Exercise and recovery after surgery in patients with breast cancer: An analysis of the literature.

This review explores the impact of exercise on post-surgical recovery in breast cancer patients. Breast cancer, the most prevalent cancer globally, necessitates treatments beyond conventional modalities such as surgery, chemotherapy, radiotherapy, and immunotherapy. While exercise as an adjuvant therapeutic tool is not novel, it is generally accepted for improving cancer outcomes. Yet, it is not included in current treatment guidelines. This study reviews literature using the FACT-B (Functional Assessment of Cancer Therapy - Breast) tool to evaluate quality of life in breast cancer patients undergoing exercise interventions post-surgery. Despite mixed results, with some studies showing significant improvements and others indicating no notable benefits, the general consensus suggests potential advantages of integrating structured exercise programs into recovery protocols. Standardizing the use of quality of life measures like FACT-B could enhance future research and clinical practices, leading to more effective patient care strategies.

Computerized Versus Traditional Approaches for Total Knee Arthroplasty: A Quantitative Analysis of Knee Society Score and Western Ontario and McMaster Universities Osteoarthritis Index.

Total knee arthroplasty (TKA) is a common surgery for osteoarthritis, with increasing prevalence expected in the near future. This systematic review and meta-analysis compared the effectiveness of computerized TKA versus traditional TKA, focusing on postoperative outcomes measured by the Western Ontario and McMaster Universities osteoarthritis index (WOMAC) and the Knee Society score (KSS). A search on PubMed and Cochrane databases on November 14, 2023 for retrospective randomized controlled trials (RCTs) yielded data on WOMAC and KSS. The search strategy was predefined, and methodological quality of studies was critically appraised. Two researchers extracted data. Unpaired t-testing assessed the mean monthly changes in KSS and WOMAC for computer-aided versus traditional TKA. Review Manager 5.3 was used for data synthesis and analysis. Out of 729 records, five RCTs enrolling 339 patients were eligible and analyzed using a random effects meta-analysis. The mean monthly ΔKSS score differed significantly between the traditional and computerized groups (11.47 ± 8.76 vs. 9.26 ± 6.05, respectively; p < 0.01). However, the pooled mean difference estimate showed no significant differences (D = 0.20, 95% CI = -0.53 to 0.93, p = 0.59), with high heterogeneity (I2 = 85%, p < 0.001). The mean monthly ΔWOMAC score also differed significantly (-14.18 ± 21.54 vs. -18.43 ± 20.65, respectively; p < 0.05), but again, no significant differences were found in the pooled estimate (D = 0.17, 95% CI = -0.46 to 0.79, p = 0.60), with moderate heterogeneity (I2 = 28%, p = 0.24).There is no significant difference in KSS or WOMAC outcomes between traditional and computerized TKA. The study suggests the need for further research with longer follow-up periods, more timepoints, and a broader range of patient outcome measures to fully evaluate the advantages and disadvantages of each method.

Glucometrics in the first week of critical illness and its association with mortality / Glucometría en la primera semana de enfermedad crítica y su asociación con la mortalidad

Objective Evaluation of glucometrics in the first week of ICU stay and its association with outcomes. Design Prospective observational study. Setting Mixed ICU of teaching hospital. Patients Adults initiated on insulin infusion for 2 consecutive blood glucose (BG) readings ≥180mg/dL. Main variables of interest Glucometrics calculated from the BG of first week of admission: hyperglycemia (BG>180mg/dL) and hypoglycemia (BG<70mg/dL) episodes; median, standard deviation (SD) and coefficient of variation (CV) of BG, glycemic lability index (GLI), time in target BG range (TIR). Factors influencing glucometrics and the association of glucometrics to patient outcomes analyzed. Results A total of 5762 BG measurements in 100 patients of median age 55 years included. Glucometrics: hyperglycemia: 2253 (39%), hypoglycemia: 28 (0.48%), median BG: 169mg/dL (162–178.75), SD 31mg/dL (26–38.75), CV 18.6% (17.1–22.5), GLI: 718.5 [(mg/dL)2/h]/week (540.5–1131.5) and TIR 57% (50–67). Diabetes and higher APACHE II score were associated with higher SD and CV, and lower TIR. On multivariate regression, diabetes (p=0.009) and APACHE II score (p=0.016) were independently associated with higher SD. Higher SD and CV were associated with less vasopressor-free days; lower TIR with more blood-stream infections (BSI). Patients with higher SD, CV and GLI had a higher 28-day mortality. On multivariate analysis, GLI alone was associated with a higher mortality (OR 2.99, p=0.04). Conclusions Glycemic lability in the first week in ICU patients receiving insulin infusion is associated with higher mortality. Lower TIR is associated with more blood stream infections (AU)

Objetivo Evaluación de la glucometría en la primera semana de estancia en la UCI y su asociación con los resultados. Diseño Estudio observacional prospectivo. Ámbito UCI mixta de hospital docente. Pacientes Adultos que iniciaron una infusión de insulina para dos lecturas consecutivas de glucosa en sangre (GS) ≥180mg/dl. Principales variables de interés Glucometría calculada a partir de la GS de la primera semana de ingreso: episodios de hiperglucemia (GS >180mg/dl) e hipoglucemia (GS <70mg/dl); mediana, desviación estándar (DE) y coeficiente de variación (CV) de GS, índice de labilidad glucémica (ILG), tiempo en el rango objetivo de GS (TIR). Resultados Se incluyeron un total de 5.762 GS en 100 pacientes con una mediana de edad de 55años. Glucometría: hiperglucemia: 2.253 (39%), hipoglucemia: 28 (0,48%), mediana GS: 169mg/dl, DE 31mg/dl, CV 18,6%, ILG: 718,5 [(mg/dl)2/h]/semana, TIR 57%. La diabetes y una puntuación APACHEII más alta se asociaron con una DE y un CV más altos y una TIR más baja. En la regresión multivariada, la diabetes (p=0,009) y la puntuación APACHEII (p=0,016) se asociaron de forma independiente con una DE más alta. La DE y el CV más altos se asociaron con menos días sin vasopresores; menor TIR, con más infecciones del torrente sanguíneo (ITS). En el análisis multivariado, el ILG solo se asoció con una mayor mortalidad (OR: 2,99, p=0,04). Conclusiones La labilidad glucémica en la primera semana en pacientes de UCI que reciben infusión de insulina se asocia con mayor mortalidad. Una TIR más baja se asocia con más ITS (AU)

Glucometrics in the first week of critical illness and its association with mortality.

OBJECTIVE: Evaluation of glucometrics in the first week of ICU stay and its association with outcomes. DESIGN: Prospective observational study. SETTING: Mixed ICU of teaching hospital. PATIENTS: Adults initiated on insulin infusion for 2 consecutive blood glucose (BG) readings ≥180mg/dL. MAIN VARIABLES OF INTEREST: Glucometrics calculated from the BG of first week of admission: hyperglycemia (BG>180mg/dL) and hypoglycemia (BG<70mg/dL) episodes; median, standard deviation (SD) and coefficient of variation (CV) of BG, glycemic lability index (GLI), time in target BG range (TIR). Factors influencing glucometrics and the association of glucometrics to patient outcomes analyzed. RESULTS: A total of 5762 BG measurements in 100 patients of median age 55 years included. Glucometrics: hyperglycemia: 2253 (39%), hypoglycemia: 28 (0.48%), median BG: 169mg/dL (162-178.75), SD 31mg/dL (26-38.75), CV 18.6% (17.1-22.5), GLI: 718.5 [(mg/dL)2/h]/week (540.5-1131.5) and TIR 57% (50-67). Diabetes and higher APACHE II score were associated with higher SD and CV, and lower TIR. On multivariate regression, diabetes (p=0.009) and APACHE II score (p=0.016) were independently associated with higher SD. Higher SD and CV were associated with less vasopressor-free days; lower TIR with more blood-stream infections (BSI). Patients with higher SD, CV and GLI had a higher 28-day mortality. On multivariate analysis, GLI alone was associated with a higher mortality (OR 2.99, p=0.04). CONCLUSIONS: Glycemic lability in the first week in ICU patients receiving insulin infusion is associated with higher mortality. Lower TIR is associated with more blood stream infections.

Prevention of malocclusion and the importance of early diagnosis in the Italian young population.

AIM: Malocclusion is an alteration of the normal relationships between skeletal, muscle and dental structures that can lead to impaired functionality as well as aesthetic alteration of the stomatognathic system. Functional alteration can affect various aspects, ranging from chewing ability to respiratory disorders. Paediatricians and dentists are called to prevent and diagnose these conditions as early as possible in order to preserve the patient's health. The purpose of this research is to study the incidence of malocclusion and its relationship with Obstructive Sleep Apnea Syndrome (OSAS) in a young population. Also, the role of paediatricians and dentists in prevention and early diagnosis of this condition was evaluated METHODS: An anonymous survey was given through Google form to 300 Italian children (139 males and 161 females) from different private dental practices in Italy. No personal information that identifies the individuals was collected, and the data was analysed in aggregate form only. All data was collected and statistically analysed. CONCLUSION: The data highlight the patients' good attitude towards dental check-ups, which help to intercept malocclusions. Unlike the past, the knowledge of the importance of oral health and dental occlusion is high among young patients, parents and paediatricians. This study underlines the role of paediatricians as key players in the prevention of dental health problems.

Motivation, Perception, and Behavior of the Adult Orthodontic Patient: A Survey Analysis.

Purpose: The article is aimed at improving the understanding of the sociocultural profile of adult orthodontic patients and their expectations. In particular, it addresses three main aspects: the motivation and needs that underpin the decision to start orthodontic treatment, how it influences the patients' daily life, and the different oral hygiene demands. Materials and Methods: An online survey was completed by 276 patients undergoing orthodontic treatment with different techniques. The questions asked concerned gender, age, type of appliance, any previous orthodontic treatments, type of any previous retainers, reasons for therapy, satisfaction, pain, problems in eating, daily number of teeth brushings and flossings before and during the treatment, perception of cost, sensation of visibility of the appliance, and if they would recommend orthodontic treatment. Results: A significant role within our sample is played by gender; 87.94% consisted of female patients out of which 72.57% wanted to improve their aesthetics, while only 54.84% of male patients cited the same reason. Invisible aligners were preferred by 67.70% of the patients due to them being considered the least painful, causing the fewest problems with eating, and the least visible. Metal braces were perceived as the less expensive treatment. Over a third of the patients (33.85%) had previously undergone orthodontic treatment, among them 54.05% wore a mobile retainer, 31.08% a fixed one, and 14.86% both. Daily tooth brushing and flossing increased during therapy with clear aligners by 48.94% and 126.39%, respectively. Conclusions: The greatest demand for orthodontic treatments comes from women, as they pay more attention to aesthetics, which makes the clear aligners the most common choice. The relapse after orthodontic treatment seems to cause a higher demand for retreatment, and oral hygiene habits significantly improve during orthodontic treatment, especially with the clear aligners.

The relationship between TMJ symptoms and orthodontic treatments: a survey on 236 orthodontic patients.

The study analyzes how and if temporomandibular joint symptoms are influenced by different types of orthodontic therapy. Two-hundred-and-thirty-six adult orthodontic patients treated by different clinicians, were asked to complete a survey in which factors as the age, the gender and the type of device were considered. The questions were about the typical symptoms of temporomandibular disorders, in particular headache, bruxism, clenching, pain while opening the mouth and joint's noise. It was highlighted if these symptoms changed during the therapy and if they increased or decreased. The answers to our questionnaire revealed that the only statistically significative difference was related to bruxism, because we found a higher rate in patients treated with aligners than patients treated with metal braces, so we can suggest the fixed technique in the orthodontic patient who suffers of bruxism, even if further studies are required.

Proposal of use of the autotransplantation of the third molar as space maintainer in growing patients: a review of literature and a clinical case.

The review of literature shows that 48,22% of the autotranspated teeth were orthodontically treated. A 13-year-old male patient presented a destructive decay in the element 3.6, which was underoccluded. To maintain the arch space and the quantity of bone necessary for a potential implant, it was decided to perform an autotransplantation of the impacted element 3.8. Tooth autotransplantation is a valid and durable alternative to the prosthetic and the implant solutions with high success rate.

Facile green synthesis of Ag-Cu decorated ZnO nanocomposite for effective removal of toxic organic compounds and an efficient detection of nitrite ions.

A facile and eco-friendly green synthesis of silver-copper@zinc oxide (Ag-Cu@ZnO) nanocomposite using Acacia caesia flower extract and their application on catalytic reduction of toxic compounds and electrochemical sensing of nitrite ions are reported. The phytochemicals present in the extract were utilized for the Ag-Cu metal nanoparticles synthesis and also enhanced the binding capability between ZnO and Ag-Cu NPs. The synthesized nanocomposites were characterized by XRD, UV-Vis spectroscopy, Raman spectra, FTIR, SEM, TEM, EDX, XPS and ICP-AES for the formation of Ag-Cu NPs on ZnO. The Ag-Cu@ZnO nanocomposite showed better catalytic efficiency as compared to monometallic nanoparticles for 4-nitrophenol to 4-aminophenol conversion and Rhodamine B and Congo red dye degradation with 99% efficiency up to four cycles. The Ag-Cu@ZnO modified GC electrode showed enhanced catalytic activity towards nitrite oxidation, and it exhibited better performance compared to the other nanocomposites. An appreciable detection limit (17 µM) was achieved with excellent sensitivity for nitrite detection. The sensor was highly selective even in a many-fold higher concentration of co-existing interfering compounds. The good catalytic and electrochemical sensing is mainly ascribed due to the synergistic effect of Ag-Cu on the ZnO in the Ag-Cu@ZnO nanocomposite materials.

Data on the expression and purification of Sestrin protein from Dictyostelium discoideum.

The data present here is related to the research article entitled "Sestrin-like protein from Dictyostelium discoideum is involved in autophagy under starvation stress" [1]. The article provides data to show that Dictyostelium Sestrin share conserved amino acid residues, cysteine and aspartic acid with human Sestrin2. In human Sestrin2, these residues are involved in antioxidant activity along with AMPK activation and mTORC1 suppression [2]. The article provides the method of purification and expression of the fusion protein (Sesn + Igfp) driven by the endogenous sesn promoter and show prestalk expression during development.

Sestrin-like protein from Dictyostelium discoideum is involved in autophagy under starvation stress.

Sestrins are highly conserved; stress inducible proteins that help maintain metabolic homeostasis and protect cells under stress conditions. They are up-regulated during stress and influence AMPK and mTOR pathways. Our objective was to find the role of Sestrin protein from Dictyostelium discoideum (Dd), a lower eukaryote where starvation stress initiates multicellular development. The single DdSesn-like gene was expressed and its endogenous functions were characterized. Both, the knockout and constitutively expressing strains were made and their involvement in starvation-induced autophagy was analyzed. Autophagic fluxes and ROS levels were also monitored. Additionally, overexpression of DdSesn decreased cell growth and showed a longer lag phase. Upon starvation both DdSesn and ROS levels increased. SesnOE showed reduced ROS levels while sesn- showed increased ROS levels when compared to the wild type. Therefore, we suggest that increased sesn expression may be beneficial in reducing ROS levels during starvation. Deletion of sesn showed reduced autophagic flux and increased p4EBP1 levels. We show that DdSesn promotes autophagy in D. discoideum upon starvation.

Isolation of active coagulant protein from the seeds of Strychnos potatorum - a potential water treatment agent.

The application of natural coagulants for decentralized water treatment is gaining importance as a part of global sustainable initiative. This study focuses on the isolation of active coagulation components responsible for water clarification with respect to Strychnos potatorum seeds. The active coagulant components, protein and polysaccharide, were successfully isolated, dialysed and subjected to gel permeation chromatography. The polysaccharide was isolated with the saline extraction method and characterized using FTIR and NMR spectroscopy. Protein was precipitated with 80% ammonium sulphate solution combined with dialysis and gel permeation chromatography using Sephadex G-50. SDS-PAGE revealed that the isolated protein has a molecular weight of 12 kDa. The small-scale coagulation assay suggests that the protein fraction has superior coagulation activity than the isolated polysaccharide residue. The active coagulant fractions reported in this study would be helpful in deploying cheaper and simple methods in scaling up the coagulant fraction from these seeds acting as a potential water treatment agent.

Pilot scale thin film plate reactors for the photocatalytic treatment of sugar refinery wastewater.

Pilot scale thin film plate reactors (TFPR) were fabricated to study the solar photocatalytic treatment of wastewater obtained from the secondary treatment plant of a sugar refinery. Silver-impregnated titanium dioxide (TiO2) was prepared by a facile chemical reduction method, characterized, and immobilized onto the surface of ceramic tiles used in the pilot scale reactors. On 8 h of solar irradiation, percentage reduction of chemical oxygen demand (COD) of the wastewater by Ag/TiO2, pure TiO2, and control (without catalyst) TFPR was about 95, 86, and 22 % respectively. The effects of operational parameters such as, flow rate, pH, and addition of hydrogen peroxide (H2O2) were optimized as they influence the rate of COD reduction. Under 3 h of solar irradiation, 99 % COD reduction was observed at an optimum flow rate of 15 L h(-1), initial pH of 2, and addition of 5 mM of H2O2. The results show that Ag/TiO2 TFPR could be effectively used for the tertiary treatment of sugar refinery effluent using sunlight as the energy source. The treated water could be reused for industrial purposes, thus reducing the water footprint of the industry. Graphical Abstract Sugar refinery effluent treatment by solar photocatalytic TFPR.

Depletion of three combined THOC5 mRNA export protein target genes synergistically induces human hepatocellular carcinoma cell death.

Hepatocellular carcinoma (HCC) is a frequent form of cancer with a poor prognosis and with limited possibilities of medical intervention. It has been shown that over 100 putative driver genes are associated with multiple recurrently altered pathways in HCC, suggesting that multiple pathways will need to be inhibited for any therapeutic method. mRNA processing is regulated by a complex RNA-protein network that is essential for the maintenance of homeostasis. THOC5, a member of mRNA export complex, has a role in less than 1% of mRNA processing, and is required for cell growth and differentiation, but not for cell survival in normal fibroblasts, hepatocytes and macrophages. In this report, we show that 50% depletion of THOC5 in human HCC cell lines Huh7 and HepG2 induced apoptosis. Transcriptome analysis using THOC5-depleted cells revealed that 396 genes, such as transmembrane BAX inhibitor motif containing 4 (TMBIM4), transmembrane emp24-like trafficking protein 10 (Tmed10) and D-tyrosyl-tRNA deacylase 2 (Dtd2) genes were downregulated in both cell lines. The depletion of one of these THOC5 target genes in Huh7 or HepG2 did not significantly induce cell death, suggesting that these may be fine tuners for HCC cell survival. However, the depletion of a combination of these genes synergistically increased the number of TUNEL (terminal deoxynucleotidyl transferase dUTP nick end labeling)-positive HCC. It must be noted that the depletion of these genes did not induce cell death in the hepatocyte cell line, THLE-2 cells. THOC5 expression was enhanced in 78% of cytological differentiation grading G2 and G3 tumor in primary HCC. Furthermore, the expression of a putative glycoprotein, Tmed10, is correlated to THOC5 expression level in primary HCCs, suggesting that this protein may be a novel biomarker for HCC. These data imply that the suppression of the multiple THOC5 target genes may represent a novel strategy for HCC therapy.

Transcriptional regulation of immediate-early gene response by THOC5, a member of mRNA export complex, contributes to the M-CSF-induced macrophage differentiation.

Hematopoiesis and commitment to a restricted lineage are guided by a timely expressed set of cytokine receptors and their downstream transcription factors. A member of the mRNA export complex, THOC5 (suppressors of the transcriptional defects of hpr1 delta by overexpression complex 5) is a substrate for several tyrosine kinases such as macrophage colony-stimulating factor (M-CSF) receptor and various leukemogenic tyrosine kinases, such as Bcr-Abl, or NPM-ALK. THOC5 tyrosine phosphorylation is elevated in stem cells from patients with chronic myeloid leukemia, suggesting that THOC5 may be involved in leukemia development. THOC5 is also an essential element in the maintenance of hematopoiesis in adult mice. In this report, we show that THOC5 is located in the nuclear speckles, and that it is translocated from the nucleus to cytoplasm during M-CSF-induced bone marrow-derived macrophage differentiation. Furthermore, we have identified THOC5 target genes by trancriptome analysis, using tamoxifen-inducible THOC5 knockout macrophages. Although only 99 genes were downregulated in THOC5-depleted macrophages, half of the genes are involved in differentiation and/or migration. These include well-known regulators of myeloid differentiation inhibitor of DNA binding (Id)1, Id3, Smad family member 6 (Smad6) and Homeobox (Hox)A1. In addition, a subset of M-CSF-inducible genes, such as Ets family mRNAs are THOC5 target mRNAs. Upon depletion of THOC5, unspliced v-ets erythroblastosis virus E26 oncogene homolog (Ets1) mRNA was accumulated in the nucleus. Furthermore, THOC5 was recruited to chromatin where Ets1 was transcribed and bound to unspliced and spliced Ets1 transcripts, indicating that THOC5 has a role in processing/export of M-CSF-inducible genes. In conclusion, regulation of immediate-early gene response by THOC5, a member of mRNA export complex contributes to the M-CSF-induced macrophage differentiation.

Speed of spinal vs general anaesthesia for category-1 caesarean section: a simulation and clinical observation-based study.

Controversy exists as to whether effective spinal anaesthesia can be achieved as quickly as general anaesthesia for a category-1 caesarean section. Sixteen consultants and three fellows in obstetric anaesthesia were timed performing spinal and general anaesthesia for category-1 caesarean section on a simulator. The simulation time commenced upon entry of the anaesthetist into the operating theatre and finished for the spinal anaesthetic at the end of intrathecal injection and for the general anaesthetic when the anaesthetist was happy for surgery to start. In the second clinical part of the study, the time from intrathecal administration to 'adequate surgical anaesthesia' (defined as adequate for start of a category-1 caesarean section) was estimated in 100 elective (category-4) caesarean sections. The median (IQR [range]) times (min:s) for spinal procedure, onset of spinal block and general anaesthesia were 2:56 (2:32-3:32 [1:22-3:50]), 5:56 (4:23-7:39 [2:9-13:32]) and 1:56 (1:39-2:9 [1:13-3:12]), respectively. The limiting factor in urgent spinal anaesthesia is the unpredictable time needed for adequate surgical block to develop.

Analysis of the arterial anatomical variations of thyroid gland: anatomic guide for surgical neck dissection.

PURPOSE: Aim of this study was to establish preliminary data on the variations of arterial supply of thyroid gland in Karnataka population. METHODS: The anterior triangles in the neck of formalin fixed cadavers were dissected. The length, branching pattern, number and length of branches of superior thyroid artery (STA) were noted. We measured the length of inferior thyroid artery (ITA) from its point of emergence from thyrocervical trunk (TCT) to lower pole of thyroid gland. The length of the external carotid artery (ECA), TCT from the point of its emergence to the point of its branching was noted. We noted the number of branches from ITA and TCT. Presence of any additional artery supplying the thyroid gland was searched for. Difference in the length of STA and ITA between the two sexes and sides were noted. Statistical analysis was done by Student's t-test. RESULTS: In our study the maximum length of STA was 5.34cm and that of ITA was 5.07cm and there were no statistically significant side-to-side differences in level of bifurcation. CONCLUSIONS: Observations of the present study on the course and branching pattern of arteries around thyroid gland will help in easier approach during thyroid surgeries and interventional techniques (Tab. 1, Fig. 3, Ref. 38).

Correlation of acanthosis nigricans with insulin resistance, anthropometric, and other metabolic parameters in diabetic Indians.

INTRODUCTION: Acanthosis nigricans is a non-specific reaction pattern that may accompany obesity, diabetes, excess corticosteroids, pineal tumors, malignancies, and other endocrine disorders. It is considered a cutaneous marker of tissue insulin resistance. AIMS AND OBJECTIVES: To determine the prevalence of acanthosis nigricans in type 2 diabetes mellitus (DM) and its correlation with various anthropometric measurements and insulin resistance by HOMA-IR and other metabolic parameters. MATERIALS AND METHODS: One hundred and fifty consecutive subjects with newly diagnosed type 2 DM, attending the endocrinology OPD of LLRM Medical College, Meerut were studied. Acanthosis was graded based on standard scale of 0-4 as described by Burke et al. Anthropometric data were obtained and insulin resistance calculated as HOMA-IR from fasting insulin and fasting blood sugar values. RESULTS: The average age of the study population was 45.2 years, with male to female ratio of 1:5. The prevalence of acanthosis in males was 56.67% and in females was 86.92%. The acanthosis neck severity grading had a statistically significant correlation with fasting glucose levels, fasting insulin levels, and insulin resistance values: HOMA-IR, HOMA-S, and HOMA-B (P < 0.05). Other acanthosis parameters such as axillary grading, acanthosis at knuckles, and skin tags, did not have a statistically significant correlation with insulin resistance. CONCLUSION: Acanthosis nigricans neck severity grading correlates well with insulin resistance and can be used as a clinical surrogate for assessment of severity of insulin resistance.

Atypical presentations of Wolframs syndrome.

BACKGROUND: Wolfram syndrome is a rare hereditary or sporadic neurodegenerative disorder also known as DIDMOAD. The classically described presentation is of insulin-dependent diabetes, followed by optic atrophy, central diabetes insipidus, and sensory neural deafness. Also included are less well-described presentations of Wolframs syndrome. We here present three cases of atypical presentation of this syndrome. CASE 1: A 15-year-old boy with insulin-dependent diabetes was presented for evaluation of depressive symptoms associated with suicidal tendency. Neuropsychiatric manifestations are described with Wolframs syndrome, and wolframin gene, in recessive inheritance, is associated with psychiatric illnesses without other manifestations of Wolframs syndrome. CASE 2: A 17-year-old diabetic boy on insulin with good control of blood sugar presented for evaluation of delayed puberty. Central hypogonadism and other anterior pituitary hormone dysfunctions are the less publicized hormone dysfunctions in Wolframs syndrome. CASE 3: A 23-year-old female who was on insulin for diabetes for the past 14 years, got admitted for evaluation of sudden loss of vision. This patient had developed a vitreous hemorrhage and, on evaluation, was found to have optic atrophy, sensory neural hearing loss, and diabetes insipidus, and presented differently from the gradual loss of vision described in Wolframs syndrome. CONCLUSION: Wolframs syndrome being a multisystem degenerative disorder can have myriad other manifestations than the classically described features. Neuropsychiatric manifestations, depression with suicidal risk, central hypogonadism, and secondary adrenal insufficiency are among the less well-described manifestations of this syndrome.

Endocrine manifestations of celiac disease.

BACKGROUND: Celiac disease can have extra gastrointestinal tract (GIT) presentations, most of which are endocrine. The aim of this study was to present patients diagnosed to have celiac disease from an endocrine department and to study the prevalence of endocrinopathies in celiac disease. MATERIALS AND METHODS: A total of 36 patients from the endocrinology department (LLRM Medical College, Meerut) between January 2011 and July 2012 and who were diagnosed to have celiac disease were included in the study. RESULTS: Short stature was the commonest presentation (25%), other presentations included short stature and delayed puberty (20%), delayed puberty (11%), screening for celiac disease in type-1 DM patients (17%), rickets (6%), anemia not responding to oral therapy (6%), type-1 DM with recurrent hypoglycaemia (6%), and osteomalacia (3%). The endocrine manifestations include (after complete evaluation) short stature (58%), delayed puberty (31%), elevated alkaline phospahatase (67%), low calcium (22%), X-rays suggestive of osteomalacia or rickets (8%), capopedal spasm (6%), and night blindness (6%). Anti-TPO antibody positivity was found in 53%, hypothyroidism in 28%, subclinical hypothyroidism in 17%, and type-1 DM in 25% of the patients. A total of 14% patients had no GI symptoms. CONCLUSION: Celiac disease is an endocrine disrupter as well as the great masquerader having varied presentations including short stature, delayed puberty, and rickets. Some patients who have celiac disease may not have any GI symptoms, making the diagnosis all the more difficult. Also, there is significant incidence of celiac disease with hypothyroidism and type-1 DM, making screening for it important in these diseases.