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ABSTRACT Objective: Data regarding rare FPAs from India, a resource limited setting, are limited. We describe a case series of rare FPAs from a single center in western India. Materials and methods: This was a retrospective case record review of patients diagnosed between January 2010 and July 2022. The diagnosis was based on biochemical (inappropriately elevated serum FSH/LH) and pathologic (positive immunostaining for FSH/LH) features in patients with FGA, and elevated serum thyroid hormones and normal/elevated TSH in patients with TSHomas. Results: We identified 11 patients with a total of six FGAs (median age 43.5 years, five men, one FGA cosecreting TSH, median largest dimension 40 mm, range 33-60 mm) and six TSHomas (median age 34.5 years, four women, two TSHomas cosecreting GH, median largest dimension 42.5 mm, range 13-60 mm). Symptoms of sellar mass effects led to pituitary imaging in most patients with FGA. Patients with TSHomas had symptoms of excess hormone secretion (GH/TSH) or sellar mass effects. The TSHomas that cosecreted GH/FSH were larger than those secreting only TSH. Transsphenoidal resection was the most common first-line therapy but significant residual disease was frequent (3 out of 6 FGAs and 4 out of 5 TSHomas). Conclusion: This is the first and second case series of FGAs and TSHomas, respectively, from India. In this study, TSHomas presented at younger age, were larger and had low surgical cure rates.
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Objective: To describe the characteristics of gonadotropin-dependent precocious puberty (GDPP) in Indian children. Methods: Clinical profiles of GDPP (n=78, 61 females) and premature thelarche (n=12) from a single center in Western India were retrospectively studied. Results: Pubertal onset was earlier in boys than girls (29 vs 75 months, respectively; P=0.008). The basal luteinizing hormone (LH) was ?0.3 mIU/mL, except 18% of GDPP girls. At 60 minutes after GnRHa-stimulation, all patients (except one girl) had LH ?5 mIU/mL. The GnRHa-stimulated LH/FSH ratio was ?0.34 at 60 minutes in girls with GDPP unlike premature thelarche. Only one girl had an allergic reaction to long-acting GnRH agonist. Among GnRH agonist-treated girls (n=24), the predicted final adult height was -1.67±1.5 SDS, whereas the attained final height was -0.25±1.48 SDS. Conclusion: We establish the safety and efficacy of long acting GnRH agonist therapy in Indian children with GDPP. The 60-minute stimulated serum LH/FSH of ?0.34 differentiated GDPP from premature thelarche.
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Background: Non-communicable diseases like DM2, cardiac diseases, chronic respiratory disorders, brain disorders like stroke have created a havoc in developing countries, especially India which harbors 2nd largest population in the world. The present study was planned in this area to capture the data regarding epidemiology, risk factors of DM2, and use this information to plan health program to formulate effective preventive measures, including raising general awareness about the disease in that geographical area.Methods: The present cross sectional study was carried out in population of Karad area of Satara district in Maharashtra state. The study duration was of 1 year, from 1st February 2018 to 1st February 2019.Results: Out of total 1100 study population in the present study, 99 (9%) were diagnosed as diabetics (DM2) while 1001 were normal/non-diabetics. Majority of the diabetic patients were of the age group 41 to 50 years. Females (47%) showed slightly more prevalence of diabetes as compared to males (53%). Majority of the diabetic patients were having sedentary lifestyle, which consisted of 69 patients (70%), which was statistically significant, as compared to non-diabetic group.Conclusion: Thus, findings of the present study amply clarifies that DM2 is on longer a disease of urban population. Its prevalence is increasing in rural population, as well. Lack of awareness, sedentary lifestyle, faulty dietary habits, etc. are some of the reasons for such high prevalence.
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Acinetobacter is a complex genus, with multiple species. Acinetobacterspecies are the common etiology of nosocomial infections, principally nosocomial pneumonia catheter-associated bacteremia and urinary tract infections. Multidrug Resistant (MDR) Ventilator Associated Pneumonia (VAP) by Acinetobacter spp is increasingly reported from different parts of the world. Transmission of Acinetobacter is aid by the organism's environmental stubbornness, resistance to desiccation and evasion of host immunity. The virulence properties demonstrated by Acinetobacter spp. is primarily by evasion of rapid clearance by the immune system. The capsular polysaccharide is a critical virulence factor that enables immune evasion and lipopolysaccharide triggers septic shock. Conversely, the primary factor of clinical outcome is antibiotic resistance. Acinetobacter spp. has become a discreditable threat for patients on mechanical ventilation. Considering high rate of antibiotic resistance, new preventive and therapeutic alternative pproach for MDR Acinetobacter spp. infections are urgently needed. Worldwide drug esistance in Acinetobacter baumannii is growing. This review article is emphasised on incidence of VAPdue to MDR Acinetobacter, phenotypes, genotypes, associated risk factors and preventive strategy
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Background: Derangements in stress hormone levels i.e. steroids, thyroid hormones is routinely encountered in almost all the seriously ill patients, which have been found to be associated with morbidity and mortality. The present study was planned to assess the thyroid hormone derangements in seriously ill patients, with respect to mortality.Methods: The present study was a retrospective, observational, record-based study done at Krishna Institute of Medical Sciences, Karad, Maharashtra, India.Results: Out of total 170 patients, 108 were females (63.5%) and 62 (36.4%) were males. On age wise analysis, it was found that majority of the patients were in the age group >50 years comprising of 78 (45.8%) patients. Thyroid hormonal status was deranged in 94 patients (55%), out of which 53 (31%) died and 41 patients (24%) were alive. Most common derangement was seen in free T3 (triiodothyronine), with 60% of the patients showing lowered values, 35% showing raised values and 5% showing normal values. T4 (thyroxine) levels were normal in major bulk of the patients.Conclusions: Serum T3 levels should be routinely done in critically ill patients, to detect any thyroid disorders, which might go undetected until it is too late.
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Background: Subclinical hypothyroidism (SCH) is defined by increase in serum thyroid stimulating hormone (TSH) and free thyroxine (FT4) and free triiodothyronine (FT3) levels within normal range, coupled with absence of typical clinical symptoms. The present study was undertaken to analyse the SCH associated comorbidities, especially lipid disturbances, thyroid autoantibodies, etc.Methods: The present study was retrospective observational study, which was carried out at a tertiary health care center.Results: Out of the 100 patients, majority were in the age group 21 to 30 years (31 patients), followed by 26 patients in age group >51 years and least in age group 41 to 50 years. Prevalence showed female predilection, with female: male ratio of 1.9:1. Most common symptom reported was general fatigue, which was encountered in 40 patients, followed by weight gain, menstrual abnormalities, and constipation. 10 patients were asymptomatic. Serum TSH range in the patients was 5 to 21.1 µIU/l, while mean TSH was 10.9 µIU/l. 20 patients were found to have serum TSH>10.Conclusions: Despite high prevalence, detection rate of subclinical hypothyroidism is very low. Carrying out epidemiological study on national scale is need of the hour, as lack of typical clinical features makes the detection less likely and it has numerous complications, if untreated
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Background: The 2009 flu outbreak in humans, knownas "swine influenza" or H1N1 influenza A, refers toinfluenza A due to a new H1N1 strain called SwineOrigin Influenza Virus A (S-OIV). Global pandemicswith high mortality and morbidity occur when avirulent new viral strain emerges. Aim and Objectives:To study demography, clinical profile and outcome ofH1N1 influenza infection at a tertiary care teachinghospital. Material and Methods: This was aprospective observational study conducted at theteaching hospital during six month period. It was a timest bound study over a period of six months (from 1 Julyth 2018 to 30 December 2018). All suspects with throatswab/nasal swab positive for influenza H1N1 virus byReverse Transcriptase Polymerase Chain Reaction(RT-PCR) with age more than 15 years were includedin the present study. Data were analysed for mean,percentage, standard deviation and Chi square test forquantitative data by using Microsoft Excel spreadsheet. Results: A total 60 patients were admitted withconfirmed diagnosis of H1N1 infection. Out of the 21(35%) were males and 39 (65%) were females,predominated by female gender (p=0.001). The meanage in male (46.14 ± 20.058) was relatively morecompared to female gender (36.33 ± 11.50). The malegender had more co-morbidities and risk factorscompared to female patients (p=0.01) and wasstatistically significant. Out of total 21 male patients 7patients died because of bilateral pneumonia and AcuteRespiratory Distress Syndrome (ARDS) and MultiOrgan Dysfunction (MOD) with case fatality rate of33.33%. Out of total 39 female patients 5 patients diedwith case fatality rate of 12.82%. Conclusion: Thepresent study highlighted the disease burdenassociated with H1N1 infection. The advancing age,male gender, associated co-morbidities and delayedpresentation were the risk factors for mortality inpresent cohort study of H1N1 patients. The communityawareness, early case detection and timelymanagement can reduce the disease burden at large
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Introduction: Dengue is the most common arboviral diseaseworldwide and is usually endemic, but several epidemics havebeen recorded. Dengue fever is associated with electrolytedisturbances.Material and methods: This study was a cross sectional,descriptive and non interventional study conducted onpatients of Dengue fever, during the period of 18 monthsbetween October 2016 to March 2018 in a tertiary care centre.This study was conducted to find relation between electrolytedisturbances in patients with dengue fever.Results: The majority of the patients 136 (67.32%) weremales while 66 (32.67%) were female patients. The majorityof patients 84.65% were with Dengue fever and 14.35%patients were with Dengue hemorrhagic fever and 0.99%patients were with Dengue shock syndrome. Hyponatremiaand hypokalemia was the frequent electrolyte disturbancesfound in dengue patients. The mean value of serum sodiumwas 133.92mEq/L and of serum potassium was 3.62mEq/L.There exists a positive and significant correlation betweendifference in serum sodium (r = 0.38) and potassium levels(r = 0.41) with Dengue clinical syndrome (DF, DHF, andDSS) which implies that as the difference between the levelsincreases, greater are chances of the Dengue fever towardsDHF or DSS.Conclusions: Hyponatremia was the most frequent electrolytedisturbance and hyperkalemia was least common observed inpatients with Dengue viral infection. Mild hyponatremia andmild hypokalemia were more common among patients ofDengue fever whereas moderate and severe hyponatremia andhypokalemia were more common among Dengue hemorrhagicfever (DHF) and Dengue shock syndrome (DSS).
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Amoebic Liver Abscess (ALA) is a most commonextraintestinal manifestation of amoebiasis which ismost commonly present with high grade fever withright upper quadrant abdominal pain. Here we present acase of 32 year male patient newly diagnosed as PeopleLiving with HIV/AIDS (PLHIV) with ALA. Patientwas treated with Metronidazole (500 mg 8 hourly) andtherapeutic drainage.
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Introduction: Diabetes mellitus is one of the major noncommunicable diseases of which world is experiencing aserious epidemic these recent years. Uric acid serves as anearly indicator of renal complications in diabetes mellituspatients.Material and methods: This was an Observational,descriptive cross sectional study which was conducted duringa period of 18 months (October 2016 and March 2018) Thisstudy was designed to check the levels of serum uric acidand its relation with creatinine, microalbuminuria, HbA1c,fasting and post prandial blood sugar levels in type 2 Diabetessubjects.Results: Study included a total of 120 cases of type 2 Diabetesmellitus, out of which there were 69 males (57.5%) and 51females (42.5%), with a mean age of 59.04 ±13.47 years.Mean FBS was 186.10 ±77.53 mg/dl, with majority of thesubjects having elevated FBS. Mean PPBS of 274.94 ±108.66mg/dl and of HbA1c 8.15 ± 1.7 was observed. The uric acidof majority number of our study participant males (65.22%)had level of ≥ 7.4, with a mean of 9.53 ± 4.38. Mean bloodurea and serum creatinine levels were 46.91 ± 15.13 and 1.44± 0.29 respectively. There was significant association seenbetween uric acid levels and urine albumin, serum creatinine,twenty four hour urinary albumin, FBS and PPBS levels andHbA1c levels.Conclusion: Present study had about two-third subjects withtype 2 Diabetes mellitus with elevated uric acid levels hadmicroalbuminuria and elevated serum creatinine levels.