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Introduction: The protocols and criteria used for adrenal venous sampling (AVS) differ across centres. There are no studies from the Indian subcontinent describing AVS-based outcomes in primary aldosteronism (PA). We aim to describe our experience from a single centre. Methods: Retrospective records from 2018 to 2020 of patients with confirmed PA who underwent AVS were reviewed. Clinical, imaging, AVS data and outcomes (as per PASO criteria) were recorded. AVS was performed by sequential sampling with cosyntropin stimulation with intraprocedural cortisol and cut-off of selectivity >5 and lateralization >4 by a single radiologist. Results: Fifteen patients with median age of 50 years (41–58) and duration of hypertension of 156 (36–204) months were included. Ten had grade 3 hypertension, 13 had hypokalaemia and 3 had hypokalaemic paralysis. On CT scan, eight patients had bilateral adrenal lesions, four had unilateral adenoma and three patients had normal adrenals. AVS was bilaterally successful in all and showed lateralization of disease in 10 patients and was bilateral in the remaining 5 patients. Overall concordance of CT and AVS was 5/15 (33.3%). Among seven patients who underwent surgery, complete clinical success was seen in two and partial clinical success in the remaining five. Complete biochemical success was seen in two and partial in one. There were no major complications. Conclusions: AVS performed by a single radiologist with defined protocols has a good success rate. AVS has additional value over CT scan in lateralization, especially when CT shows bilateral disease. [ABSTRACT FROM AUTHOR]

Background: Peritoneal dialysis (PD) as a modality of kidney replacement therapy (KRT) is largely underutilized globally. We analyzed PD utilization, impact of economic status, projected growth and impact of state policy(s) on PD growth in South Asia and Southeast Asia (SA&SEA) region. Methods: The National Nephrology Societies of the region responded to a questionnaire on KRT practices. The responses were based on the latest registry data, acceptable community‐based studies and societal perceptions. The representative countries were divided into high income and higher‐middle income (HI & HMI) and low income and lower‐middle income (LI & LMI) groups. Results: Data provided by 15 countries showed almost similar percentage of GDP as health expenditure (4%–7%). But there was a significant difference in per capita income (HI & HMI ‐US$ 28 129 vs. LI & LMI ‐ US$ 1710.2) between the groups. Even after having no significant difference in monthly cost of haemodialysis (HD) and PD in LI & LMI countries, they have poorer PD utilization as compared to HI & HMI countries (3.4% vs. 10.1%); the reason being lack of formal training/incentives and time constraints for the nephrologist while lack of reimbursement and poor general awareness of modalities has been a snag for the patients. The region expects ≥10% PD growth in the near future. Hong Kong and Thailand with 'PD first' policy have the highest PD utilization. Conclusion: Important deterrents to PD underutilization were lack of PD centric policies, lackadaisical patient/physician's attitude, lack of structured patient awareness programs, formal training programs and affordability. SUMMARY AT A GLANCE: This questionnaire study examined the dialysis practice and utilization of peritoneal dialysis (PD) in the south and southeast Asia region and found that low and low‐middle income countries had worse PD utilization rate. The major barriers were related to healthcare policy, lack of training programs and patients' and physicians' awareness. [ABSTRACT FROM AUTHOR]

The study aimed to analyze clinical and hormonal phenotype,and genotype in patients with genetically proven androgen insensitivity syndrome (AIS) from Western India. Index patients with pathogenic variants in the androgen receptor (AR) gene were identified from a consecutive 46,XY DSD cohort (n = 150) evaluated with clinical exome sequencing, and their genetically-proven affected relatives were also included. In sum, 15 index cases (9 complete AIS [CAIS] and 6 partial AIS [PAIS]) were identified making AIS the second most common (10%) cause of 46,XY DSD, next to 5α-reductase 2 deficiency (n = 26; 17.3%). Most patients presented late in the postpubertal period with primary amenorrhoea in CAIS (89%) and atypical genitalia with gynecomastia in PAIS (71.4%). All CAIS were reared as females and 83.3% of PAIS as males with no gender dysphoria. Four of 6 patients with available testosterone to dihydrotestosterone ratio had a false elevation (>10). Metastatic dysgerminoma was seen in 1 patient in CAIS, while none in the PAIS group had malignancy. Fifteen different (including 6 novel) pathogenic/likely pathogenic variants in AR were found. Nonsense and frameshift variants exclusively led to CAIS phenotype, whereas missense variants led to variable phenotypes. In this largest, monocentric study from the Asian Indian subcontinent, AIS was the second most common cause of 46,XY DSD with similar phenotype but later presentation when compared to cases in the rest of the world. The study reports 6 novel pathogenic variants in AR. [ABSTRACT FROM AUTHOR]

Purpose: Pheochromocytoma and paraganglioma (PGL), together called PPGL, are rare tumors with a limited number of studies on the diagnostic performance of 68Ga-DOTA (0)-Tyr (3)-octreotate positron emission tomography-computed tomography (68Ga-DOTATATE PET/CT) from the Asian-Indian subcontinent. Materials and Methods: In this retrospective study, PPGL suspects (n = 87) who had undergone at least contrast-enhanced computed tomography (CECT) and 68Ga-DOTATATE PET/CT, were included. Lesion-wise, patient-wise, and region-wise sensitivities of 68Ga-DOTATATE PET/CT, 18F fluorodeoxyglucose positron emission tomography CT (18F-FDG PET/CT, n = 53), 131I-metaiodobenzylguanidine (131I-MIBG, n = 37), and CECT were compared, and diagnostic performance of 68Ga-DOTATATE PET/CT in the detection of PPGL was calculated. Results: 68Ga-DOTATATE PET/CT had significantly higher lesion-wise sensitivity than 131I-MIBG for both primary (94% vs 75%, P = 0.004) and metastatic disease (85% vs 59%, P = 0.001) and higher sensitivity than CECT for metastatic lesions (83% vs 43%, P = 0.0001). The lesion-wise sensitivity of 68Ga-DOTATATE PET/CT was similar to 18F-FDG PET/CT for both primary tumors (94% vs 85%, P = 0.08) and metastatic lesions (82% vs 84%, P = 0.76) in the whole cohort but tended to be inferior in the head to head comparison. Conclusion: 68Ga-DOTATATE PET/CT had higher sensitivity for detection of PPGL than 131I-MIBG (primary and metastatic) and CECT (metastatic) but similar to 18F-FDG PET/CT (primary and metastatic). [ABSTRACT FROM AUTHOR]

The data from the Indian subcontinent on Medullary thyroid carcinoma (MTC) and associated endocrinopathies in hereditary MTC (HMTC) syndromes are limited. Hence, we analyzed clinical and biochemical characteristics, management, and outcomes of HMTC and other associated endocrinopathies [Pheochromocytoma (PCC) and Primary hyperparathyroidism (PHPT)] and compared with apparently sporadic MTC. The records of 97 (51 sporadic and 46 hereditary) consecutive MTC patients were retrospectively analyzed. RET mutation was available in 38 HMTC patients. HMTC group was subclassified into Multiple endocrine neoplasia (MEN) 2A index (n = 25), MEN2B index (n = 8), and MEN2A detected by familial screening (n = 12). Patients with HMTC and MEN2B index were younger at presentation than sporadic MTC. MEN2A patients detected by familial screening, but not MEN2A index and MEN2B index patients, had significantly lower serum calcitonin, smaller thyroid nodule size, more frequent early stage presentation (AJCC Stage ≤ II), and higher cure rate than sporadic MTC, which emphasizes the need for early diagnosis. RET (REarranged during Transfection) 634 mutations were the most common cause of HMTC and more frequently associated with PCC (overall 54% and 100% in those aged ≥ 35 years). Patients in ATA-Highest (HST) group had a universal presentation in stage IV with no cure. In contrast, the cure rate and postoperative disease progression (calcitonin doubling time) were similar between ATA-High (H) and ATA- Moderate (MOD) groups, suggesting the need for similar follow-up strategies for the latter two groups. Increased awareness of endocrine (PCC/PHPT) and non endocrine components may facilitate early diagnosis and management. [ABSTRACT FROM AUTHOR]

Introduction: Radionuclide therapy is a promising treatment modality in metastatic pheochromocytoma/paraganglioma (PPGL). There is scarce data on 131I-metaiodobenzyl guanidine (131I-MIBG) therapy from the Indian subcontinent. Hence, we aim to study the safety and effectiveness of low-dose, low-specific activity (LSA) 131I-MIBG therapy in patients with symptomatic, metastatic PPGL. Methods: Clinical, hormonal, and radiological response parameters and side effects of LSA 131I-MIBG therapy in patients with symptomatic, metastatic PPGL were retrospectively reviewed. World health organizations' (WHO) symptomatic, hormonal, and tumor response, and response evaluation criteria in solid tumors (RECIST1.1) criteria were used to assess the response. Results: Seventeen (PCC: 11, sympathetic PGL: 06) patients (15 with disease progression) received low-dose LSA 131I-MIBG therapy. Complete remission (CR), partial remission (PR), stable disease (SD), and progressive disease (PD) were 18% (3/17), 24% (4/17), 18% (3/17), and 41% (7/17), respectively, for WHO symptomatic response; 20% (2/10), 10% (1/10), 30% (3/10), and 40% (4/10), respectively, for WHO hormonal response; and 19% (3/16), 6% (1/16), 31% (5/16), and 44% (7/16), respectively for tumor response based on RECIST1.1. All patients with symptomatic PD and 50% (2/4) with hormonal PD had progression as per RECIST1.1 criteria. Side effects included thrombocytopenia, acute myeloid leukemia, mucoepidermoid carcinoma, and azoospermia in 6% (1/17) each. Conclusions: Our study reaffirms the modest efficacy and safety of low-dose, LSA 131I-MIBG therapy in patients with symptomatic, metastatic PPGL. Symptomatic, but not hormonal, progression after 131I-MIBG therapy correlates well with tumor progression and should be further evaluated with imaging. In resource-limited settings, anatomic imaging alone may be used to assess tumor response to 131I-MIBG therapy. [ABSTRACT FROM AUTHOR]

Aim: There is paucity of data on the epidemiology of end‐stage kidney disease (ESKD) from South Asia and South‐East Asia. The objective of this study was to assess the aetiology, practice patterns and disease burden and growth of ESKD in the region comparing the economies. Methods: The national nephrology societies of the region; responded to the questionnaire; based on latest registries, acceptable community‐based studies and society perceptions. The countries in the region were classified into Group 1 (High|higher‐middle‐income) and Group 2 (lower|lowermiddle income). Student t‐test, Mann‐Whitney U test and Fisher's exact test were used for comparison. Results: Fifteen countries provided the data. The average incidence of ESKD was estimated at 226.7 per million population (pmp), (Group 1 vs. Group 2, 305.8 vs. 167.8 pmp) and average prevalence at 940.8 pmp (Group 1 vs. Group 2, 1306 vs. 321 pmp). Group 1 countries had a higher incidence and prevalence of ESKD. Diabetes, hypertension and chronic glomerulonephritis were most common causes. The mean age in Group 2 was lower by a decade (Group 1 vs. Group 2—59.45 vs 47.7 years). Conclusion: Haemodialysis was the most common kidney replacement therapy in both groups and conservative management of ESKD was the second commonest available treatment option within Group 2. The disease burden was expected to grow >20% in 50% of Group 1 countries and 78% of Group 2 countries along with the parallel growth in haemodialysis and peritoneal dialysis. SUMMARY AT A GLANCE: There are few data on the epidemiology and pattern of practice for end‐stage kidney disease from South Asia and South‐East Asia. This survey covers 15 Asian countries and provide important information on how ESKD patients are managed in this part of the world. [ABSTRACT FROM AUTHOR]

Rock stress memory, often referred as Kaiser effect, in rocks can be an effective tool to estimate the in situ stress conditions, if the uncertainties in rock damage and its behavior during loading conditions are properly understood. In view of this, the present study is an attempt to investigate the variations in rock stress memory, i.e., the Kaiser effect in a metamorphic rock under multi-stage uniaxial compression. The khondalite rock samples from Eastern Ghats Mobile Belt (EGMB) belonging to southeastern part of Indian subcontinent having complex geological history are examined. The effects of multi-stage compression on the damage evolution and subsequent variations in rock stress memory are investigated. The samples were categorized into different levels of rock stress memory, depending on the stress the rock was able to withhold after loading stages. The damage evolution in the tested rocks was predominantly controlled either by initial loading or failure stress. Higher damage imparted by initial loading and intense fracturing could be the possible reason for poor stress memory function in the investigated rock. Felicity ratio, an indicative of rock damage with stages of loading, supported the observation that rock damage was dominant during initial loading stage. Rock heterogeneity has played a dominant role in decay of Kaiser effect, with intense fracturing during subsequent loading stages in the investigated rocks. To summarize, Kaiser effect can be used to infer rock damage and stress conditions, provided the geological history of the region is also taken into consideration. With rocks from complex geological conditions, Kaiser effect or rock stress memory should be supported by other tools to infer in situ stress, but the method can be effectively used to understand the stress changes and damage mechanism of multiple loading. [ABSTRACT FROM AUTHOR]

Background: Gonadotropin-dependent precocious puberty (GDPP) is the most common cause of precocious puberty. Data on GDPP from Indian subcontinent is scarce. Objectives: We aim to describe single centre experience of patients with GDPP. Methods: The clinical, biochemical features and therapeutic outcomes of patients presenting with diagnosis of GDPP from Jan 2000 to July 2021 were analyzed. Results: 78 patients (girls, n = 61, 78.2%) with GDPP were included. The median age of pubertal onset (29 vs. 75 months) and age at presentation (58 vs. 82 months) was earlier in boys than in girls. The commonest presenting symptom was genitalia growth (76.47%) in boys and breast development (75.4%) in females, followed by height spurt (boys: 17.6%, girls: 11.4%), pubic hair development (boys: 5.8%, girls: 6.5%) and vaginal bleeding (6.5%). The height at presentation and target height SDS were 1.02 and -0.77 in males and 0.75 and -0.82 in females, respectively. In boys, median (range) basal serum FSH, LH and testosterone were 2.48 mIU/ml (0.42-5.7), 2.6 mIU/ml (0.52-10.01), and 3.75 ng/ml (0.1-8.27) respectively. In girls, the median (range) basal serum FSH and LH were 5.24 mIU/ml (1.03-19.8) and 2.2 mIU/ml (0.05-15.8); basal serum LH being <0.3 mIU/ml was seen in 11 females. The median post gonadotropin stimulated peak serum LH in the latter 11 females (age range: 82-99 months) was 9.37 mIU/ml (range: 5.42-19 mIU/ml). At 60 minutes, all except one patient reached a stimulated serum LH value of 3 5 mIU/ml. The median (range) difference in bone age and chronological age was 33 months (-2.0 to 98) and 2.5 months (4.0 to 76) in boys and girls, respectively. Ultrasonogram pelvis was available for 38 females. Uterine length 3 3.2 cm was found in 84.2% of patients. In boys, precocity-related MRI brain abnormality was seen in 80% whereas it was found in 23.6% of girls. Fifty-five patients were treated with injection leuprolide acetate depot [monthly 3.75 mg per (n = 2) or 7.5 mg (n = 1), three monthly 11.25 mg (n = 27) or 22.5 mg (n = 25)] whereas five patients were treated with triptorelin. Only one girl had an allergic reaction to leuprolide and was switched to triptorelin. In males, final height SDS was 0.16 (n = 2); in females, final height SDS was -0.25 (n = 20). MPH SDS in treated patients were -0.38 and -0.86 in boys and girls, respectively. Conclusion: GDPP was more common in girls. Post gonadotropin stimulated peak serum LH 35 mIU/ml at60 min aids in diagnosis in those with LH £0.3 mIU/ml. GnRH therapy helps in reducing height loss. [ABSTRACT FROM AUTHOR]

This paper makes an attempt to provide a review on challenges, outcomes and present situation in vocational education and training (VET) programs in some Asian countries. Various country-specific studies indicate that the VET system has not responded very well in the South Asian region. The VET stream is quite small. Despite there being a growing demand for a skilled labor force, the labor market outcomes of those who have followed the vocational path are not good. However, the governments are giving full attention to making the VET system robust in these countries. Various new policy initiatives have been undertaken by the governments in recent years [ABSTRACT FROM AUTHOR]