Dehydroepiandrosterone Sulfate (DHEAS) Levels in Polycystic Ovarian Syndrome (PCOS).

OBJECTIVE: To compare DHEAS levels among subjects with and without PCOS, evaluating differences between lean-PCOS or obese-PCOS phenotype for insulin resistance, anthropometric indices, glycemic and lipid parameters. STUDY DESIGN: Descriptive study. Study Place and Duration of Study: PNS Hafeez Naval Hospital, Islamabad, Pakistan, from January 2018 to August 2019. METHODOLOGY: Three hundred and twenty-eight subjects were included in the study for evaluation. PCOS was defined as per Rotterdam criteria, while insulin resistance, anthropometric measurements, various hormonal and biochemical analyses were carried out as per standard protocols. Hirsutism was calculated as per modified Ferrimen Gallwey score and free androgen index (FAI) was calculated using formula as: FAI = [(Total testosterone/Sex hormone binding globulin (SHBG)] x100. These subjects underwent clinical biochemical evaluation and were segregated into 2 groups: lean-PCOS and obese-PCOS.   Results: DHEAS levels were higher in subjects with PCOS [(171.50) (111.75-244.25) ug/dl], n=164] than in subjects without PCOS [(130.50) (78.95-189.75) ug/dl, n=164, p<0.001]. Area under curve (AUC) in diagnosing PCOS was highest for modified FG score [0.802, p<0.001], followed by FAI [0.785, p<0.001]. Total testosterone [0.743, p<0.001] and DHEAS [0.637, p<0.001]. DHEAS levels were found to be inversely related to age, anthropometric indices, glycemia, dyslipidemia, nephropathy and reproductive hormones. The DHEAS in lean-PCOS was higher than obese female subjects with or without PCOS. CONCLUSION: DHEAS levels were high in lean-PCOS in comparison to obese-PCOS and non-PCOS females. However, receiver operating curve (ROC) analysis showed DHEAS as a weaker marker for diagnosing PCOS than FAI and modified FG score. Key Words: DHEAS, Polycystic ovarian syndrome (PCOS), Homeostasis model assessment for insulin resistance (HOMAIR), Rotterdam criteria, Free androgen index.

Comparison of Various Abdominal Obesity Measures for Predicting Metabolic Syndrome, Diabetes, Nephropathy, and Dyslipidemia.

OBJECTIVE: To evaluate abdominal volume index (AVI), body roundness index (BRI), body adiposity index (BAI), a body shape index (ABSI) and conicity index (C-Index) for differences in subjects with or without metabolic syndrome, diabetes, nephropathy, and dyslipidemia; and secondly, to evaluate the diagnostic performance through measuring area under curve (AUC) by ROC curve analysis for new and conventional obesity measures in diagnosing metabolic syndrome. STUDY DESIGN: Cross-sectional analytical study. PLACE AND DURATION OF STUDY: PNS Hafeez Hospital, Islamabad, from January 2016 to December 2018. METHODOLOGY: Baseline anthropometric measures including BMI, WHpR, WHtR, AVI, BRI, BAI, ABSI and C-Index were measured for 232 subjects along with measurement of various biochemical parameters. Differences among subjects with and without metabolic syndrome, diabetes, nephropathy, and groups based upon insulin resistance were noted. ROC curve analysis was utilised to measure AUC for all anthropometric measures for diagnosing metabolic syndrome. RESULTS: Pearson's correlation between obesity measures and lipid indices suggested highest correlation for AVI for most lipid indices followed by WHpR and WHtR. Mean AUC for obesity measures were greater than 0.80 for WHtR and AVI, followed by other parameters. The least AUC i.e. 0.320, was observed for ABSI. The differences between various anthropometric measures for groups based upon metabolic syndrome, diabetes, nephropathy, and insulin resistance remain variable indicating that each anthropometric index may depict a different aspect of the metabolic risk. CONCLUSION: WHtR and AVI showed the highest AUC to diagnose metabolic syndrome and were better associated with metabolic diseases.

Isolated cardiac hydatid cyst.

Hydatid cyst disease is common in our part of the world. Cardiac hydatid cyst is its rare manifestation. We report this case of 48-year male having isolated cardiac hydatid cyst, incidentally found on computed tomography. This patient presented in medical OPD of Combined Military Hospital, Lahore with one month history of mild retrosternal discomfort. His general physical and systemic examinations as well as ECG were unremarkable. Chest X-ray showed an enlarged cardiac shadow with mildly irregular left heart border. Contrast enhanced CT scan of the chest showed a large well defined multiloculated non-enhancing cystic lesion with multiple daughter cysts involving wall of left ventricle and overlying pericardium. Serology for echinococcus confirmed the diagnosis of hydatid cyst. Patient was offered the surgical treatment but he opted for medical treatment only. Albendezol was prescribed. His follow-up echocardiography after one month showed no significant decrease in size of the cyst.

Role of grey scale ultrasound in benign and malignant breast lesions.

OBJECTIVE: To evaluate the sensitivity and specificity of ultrasound in diagnosis of benign and malignant disease in correlation with histopathological findings. DESIGN: A comparative study. PLACE AND DURATION OF STUDY: Diagnostic Radiology Department of PNS Shifa, Karachi, from January 2000 to July 2002. PATIENTS AND METHODS: Adult female patients presenting with breast lump were included. Grey-scale ultrasound was done with high frequency probe. Findings were compared with histopathology. The sensitivity and specificity was determined. RESULTS: Eighty-five female patients with positive clinical findings were differentiated into benign (n =45, 52.9%), intermediate (n =15, 17.6%) and malignant (n =25, 29.4%), by ultrasound examination. Only one (2.2%) benign lesion was found malignant on histopathology, 8 (32%) cases of malignant group were benign on histopathology. The sensitivity of ultrasound for malignant lesion was 95.24% and specificity was 68.75% for a benign lesion. Our results were compatible with international studies. CONCLUSION: Ultrasound of breast is very useful in evaluating breast lumps. This modality is, however, not a good screening tool. When combined with clinical evaluation and mammographic studies, a subset of patients can be identified which do not require biopsy. This will not only save the cost but will also alley the anxiety of patients.