Search

Context : The erratic lifestyle of resident doctors may affect their serum 25-hydroxy vitamin D [25-(OH)D] levels and bone mineral density (BMD). Aim : To study BMD and the effect of environmental factors on it in resident doctors. Settings and Design : Prospective, cross-sectional study conducted in a tertiary healthcare centre. Materials and Methods : BMD was obtained by dual-energy X-ray absorptiometry and was correlated with various factors including weight, height, body mass index (BMI), sun exposure, physical activity, parathyroid hormone, 25-(OH)D, dietary factors. Statistical Analysis : SPSS software Version 10 (Unpaired t test was used to compare BMD of different groups and Pearson′s correlation coefficient was used to calculate correlation). Results : Two hundred and fourteen apparently healthy resident doctors were enrolled in the study. Based on Caucasian normative data, osteopenia was noted in 104 (59.7%) males and 27 (67.5%) females. Thirty-two (18.39%) males and five (12.5%) females had osteoporosis. The BMD values of males were 0.947±0.086, 0.911±0.129 and 1.016±0.133 at lumbar spine, femur neck and total hip while those in females were 0.981±0.092, 0.850±0.101 and 0.957±0.103 respectively. BMD of our cohort was lesser by 12.5-18.2% and 4.2-14.5% than the Caucasian and available Indian figures, respectively. BMD had significant positive correlation with weight, height, BMI, physical activity, and dietary calcium phosphorus ratio. 25-(OH)D levels were insufficient in 175 (87.5%) subjects but had no correlation with BMD. Conclusions : Young healthy resident doctors had significantly lower BMD, contributors being lower BMI, lower height, reduced bioavailability of dietary calcium and inadequate physical activity. Deficiency of vitamin D did not contribute to low BMD.

Background: Primary hyperparathyroidism (PHPT) has a variable clinical presentation and symptomatic PHPT is still the predominant form of the disease in India. Data from western India is lacking. Aim : To present the clinical profile of PHPT from western India. Settings and Design : This retrospective study was conducted at a tertiary care referral center. Materials and Methods : We analyzed the clinical presentation, biochemical, radiological features, and operative findings in adult patients with PHPT (1986-2008) and compared with our published data of children and adolescent patients with PHPT. Statistical Analysis : was done with SPSS 16 software. Results : Seventy-nine patients (F: M-2:1) with age ranging from 21 to 55 years (mean 33.5±8.82) were analyzed. Skeletal manifestations (75.5%), renal calculi (40.5%) and proximal muscle weakness (45.5%) were the most common symptoms of presentation with mean duration of symptoms being 33.70 (median: 24, range 1-120) months. Biochemical features included hypercalcemia (total corrected calcium 12.55±1.77 mg/dl), low inorganic phosphorus (1.81±0.682 mg/dl), elevated total alkaline phosphatase (mean: 762.2; median: 559; range: 50-4930IU/L) and high parathyroid hormone (PTH) (mean±SD: 866.61±799.15; median: 639.5; range: 52-3820 pg/ml). Preoperative localization was achieved in 74 patients and single adenoma was found during surgery in 72 patients. Hungry bone disease was seen in 30.3% and transient hypoparathyroidism developed in 62% patients. In comparison to PHPT in children there were no significant differences with regard to clinical, laboratory and radiological features. Conclusions : PHPT in western India is symptomatic disorder with skeletal and renal mani-festations at a much younger age. Clinical profile of PHPT in children is similar to that of adults.

Context: The usefulness of the acute octreotide test in the selection of patients with acromegaly for chronic somatostatin depot analogues treatment is controversial. Aims: To determine the efficacy of acute octreotide suppression test (OST) in predicting response to long-term somatostatin analogue (Octreotide-long-acting repeatable, OCT-LAR) therapy in patients with acromegaly. Settings and Design: Prospective study (2006-2007) conducted at a tertiary healthcare centre in western India. Materials and Methods: Sixteen drug-naive patients with active acromegaly (postoperative±post radiotherapy) underwent 50 µg subcutaneous OST. Ten patients were treated with OCT-LAR for one year. Remission was defined as a nadir growth hormone (GH) < 1 ng/ml during 75 g oral glucose tolerance test (OGTT) (0, 10, 30, 60, 120, 180 min) and normal age, sex-matched insulin-like growth factor 1 (IGF1) levels. Statistical Analysis: SPSS Software Version 11 was used for data analysis. Results: Using GH cutoff < 1 ng/ml, four patients (40%) achieved control at 12 months, while five patients (50%) achieved normal IGF1 values. The mean basal GH levels in 10 responsive, four controlled and six uncontrolled patients were 34.7±61.14, 4.5±1.3 and 54.8±74.2 ng/ml respectively which suppressed to mean nadir GH of 3.75±4.03, 0.66±0.15 and 5.8±4 ng/ml respectively. Sensitivity, specificity, negative and positive predictive value for nadir GH < 1 ng/ml reached after an OST was 100% each in predicting remission in our cohort. Odds for control increased if the baseline GH was low (< 5 ng/ml in our cases). Conclusions: Nadir GH < 1 ng/ml following an OST is a useful predictive marker of achieving disease remission with long-term OCT-LAR therapy.

Background: Hardly any data is available on Adult onset growth hormone deficiency (AOGHD) in Patients with hypothalamopituitary diseases in India. Aims: To characterize Asian Indian AOGHD syndrome in hypothalamopituitary diseases. Settings and Design: Cross-sectional analysis of data from a tertiary care hospital. Materials and Methods: Thirty patients with AOGHD were compared with 30 age-, sex-, body mass index-matched controls with respect to endocrine evaluation, biochemistry, body composition (BC), bone mineral density (BMD), cardiovascular risk profile and quality of life (QoL). Statistical Analysis Used: Comparisons were performed using two-tailed Student′s test (SPSS Software version 10.0). Results: Most of the patients had abnormal BC with central obesity [Truncal FM (%): males {33.9±4.4 (patient) vs. 29.31±6.2 (control); P -0.027}; females {39.87±5.93 (patient) vs. 35.76±3.16 (control); P - 0.025}] and poor QoL. Patients aged over 45 years did not show low bone mass or lipid abnormalities as compared to controls. Low BMD and abnormal lipid profile {Triglycerides [mg/dl]:170.55±72.5 (patient) vs101.24±31.0 (control); P -0.038}; {very low density lipoprotein cholesterol [mg/dl]: 33.54±14.9 (patient) vs. 20.25±6.18 (control); P - 0.05} was seen in female patients less than 45 years of age. Conclusions: Male and female (more than 45 years) AOGHD patients have increased cardiovascular risk factors and poor QoL while BMD is unaffected. Females less than 45 years of age have the major characteristics of AOGHD and would be the group to benefit maximally with recombinant human Growth Hormone treatment, which is similar to that in the western literature.

BACKGROUND: Several studies in the last few years have shown that the standard 250 micro g dose used in ACTH stimulation test may be very high and have suggested that a dose of 1 micro g may be sufficient for evaluating hypothalamo-pituitary adrenal (HPA) axis. AIMS: To evaluate the role of low dose ACTH stimulation test in patients with suspected Secondary Adrenal Insufficiency (SAI). SUBJECTS AND METHODS: Thirty-one patients of suspected SAI with a documented pituitary lesion and seven normal healthy controls were included in the study. All the subjects underwent ACTH stimulation test with standard high dose (HD= 250 microg) and low dose (LD= 1 microg) ACTH. Insulin Induced Hypoglycaemia (IIH) test was done in 7 out of 9 patients in whom the results of the two tests were discordant. The cut off for normal HD stimulation test was taken as peak cortisol response > 18 microg/dl and for LD test, either a cortisol response of > 18 microg/dl or an increment of more than 7 micro g/dl over the basal value at any time during the test, on the basis of response observed in controls. RESULTS: 22/31 patients (74%) in SAI group showed concordant results with both tests, whereas nine patients had discordant results. These nine patients showed AI with LD ACTH, but HD ACTH test showed a normal response. In 7 of these 9 patients who underwent IIH, AI was confirmed in 6. CONCLUSION: The LD ACTH stimulation test seems to be better than HD ACTH stimulation test for evaluating HPA axis in patients with suspected SAI. When basal cortisol is normal, LD ACTH stimulation test detects subtle SAI.

Vitreous loss is a dreaded complication of cataract surgery, especially so with IOL implant which then may have to be abandoned. Thirty three cases of IOL implants, either anterior chamber or posterior chamber, after vitreous loss done in the past 3 years were studied. Of these, 18 (55%) had a final visual acuity of 6/18 or better and none was worse than 6/60. The postoperative complications and findings and a review of literature are discussed.

Twenty four cases of endophthalmitis were subjected to pars plana vitrectomy. A final vitreous clearance was obtained in 62.50% cases. Visual improvement occurred in 41.67% cases. It was concluded that prompt detection and early and vigorous therapy--medical and surgical--is the mainstay in the management of endophthalmitis.

Orbital cysticercosis is a rare condition. We report here 3 cases with orbital cysticercosis who presented with proptosis and ptosis (Case no. 1 and 2) and focal seizures (Case no. 3). All of them had a vision of 6/6. Diagnosis of cysticercosis was made on CT Scan. The lesions isolated in Cases 1 and 2 and were excised. Drug therapy was given to treat any persisting infestation. Case no 3 had multiple brain cysticerci in addition to the orbital one. However, the patient was lost to follow-up.

A prospective study of hundred patients of acute myocardial infarction admitted in the Intensive Cardiac Care Unit was carried out. The prognosis of each patient, immediate and delayed morta-lity, were assessed on admission by the coronary prognostic indices (C.P.I.) formulated by Peel, Norris and Chapman. The merits and drawbacks of each coronary prognostic index system are discussed. It is felt that the coronary prognostic index would be more accurate if a higher score is given to precursor, life threatening arrhy-thmias, and conduction defects, and the prognostic index is calculat-ed daily during the stay in the I.C.C.U.

A female aged 45 years was admitted to the hospital with chronic diarrhoea. Probable diagnosis of rectal carcinoma was made on clinical and radiologic examination. Biopsy showed histology of tuberculosis. Patient was treated by antituberculous drugs with remarkable improvement.