High Diagnostic Accuracy of Thyroid-Stimulating Hormone (TSH) Receptor Antibodies in Distinguishing Graves' Disease and Subacute Thyrotoxicosis in the Indian Population.

BACKGROUND AND OBJECTIVE: Thyrotoxicosis is a common clinical condition encountered in endocrine practice. Graves' disease and subacute thyroiditis are the two common causes of thyrotoxicosis and often have overlapping clinical and biochemical features. 99mTc thyroid scintigraphy is the most commonly used confirmatory test to differentiate the two conditions but is not available in the majority of the second-tier cities of India. However, obtaining thyroid stimulating hormone (TSH) receptor antibodies (TSHrAb), another accurate test to differentiate the two conditions, in second-tier cities by outsourcing to labs in major cities is a feasible option nowadays. However, the data on the performance of TSHrAb to differentiate the two conditions in Indian patients is limited. Hence, we have evaluated the diagnostic accuracy of TSHrAb in the Indian population to differentiate Graves' disease and subacute thyroiditis. MATERIALS AND METHODS: This prospective study was conducted on 115 consecutive newly diagnosed thyrotoxicosis patients presenting to the Department of Endocrinology at a tertiary health care centre in India. Clinical parameters like throat pain, duration of symptoms, and grade of goitre were noted. Measurement of total tri-iodothyronine (TT3), total thyroxine (TT4), TSH, TSHrAb, and 99mTc thyroid scintigraphy were performed in all participants. All participants were followed up at least for six months after the recruitment. Increased tracer uptake (>4%) and/or increased thyroid to parotid trace uptake ratio (>2.5) were used to diagnose Graves' disease. RESULTS: Eighty-one and 34 patients were diagnosed with Graves' disease and subacute thyroiditis, respectively. TT3/TT4 ratio had low diagnostic accuracy (area under the curve (AUC): 0.6, best cut-off: 15.6, sensitivity: 53.1%, specificity: 79.4%). TSHrAb had the best AUC (0.9) to distinguish Graves' disease from subacute thyroiditis (cut-off: 2.0 IU/L, sensitivity: 97.5%, specificity: 100%). In contrast, the kit manufacturer's reference range (1.75 IU/L) was slightly more sensitive (98.8%), but less specific (94%). CONCLUSION: The TT3/TT4 ratio is not a good test to differentiate Graves' disease and subacute thyroiditis. TSHrAb is accurate in distinguishing Graves' disease from subacute thyroiditis and a level of 2.0 may be a more accurate cut-off to differentiate the two conditions in the Indian population.

Li2TiO3/Ni foam composite as high-performance electrode for energy storage and conversion.

Li2TiO3/Ni foam composites were prepared by a solid-state reaction process. They crystallized in the monoclinic Li2TiO3 structure with C2/c space group. SEM images show that the Li2TiO3 particles are monodispersed crystallites of average size 49 nm, infused into porous scaffold Ni foam. As an anode in lithium battery, the composite delivered a discharge capacity of 153 mAh g-1 in an aqueous electrolyte and retained 95% of its initial capacity after 30 cycles. Moreover, the Li2TiO3/Ni foam composite as a negative electrode of pseudo-supercapacitor delivered a specific capacitance of 593 F g-1 and retained 95% of its initial capacitance after 1000 cycles. The enhanced capacity of Li2TiO3/Ni composite is due to porous scaffold Ni foam, which provides high conductivity to the Li2TiO3 particles and high effective surface area for redox reactions. The performance of the Li2TiO3/Ni foam as an electrode material for both lithium-ion batteries (LIBs) and supercapacitors (SCs) shows that this composite is promising for energy storage devices.

Mentoring: a framework for developing health disparities researchers.

Health disparities have been conceptualized as being the result of a confluence of factors: environmental, social, biological, economic, and cultural to name a few. Given the increasingly deleterious impact of health disparities on the lives of all Americans, new research methodological research approaches are needed to adequately understand and address the component parts of health disparities. To effectively address health disparities, an increased focus is needed on implementing transdisciplinary approaches to health disparities research. One approach is to focus on mentoring young investigators and students. This article discusses the centrality of mentoring in developing young health disparities researchers. An overview of health disparities research and researchers, and a summary of the different aspects of mentoring are provided. In addition, a case study of the implementation of a transdisciplinary mentoring framework at a higher education institution is presented.

Influence of years since menopause on bone mineral metabolism in South Indian women.

BACKGROUND: Although an increase of bone turnover has been documented at the time of menopause, the subsequent abnormalities of bone resorption and formation in the elder women have not been investigated. AIM: To assess bone turnover among different YSM (years since menopause) groups of postmenopausal women. SETTINGS AND DESIGN: A case control study in a tertiary care hospital. MATERIALS AND METHODS: Forty-seven premenopausal (control) women and 257 postmenopausal women were included in this study. Based on YSM, the postmenopausal women were divided into four groups namely, 1-5 YSM (n = 82), 6-10 YSM (n = 77), 11-15 YSM (n = 58) and > 15 YSM (n = 40). The levels of calcium, phosphorus, total alkaline phosphatase, FSH, LH, estradiol, intact-paratharmone and 25-hydroxy vitamin D in serum and urine levels of calcium, phosphorus and bone resorption marker calcium/creatinine(Ca/Cre) ratios were analyzed in all subjects. STATISTICAL ANALYSIS USED: One way ANOVA followed by Duncan's multiple range test. RESULTS: Significantly increased levels of FSH (P < 0.001) and declined levels of urine calcium (P = 0.015) and Ca/Cre ratios (P = 0.006) were observed in > 15 YSM group over 1-5 and 6-10 YSM groups. An inverse correlation was observed between serum FSH levels and urine Ca/Cre ratios (r = -0.655, P < 0.001) in > 15 YSM group. Comparable deficient estradiol levels were observed in all YSM groups. CONCLUSIONS: The risk of bone resorption is greater in early years than late years of menopause. The decreased bone resorption risk in late postmenopausal women might be due to increased FSH levels. However, further studies are required to explore this finding.

Awareness and knowledge of the U.S. Public Health Service syphilis study at Tuskegee: implications for biomedical research.

The purpose of this review was to collect and interpret the findings of all published qualitative or quantitative research that assessed African Americans' 1) general awareness and/or specific knowledge of the U.S. Public Health Service (USPHS) Syphilis Study at Tuskegee, and 2) attitudes towards and/or willingness to participate in biomedical research. An exhaustive review of the literature produced eight articles that fit the aforementioned selection criteria. All articles that assessed both awareness and knowledge found that familiarity with the USPHS Syphilis Study at Tuskegee did not necessarily ensure accurate knowledge of it. Four studies also found that awareness of the USPHS Syphilis Study at Tuskegee did not relate to willingness to participate in biomedical research. In addition to awareness and knowledge of the USPHS Syphilis Study at Tuskegee, published studies suggest that a broad array of structural and sociocultural factors influence minorities' willingness to participate in biomedical studies.