Response of bisphosphonate therapy in recurrent tumoral calcinosis

Tumoral calcinosis is a rare condition characterized by solitary or multiple, periarticular masses. Surgical excision of the tumoral calcinosis lesion is a well-documented treatment, but recurrences are not uncommon. A case of 42 year old male patient of tumoral calcinosis presented to us with history of repeated surgical excision twice in past 8 years for recurrent swellings. He was started on IV zoledronic acid and the patient has shown improvement after two years with no recurrence in follow up.

Response of leuprolide on gonadal functions of women with overt hypothyroidism: a tertiary care centre study from Uttar Pradesh, India

Background: Hypothyroidism can cause menstrual disturbances mainly oligoanovualtory cycles and sometimes menorrhagia. It has also been seen to cause subfertility and pregnancy related complications. Various studies have been done to evaluate gonadal dysfunctions in overt hypothyroidism but very few studies are there which have done using a gonadotrophin response in that subset of patients. Present study evaluates the response of leuprolide on gonadal functions of women with overt hypothyroidism in a tertiary care centre at Meerut.Methods: In this study 50 females of age 20 to 40 years with newly diagnosed overt hypothyroidism were taken as cases and age and Body Mass Index (BMI) matched healthy females were taken as controls. Both in cases and controls, basal FSH, LH, estradiol was measured on 2nd day to 5th day of menstrual cycle. Thereafter Leuprolide 20 mcg/kg was given subcutaneously on the same day. Post leuprolide test, stimulated LH, FSH and estradiol were measured. Basal and stimulated values were compared between both groups.Results: Basal LH was significantly higher in controls (8.2±3.2 mIU/L) when compared to cases (6.45±2.75 mIU/L) with a p value 0.03(<0.05). Basal estradiol and FSH levels were found to be nearly similar and non-significant in cases and controls. No significant differences were found between stimulated mean LH and estradiol in both the groups. Leuprolide response after stimulation test was found to be sluggish in patients with overt hypothyroidism compared to normal euthyroid controls. This study is the rare one done on human subject in tertiary care centre of India, however large sample and multicentric trials are necessary before establishing the biochemical results.Conclusions: Pituitary and gonadal (ovarian) response to leuprolide was found to have impaired (decreased) in overt hypothyroidism cases. This is the first study to be done in overt hypothyroid subjects to asses both basal and stimulated gonadotropin levels.

Assessment of gonadal functions in women with subclinical hypothyroidism in Western Uttar Pradesh, India

Background: In females, hypothyroidism can cause menstrual disturbances mainly oligomenorrhea. Thyroid dysfunction has also been linked to reduced fertility and pregnancy complications. Several studies have been done to evaluate gonadal dysfunctions in overt hypothyroidism but very few studies are there regarding subclinical hypothyroidism. Present study evaluates the gonadal functions of women with subclinical hypothyroidism.Methods: Total 20 females of age 18 to 35 years with newly diagnosed subclinical hypothyroidism were taken as cases and 20 age and body mass index (BMI) matched healthy females were taken as controls. Both in cases and controls, basal FSH, LH, estradiol were measured on 3rd or 4th day of menstrual cycle at 8 AM on fasting. Thereafter Leuprolide 20 mcg/kg was given subcutaneously on the same day. One hour after injection, LH and estradiol were measured. Basal and stimulated values were compared between both groups.Results: Basal LH was significantly higher in controls (6.63�38 m IU/ml) when compared to cases (6.06�10 m IU) with a p value 0.01 (<0.05). No significant differences were found between stimulated LH and estradiol in both the groups.Conclusions: In mild thyroidal failure the response of pituitary gonadotrophs to leuprolide is normal in contrast to overt hypothyroidism where the response is sluggish. This is the first study to be done in subclinical hypothyroid subjects to asses both basal and stimulated gonadotropin levels. Further studies are required in large samples to confirm these findings.

Detection of microvascular complications of diabetes by EZSCAN method and their correlation with metabolic indices

Background: EZSCAN is a new, non-invasive technique to detect sudomotor dysfunction and thus neuropathy in diabetes patients at an early stage. It further predicts chances of development of other microvascular complications. In this study we evaluated EZSCAN for detection of microvascular complications in Type 2 diabetes patients and assessed their correlation with various metabolic parameters.Methods: 104 known diabetes patients, 56 males and 48 females, were studied. All cases underwent the EZSCAN test, Body mass index measurement, fasting and postprandial blood glucose, HbA1c tests. Diabetes related complications were thereafter correlated with various metabolic indices.Results: Strong correlation was found between HbA1c, body mass index (BMI), fasting blood glucose (FBG) and post-prandial blood glucose (PPBG) with diabetes related microvascular complications assessed by EZSCAN, strongest being with FBG (r=0.755) and weakest with BMI(r=0.232).Conclusions: Microvascular complications of diabetes as detected by EZSCAN method correlate strongly with metbolic indices of the patient and thus EZSCAN can be used as a simple, non-invasive and quick method to detect microvascular complications of diabetes.