosis yielded negative results. Biopsy of the antecubital areas revealed calcinosis cutis. Serum calcium levels gradually normalized with hydration and steroids. Our case illustrated that a high index of suspicion for dermatomyositis is warranted for early diagnosis and ascertaining the etiology of hypercalcemia is vital in the management of this life-threatening complication. While hypercalcemia from dermatomyositis may respond to steroids, to date, individualization of treatment remains the standard of care.

Prophylactic Administration of Oral Allopurinol with Standard IV Hydration in Preventing Contrast-Induced Nephropathy in Patients Undergoing Cardiac Catheterization: A Meta-Analysis and Systematic Review

@#BACKGROUND: Contrast-induced nephropathy (CIN) is associated with increased morbidity and mortality of patients. One of the mechanisms that have been investigated in the development of CIN is the presence of hyperuricemia. Thus, it has been postulated that using urate-lowering agents may be beneficial in preventing CIN. This report aims to determine the efficacy of giving allopurinol along with standard IV hydration in reducing the incidence of contrast-induced nephropathy after coronary catheterization. METHODS: We conducted as electronic search using PUBMED, MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Kidney and Transplant register of Studies, Google Scholar, and Research Gate. Studies fulfilling the inclusion and exclusion criteria were quality assessed based on the criteria provided in the Cochrane Handbook for Systematic Reviews of Interventions. Only published full manuscripts written in English from 1966 to April 2018 were included. The incidences of CIN were analyzed using a random-effects model in Review Manager (Rev Man) Version 5.3 with a 95% confidence interval. RESULTS: Five studies of 2,033 were included with a total of 753 patients. Results showed that there is a 63% decrease in CIN [RR = 0.37 (0.25 to 0.54, 95% CI, Z = 5.10, p < 0.00001) in the allopurinol group compared to those who received hydration alone. When adjusted for heterogeneity by using the random effects model, there remains a 35% decrease in the incidence of CIN [RR = 0.65 (0.43 to 0.99, 95% CI, Z = 2.02, p = 0.04) in the allopurinol group. CONCLUSION: Allopurinol administration may be protective in the development of CIN in patients undergoing coronary interventions. However larger, multi-centered randomized-controlled trials are needed to validate this claim.