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2. Metastatic parathyroid carcinoma: A tale of refractory hypercalcemia

Author

Johns T. Johnson, Arun George, Junita Rachel John, Nishok David, Ashish Singh, Deepak Abraham, Birla Roy Gnanamuthu, and Nihal Thomas

Subjects
Refractory hypercalcemia, Parathyroid carcinoma, Denosumab, Scintigraphy, Hyperparathyroidism, Diseases of the endocrine glands. Clinical endocrinology, RC648-665
Abstract

Background/objective: Parathyroid carcinoma is a rare entity presenting as parathyroid hormone (PTH) dependent hypercalcemia. Our objective was to report a case of metastatic parathyroid carcinoma in a middle-aged woman, who presented with refractory hypercalcemia and the strategies we used to induce remission. Case report: A 47 year old lady with a past history of a left superior parathyroid adenoma excision, presented with recurrent PTH dependent hypercalcemia. An ultrasonography of the neck and parathyroid scintigraphy were normal. Fluorodeoxyglucose-Positron Emission Tomography (FDG-PET) scan picked up metabolically active lesions in the lingular segment of the left lung and another lesion in the diaphragmatic pleura of the left hemi-thorax. Following metastectomy of the lung nodules, she developed symptomatic hypocalcemia with a reduction of serum PTH levels. The histopathology and immunoprofile were consistent with metastatic carcinoma. The PTH levels started rising 2 months after the surgery, with calcium levels remaining stable on cinacalcet, denosumab and cabozantinib. Discussion: Parathyroid carcinoma is a rare endocrine malignancy with typically indolent, yet progressive course. There is no consensus on the treatment and follow-up of parathyroid carcinoma, owing to its rarity. The greatest likelihood of cure is achieved if complete resection of all malignant tissue is successful at the time of initial surgery. Surgical reduction of the tumor mass may also render the patient's hypercalcemia more amenable to medical treatment with hydration, potent intravenous bisphosphonates, denosumab and cinacalcet. Conclusion: Surgical debulking of the metastatic lesions, followed by medical management of hypercalcemia offers promising results in the management of metastatic parathyroid carcinoma.

Published
2023
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4. Chronic alcohol consumption and its impact on bone and metabolic health – A narrative review

Author

Johns T Johnson, Mohammad Anwar Hussain, Kripa Elizabeth Cherian, Nitin Kapoor, and Thomas V Paul

Subjects
chronic alcohol consumption, low bone mass, metabolic syndrome, Diseases of the endocrine glands. Clinical endocrinology, RC648-665, Diseases of the digestive system. Gastroenterology, RC799-869
Abstract

Chronic consumption of a large quantity of alcohol often results in the disruption of the communication between the nervous, endocrine and immune systems leading to profound and serious consequences at the physiological and behavioral levels. The overall impact of excessive alcohol consumption on bone health, metabolic profile and body composition, especially at moderate levels, is not well understood. Chronic excessive alcohol consumption adversely affects bone health through multiple mechanisms leading to low bone mass. It may also be significantly associated with various components on the metabolic syndrome. This review summarizes the findings from published studies that provide consistent evidence on the various effects of alcohol abuse on the bone health and metabolism.

Published
2022
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5. Familial hypercholesterolemia: The skin speaks

Author

Johns T Johnson, Jinson Paul, Kripa Elizabeth Cherian, Nitin Kapoor, H S Asha, and Thomas Vizhalil Paul

Subjects
familial hypercholesterolemia, lipid disorder, tendon xanthoma, Medicine
Abstract

Familial hypercholesterolaemia (FH) is an autosomal dominant inherited disorder of lipoprotein metabolism caused by defects in the low-density lipoprotein receptor (LDLR) gene. It is characterized by high low-density lipoprotein (LDL) cholesterol levels, premature cardiovascular disease (CVD), and tendon xanthomas. We present the case of a 26-year-old gentleman who presented with multiple nodular eruptions over the extensor aspects of upper and lower limbs and was diagnosed as FH on the basis of positive family history, typical lipid profile abnormalities, and biopsy of the nodule consistent with tendon xanthomas. The diagnosis and management of this case is deftly feasible at the primary care level.

Published
2020
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6. A case of H. pylori infection presenting as refractory hypothyroidism

Author

Pragya Gupta, Johns T Johnson, Sudarsanababu Lalitha Soumya, Kripa Elizabeth Cherian, Nitin Kapoor, and Thomas Vizhalil Paul

Subjects
h. pylori infection, levothyroxine absorption test, refractory hypothyroidism, Medicine
Abstract

We present the case of a 45-year-old lady with long standing hypothyroidism who was euthyroid on replacement for many years, but stopped responding even to supraphysiological doses of LT4 since the last five years. She complained of abdominal discomfort, bloating, and nausea. She did not have diarrhea or weight loss. Levothyroxine absorption test was done which was suggestive of malabsorption and she was started on triple therapy for H. pylori eradication after confirmation of diagnosis. After 10 days of treatment initiation, she developed symptoms of thyrotoxicosis with her supraphysiological dose of LT4, which was then tapered to a lower dose. Euthyroid state was ultimately achieved with lower doses of LT4 replacement.

Published
2020
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11. Do proximal hip geometry, trabecular microarchitecture, and prevalent vertebral fractures differ in postmenopausal women with type 2 diabetes mellitus? A cross-sectional study from a teaching hospital in southern India

Author

Johan Paul, V. Devarapalli, Nitin Kapoor, Thomas V Paul, Felix K Jebasingh, H S Asha, Johns T Johnson, Nihal Thomas, and Kripa Elizabeth Cherian

Subjects
0301 basic medicine, Bone mineral, medicine.medical_specialty, business.industry, Endocrinology, Diabetes and Metabolism, Osteoporosis, Type 2 Diabetes Mellitus, 030209 endocrinology & metabolism, Geometry, Type 2 diabetes, medicine.disease, 03 medical and health sciences, 0302 clinical medicine, Trabecular bone score, medicine.anatomical_structure, Diabetes mellitus, Orthopedic surgery, medicine, 030101 anatomy & morphology, business, Femoral neck
Abstract

This study from southern India showed that the trabecular microarchitecture and proximal hip geometry were significantly impaired in postmenopausal women with diabetes as compared to age and BMI matched non-diabetic controls. This is despite there being no significant difference in bone mineral density at the femoral neck and hip not between both groups. One-third of the study subjects with type 2 diabetes had prevalent vertebral fractures. Bone mineral density assessment as a standalone tool may not adequately reflect bone health in subjects with diabetes. There is limited information with regard to bone health in Indian postmenopausal women with type 2 diabetes. We studied the bone mineral density (BMD), trabecular bone score (TBS), prevalent vertebral fractures (VF), proximal hip geometry, and bone mineral biochemistry in ambulatory postmenopausal women with and without type 2 diabetes mellitus (T2DM). This was a cross-sectional study conducted at a tertiary care center. BMD, TBS, prevalent vertebral fractures, and hip structural analysis (HSA) were assessed using a dual-energy X-ray absorptiometry (DXA) scanner. Bone mineral biochemical profiles were also studied. A total of 202 ambulatory postmenopausal women known to have type 2 diabetes mellitus with mean (SD) age of 65.6 (5.2) years and 200 age and BMI matched non-diabetic controls with mean (SD) age of 64.9 (4.7) years were recruited from the local community. Although the prevalence of lumbar spine osteoporosis was significantly lower among cases (30.7%) as compared to controls (42.9%), the prevalence of degraded bone microarchitecture (TBS < 1.200) was significantly higher among cases (51%) than in controls (23.5%); P < 0.001. Prevalent vertebral fractures were not significantly different in cases and controls. The various geometric indices of the proximal hip were significantly impaired in subjects with diabetes as compared to controls. This study may highlight the utility of the trabecular bone score and hip structural analysis in subjects with diabetes, where the bone mineral density tends to be paradoxically high, and may not adequately predict fracture risk.

Published
2021

12. Does hip structural analysis confer additional benefit to routine BMD assessment in postmenopausal women with hip fracture? A study from a tertiary center in southern India

Author

Johns T. Johnson, Kripa Elizabeth Cherian, Nitin Kapoor, Felix K. Jebasingh, Hesarghatta Shyamsunder Asha, Thomas Mathai, Manasseh Nithyananth, Anil Thomas Oommen, Alfred Job Daniel, Nihal Thomas, and Thomas Vizhalil Paul

Subjects
Postmenopause, Absorptiometry, Photon, Cross-Sectional Studies, Bone Density, Femur Neck, Hip Fractures, Humans, Female, Orthopedics and Sports Medicine, Middle Aged, Osteoporosis, Postmenopausal
Abstract

This study from southern India showed that proximal hip geometry was significantly impaired in postmenopausal women with femoral neck fracture. The trabecular bone score (TBS), which is reflective of bone microarchitecture, was also significantly impaired in patients with fracture.There is limited information with regard to comprehensive bone health in Indian postmenopausal women with neck of femur fracture. We studied the bone mineral density (BMD), trabecular bone score (TBS), proximal hip geometry, and bone mineral biochemistry in postmenopausal women with and without femoral neck fractures.This was a cross-sectional study conducted at a tertiary care center in South India. BMD, TBS, and hip structural analysis (HSA) were assessed using a dual-energy X-ray absorptiometry (DXA) scanner. Bone mineral biochemical profiles were also studied.A total of 90 postmenopausal women with acute femoral neck fracture with mean (SD) age of 63.2 (6.1) years and 90 age-matched controls were included. The prevalence of osteoporosis was higher among cases as compared to controls (83.3% vs 47.8%; P 0.001). Degraded bone microarchitecture (TBS value 1.200) was more frequent among women with hip fracture as compared to controls (46.7% vs 31.1%; P = 0.032). Cross-sectional moment of inertia (CSMI) was significantly lower at the narrow neck (NN) and inter-trochanteric (IT) region in cases (P 0.05) and buckling ratio (BR) was significantly higher at all three sites in postmenopausal women with femoral neck fracture as compared controls. Multivariate logistic regression analysis showed that femoral neck osteoporosis, low CSMI at NN and high BR at NN and femoral shaft emerged as factors significantly associated with femoral neck fractures.This study highlights that impaired parameters of proximal hip geometry and a low trabecular bone score may be significantly associated with femoral neck fractures in postmenopausal women.

Published
2022

17. Four Versions of a Sentence-Shuffling Program.

Author

Johns, T. F. and Lixun, Wang

Abstract

Traces the origin and development of a text-based computer-assisted language-learning activity, namely the shuffling of sentences of a text and the reconstruction on screen of that text. Emphasizes the elements of continuity between the first version, implemented on a mainframe computer, and the latest version. Classroom use of the latest version is discussed, with special attention to the methodology of reciprocal learning (Author/VWL)

Published
1999

18. The New Hadley Centre Climate Model (HadGEM1) : Evaluation of Coupled Simulations

Author

Johns, T. C., Durman, C. F., Banks, H. T., Roberts, M. J., McLaren, A. J., Ridley, J. K., Senior, C. A., Williams, K. D., Jones, A., Rickard, G. J., Cusack, S., Ingram, W. J., Crucifix, M., Sexton, D. M. H., Joshi, M. M., Dong, B.-W., Spencer, H., Hill, R. S. R., Gregory, J. M., Keen, A. B., Pardaens, A. K., Lowe, J. A., Bodas-Salcedo, A., Stark, S., and Searl, Y.

Published
2006

32. Micturition syncope secondary to urinary bladder paraganglioma

Author

Johns T Johnson, Kripa Elizabeth Cherian, Nitin Kapoor, and Thomas V Paul

Subjects
0301 basic medicine, Adult, medicine.medical_specialty, Urology, Micturition syncope, 030105 genetics & heredity, Asymptomatic, Syncope, Coronary artery disease, Diagnosis, Differential, Paraganglioma, 03 medical and health sciences, 0302 clinical medicine, Urinary Bladder Paraganglioma, Rare Disease, Preoperative Care, medicine, Endocrine system, Humans, Diagnostic Errors, Stroke, Urinary bladder, business.industry, General Medicine, Prazosin, medicine.disease, Normetanephrine, 3-Iodobenzylguanidine, medicine.anatomical_structure, Treatment Outcome, Urinary Bladder Neoplasms, Hypertension, Adrenergic alpha-1 Receptor Antagonists, Female, medicine.symptom, business, Tomography, X-Ray Computed, 030217 neurology & neurosurgery
Abstract

Paraganglioma of the bladder is a rare tumour accounting for less than 0.06% of all urinary bladder tumours and has varied presentations. It may present with clinical symptoms of phaeochromocytoma, may be non-functioning and asymptomatic or may present with haematuria. Hence, paragangliomas are occasionally misdiagnosed, and this results in unanticipated intraoperative hypertensive crisis. We present the case of a 44-year-old woman with urinary bladder paraganglioma who presented with young onset hypertension, recurrent micturition syncope with prior history of coronary artery disease and stroke. She was stabilised preoperatively with alpha blocking agents and subsequently underwent successful transurethral resection of the same.

Published
2020

33. A synopsis of land use, land-use change and forestry (LULUCF) under the Kyoto Protocol and Marrakech Accords

Author

Schlamadinger, B., Bird, N., Johns, T., Brown, S., Canadell, J., Ciccarese, L., Dutschke, M., Fiedler, J., Fischlin, A., Fearnside, P., Forner, C., Freibauer, A., Frumhoff, P., Hoehne, N., Kirschbaum, M.U.F., Labat, A., Marland, G., Michaelowa, A., Montanarella, L., Moutinho, P., Murdiyarso, D., Pena, N., Pingoud, K., Rakonczay, Z., Rametsteiner, E., Rock, J., Sanz, M.J., Schneider, U.A., Shvidenko, A., Skutsch, M., Smith, P., Somogyi, Z., Trines, E., Ward, M., and Yamagata, Y.

Published
2007
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34. Thalidomide in the treatment of cancer cachexia: a randomised placebo controlled trial

Author

Gordon, J.N., Trebble, T.M., Ellis, R.D., Duncan, H.D., Johns, T., and Goggin, P.M.

Subjects
Tumor necrosis factor -- Complications and side effects, Thalidomide -- Drug therapy, Thalidomide -- Patient outcomes, Pancreatic cancer -- Complications and side effects, Cachexia -- Care and treatment, Cachexia -- Patient outcomes, Cachexia -- Drug therapy, Health
Published
2005

49. Factors influencing self-diagnosis and treatment of perceived helminthic infection in a rural Guatemalan community

Author

Booth, S., Johns, T., and Lopez-Palacios, C.Y.

Subjects
Guatemala -- Health aspects, Medicine, Rural -- Guatemala, Helminthiasis -- Care and treatment, Infection -- Research, Health, Social sciences
Abstract

Changes in the diagnosis and treatment of helminthic infection were examined during a longitudinal study in a rural community in Guatemala. Self-diagnosis was predominant, with an increase in perceived helminthic infection during an economic crisis within the community. Allium sativum L. and Chenopodium ambrosoides L. were used as anthelmintics, often in conjunction with commercial drugs. During the economic crisis the use of plants as treatment for perceived infection increased whereas use of commercial helminthic medicine decreased. Dietary modifications were observed during periods of perceived infection, but were not consistent in the food items modified or the nature of the modification. Within the community individuals exhibited considerable heterogeneity in their approaches to treatment.

Published
1993

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