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Prolonged glucocorticoid overexposure leads to Cushing’s syndrome (CS). It is characterised by diverse metabolic, cardiovascular and bone mineral manifestations. A middle-aged woman presented for a preoperative evaluation of a pathological fracture of the left neck of the femur. She had a history of a hip fracture on the opposite side 3 years back. She exhibited several features specific to CS and was subsequently diagnosed with Cushing’s disease. She underwent transsphenoidal adenoma resection and achieved remission. Glucocorticoids primarily affect the trabecular bone compared with cortical bones, and vertebral fractures are common in CS. The femoral neck consists of both trabecular and cortical bone and can be involved in CS. Our patient was not diagnosed as CS at the first pathological fracture and was subsequently diagnosed only after the second fracture. This case report underscores the importance of a diligent search for a possible endocrinological aetiology in any case of pathological fractures. [ABSTRACT FROM AUTHOR]

Isolated cases of subacute thyroiditis exist in the early period of COVID‐19 vaccination, largely after mRNA vaccines. Here we report late onset thyroid disturbances and persistent health issues in patients of thyroid disorders after COVID‐19 vaccination. Seventy‐five patients with post COVID‐19 vaccination thyroid disturbances were identified. Among these, 41 had flare of underlying thyroid illness, majority occurring at a median time lag of 28.4 weeks since 2nd dose. Thirty‐one cases of new onset hypothyroidism and three of new onset hyperthyroidism were reported, with a median time lag respectively of 17.2 and 22.6 weeks since 2nd dose. Most cases occurred after ChAdOx1‐nCoV‐19, which was the commonest vaccine employed in mass roll out in India. Significant improvement was observed in majority, after a median follow up of 22–26 weeks. New onset health issues persisting for ≥4 weeks were reported in 37.3% and were common in individuals with history of COVID‐19 before vaccine. New onset metabolic, musculoskeletal, and reproductive disorders were the common health complaints. Active monitoring is warranted for late onset adverse events after COVID‐19 vaccines of all types. Larger studies with involvement of unvaccinated individuals are required to understand the incidence and causality of late onset thyroid disturbances after COVID‐19 vaccines. [ABSTRACT FROM AUTHOR]

Background: The year 2019 witnessed major curricular reforms in terms of launching Foundation Course (FC) by National !Medical Commission (NMC) asapartofCBME (Competency Based Medical Edttcation). Feedback from various stakeholders in medical education can register ite merits and demerits. This study aimed to explore perceptions of students and faculties of 1• year MBBS, regarding implementation of FC. Methods! A mixed-method study was employed immediately as post implementation of FC using a structured questionnaire and a focus group interview to report perception of students and faculties. Study was conducted in Government medical college & Hospital, Ratlam, Madhypradesh India in September montit of 2019. Results: Majority of students i.e. 92.15 % felt, that FC orientation module helped them acclimatize to new environment and helped them engage with peers and faculties. 91.01% were sensitized to importance of professionalism and etilics in medicine.92.68% reported an enhancement in their communication sldlls, 85.70% mentioned its help in stress management, 88.19% to 92.69% found reflective writing as an interesting exercise. Overall 87.00% graded FC as beneficial and a good program. Besides these sessions, an essential computer learning skill, community health care visit, sports, and extracurricular activities were appreciated. In addition, medical students gave mixed reviews on problems like duration of FC, didactic teaching, and language barriers in terms of English and local. Conclusions: FC provides a roadmap from a knowledge centric curriculum towards a competency based performance centric curriculum. Facilitating and nurturing such programs can pity a pivotal role in fostering holistic development of students. [ABSTRACT FROM AUTHOR]

Background: Use of sunscreens on the face is becoming popular, and patients with melasma are prescribed sunscreen for use on the face. Results of a few Western studies on the effect of sunscreen use on serum vitamin D concentration are not applicable to Indian conditions.Aims: To examine the effect of use of a high sun protection factor (SPF 50+, PA++++) sunscreen on face in patients with melasma on serum concentration of 25-hydroxyvitamin D.Methods: Forty-five Indian patients (Fitzpatrick skin types III and IV) with melasma were advised to use a sunscreen with SPF 50 + for 3 months, 43 (33 female, 10 male; age 32.9 ± 8 years) completed the study. Patients staying outdoor for <4 hours applied sunscreen once daily after bath. Patients staying outdoors for >4 hours reapplied sunscreen 4 hours after first application. Patients were provided a container to measure the amount of sunscreen for use, which was approximately equal to recommended thickness. Compliance was tested by weighing the used tubes and tubes in use during monthly visits. Serum concentration of 25-hydroxyvitamin D was tested before and after the study period.Results: Amount of sunscreen advised (100.5 ± 29.2 ml) and the actual amount used (96.6 ± 27.9 ml) were similar (P = 0.53, t-test). The difference between serum concentrations of 25-hydroxyvitamin D at the baseline (19.20 ± 9.06 ng/ml) and at 3 months (18.91 ± 8.39 ng/ml) was not significant (P = 0.87, paired t-test, 95% confidence interval of difference -3.33 to 3.92). No correlation was found between the amount of sunscreen used and the percentage change in serum 25-hydroxyvitamin D concentration at 3 months (rho = 0.099, P = 0.528, Spearman's rank correlation).Limitations: Longer duration of application and a larger sample size may detect minor differences in vitamin D concentration.Conclusion: Using a high SPF sunscreen on the face, along with physical photoprotection advice, in patients with melasma for 3 months does not influence serum 25-hydroxyvitamin D concentration in Indian conditions. [ABSTRACT FROM AUTHOR]

Introduction: Type I diabetes Mellitus (T1DM) is caused by autoimmune destruction of β-cells of pancreas. Two forms of T1DM are known called as 1A (autoimmune) and 1B (idiopathic). Aim: Aim was to study the prevalence of Anti-TTG IgA, Anti- TPO, GADA, ZnT8 and IA-2 autoantibodies and HLA DR and DQ genes and its diagnostic value in T1DM. Materials and Methods: Thirty four T1DM patients, 59 type 2 diabetes mellitus (T2DM) patients and 28 healthy controls were included in study. Antibodies levels were estimated by ELISA and HLA typing was performed by SSP-PCR method. Result: The prevalence of various autoantibodies in T1DM were Anti-TTG 14.7%, Anti-TPO 17.65%, GADA 38.23%, ZnT8 11.76% and IA-2 5.88%. Only GADA and ZnT8 were significantly positive in T1DM. GADA (66.67%) and ZnT8 (33.33%) positivity was more in patients below 15 years age while levels of other antibodies were higher after 15 years age. All autoantibodies were detected in higher frequency in T1DM than in T2DM and controls. HLA DR and DQ typing showed highly significant increase in DRB1*0301 (61.76%, p=0.00) and DQB1*0201 (64.71%, p=0.00) in T1DM. Subjects with HLA DRB1*0301 and DQB1*0201 had 80-100% positive prevalence of GADA, ZnT8, IA-2, Anti-TTG and Anti-TPO autoantibodies. Conclusion: Combination of GADA antibody with DRB1 and DQB1 estimation improved diagnosis of T1A than insulin antigen specific antibodies alone. [ABSTRACT FROM AUTHOR]

Objectives: Urinary tract infection (UTI) remains a significant concern in diabetic patients due to associated morbidity and mortality. The innate immune response against UTI is controlled by the Toll like receptors (TLRs) expressed on urinary bladder epithelium. Previous studies in non diabetic patients showed that TLR4 mutations increase susceptibility to UTIs. The present study evaluated the association of single nucleotide polymorphisms (SNPs) of TLR4. A (896) G (corresponding to an Asp299Gly substitution mutation; SNP ID: rs 4986790) and TLR4 C (1196) T (corresponding to a Thr399Ile substitution mutation; SNP ID: rs 4986791) with risk of UTIs in the patients of type 2 diabetes mellitus. Materials and Methods: A total 446 type 2 diabetic patients (224 with UTI and 222 without infection) and 270 healthy control subjects were examined for TLR4 A(896)G and C(1196)T polymorphisms by means of polymerase chain reaction and restriction fragment-length polymorphism. Results: In diabetic UTI patients TLR4 896AG genotype and TLR4 896G allele has higher prevalence than healthy control. [896AG versus control p = 0.0004 (OR 2.1 95% CI 1.428-3.312), 896G P = 0.005 (OR 2.5 95% CI 1.173-2.24). TLR4 1196CT genotype and 1196T allele has also higher prevalence than control. [1196CT versus control P = 0.0001 (OR 2.5 95% CI 1.618-3.826), 1196T P = 0.0001 (OR 2.16 95% CI 1.472-3.173). No statistically significance correlation was detected in between control and diabetic patients without infection [OR 0.9 P = 0.75]. Conclusion: TLR4 A(896)G and C(1196)T polymorphisms are associated with the development of UTI in type 2 diabetes. [ABSTRACT FROM AUTHOR]

Background: Transcription factor 7-like 2 ( TCF7L2 ) gene has a significant role in hyperglycemia in pregnancy (HIP) risk. The current study was planned with the aim to evaluate the association of single nucleotide polymorphism (SNP) rs7903146 in patients of newly detected HIP among Indian population of northern region., Methods: This study was an observational case control study done among newly detected HIP (The World Health Organization (WHO) criteria, 2013) and healthy pregnant females without diabetes. Participants from both the group were genotyped for rs7903146 (C/T) variant of TCF7L2 gene using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) technique., Results: A total of 71 cases of newly detected HIP were included in the study, out of which 25 (35.2%) of them were of first-time detected diabetes mellitus in pregnancy (DIP) and 46 (64.7%) were of gestational diabetes (GDM) and 100 were pregnant females without diabetes in third trimester were enrolled as controls. Average age of participants in the case group was 28.7 ± 4.0 years and the control group were 26.5 ± 3.6 years ( P value 0.09). The wild homozygous CC genotype, heterozygous CT genotype and homozygous TT genotype were present in 39.4%, 53.5%, 7.1% of case group vs 53%, 43% and 4% of control group, respectively. No significant association of rs7903146(C/T) SNP of TCF7L2 gene in HIP (CC/CT, CC/TT P value 0.15, 0.38, respectively) in our population was found. There was no significant difference in the distribution of genotypes between DIP and GDM., Conclusion: This study shows no evidence of association of rs7903146(C/T) SNP of TCF7L2 gene with newly detected HIP in our population., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 Indian Journal of Endocrinology and Metabolism.)

Background and Objectives: Type 2 diabetes is a multifactorial disorder that results from the interaction between genetic predisposition and environmental factors. Different Prakriti (body constitution) individuals have different susceptibility for the diseases, and this Prakriti is determined by both genetic and environmental factor. This study was undertaken to determine the association status of Methylenetetrahydrofolate reductase (MTHFR) C677T and A1298C with type 2 diabetes and Prakriti ., Materials and Methods: After informed consent, 54 patients with type 2 diabetes and 56 individuals as normal controls were analyzed. Their constitution and pathological data were collected and MTHFR C677T and A1298C genotypes were determined., Results: Kapha / Kapha-Pittaja Prakriti were associated and found to be strong risk factors (Chi-square test = 39.67, P < 0.00001, odds ratio [OR] = 16.133, 95% confidence interval [CI] = 6.32-41.20) for type 2 diabetes. MTHFR C677T was associated (Chi-square test = 7.743, P = 0.02) with type 2 diabetes where the major CC genotype was found to be a risk for type 2 diabetes (OR = 3.78, 95% CI = 1.14-12.45). A1298C was not associated with type 2 diabetes (Chi-square test = 2.264, P = 0.322). None of the Prakriti was associated with C677T and A1298C variants., Interpretation and Conclusion: In the present study, an extremely strong association between Prakriti ( Kaphaja / Kapha-Pittaja ) and type 2 diabetes ( P < 0.00001) was detected. The present study gives a strong clue for the association of Prakriti (body constitutional) and clinical phenotype., Competing Interests: There are no conflicts of interest.