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Selvan C, Thukral A, Dutta D, Ghosh S, Chowdhury S. Impact of Self-monitoring of Blood Glucose Log Reliability on Long-term Glycemic Outcomes in Children with Type 1 Diabetes. Indian J Endocrinol Metab 2017; 21:382-386. [PMID: 28553591 PMCID: PMC5434719 DOI: 10.4103/ijem.ijem_342_16] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Logbooks of self-monitoring of blood glucose (SMBG) are useful in the modulation of insulin regimens, which aid in achieving glycemic control in type 1 diabetes mellitus (T1DM). However, discrepancies in SMBG charting may impede its utility. This study aimed to assess the accuracy of log entries and its impact on long-term glycemic control. METHODS SMBG in logbooks was compared with readings in glucometer memory and discrepancies between the two were evaluated in 101 children with T1DM. The relationship between these discrepancies and glycated hemoglobin (HbA1c) over 44 months was assessed. RESULTS Errors in glucose charting were observed in 32.67% children. The most common observed error was omission (42.42%), followed by fabrication (27.27%), erroneous (18.18%), and others (12.12%). Age was not significantly different among children having accurate versus inaccurate SMBG logs. During follow-up of 44 months, children with accurate SMBG logs consistently had lower HbA1c as compared to children having inaccurate logs, which was statistically significant at 4, 16, 20, and 28 months' follow-up. The same was reflected in the proportion of children achieving HbA1c <7% and 7%-9%. Of the 14 children who had omissions, 9 had omission of high values only, 3 patients had omission of low values only, 1 had omission of both high and low values, and 1 had omission of normal values. Among logs with fabrication, parents were responsible in 2 of 9 incidents. In the remaining 7, it was the child himself/herself. Children with fabrication consistently had the highest HbA1c values among the different types of inaccurate blood glucose chartings, which was statistically significant at 32 and 36 months of follow-up. CONCLUSIONS Reliability of SMBG logs is a significant problem among children with T1DM at our center. Children with accurate logs of SMBG readings were more likely to have better glycemic control on long-term follow-up.
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Affiliation(s)
- Chitra Selvan
- Department of Endocrinology, M.S. Ramaiah Medical College, Bengaluru, Karnataka, India
| | - Anubhav Thukral
- Department of Endocrinology and Metabolism, Institute of Postgraduate Medical Education and Research, Seth Sukhlal Karnani Memorial Hospital, Kolkata, West Bengal, India
| | - Deep Dutta
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Sujoy Ghosh
- Department of Endocrinology and Metabolism, Institute of Postgraduate Medical Education and Research, Seth Sukhlal Karnani Memorial Hospital, Kolkata, West Bengal, India
| | - Subhankar Chowdhury
- Department of Endocrinology and Metabolism, Institute of Postgraduate Medical Education and Research, Seth Sukhlal Karnani Memorial Hospital, Kolkata, West Bengal, India
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Murli L, Thukral A, Sankar MJ, Vishnubhatla S, Deorari AK, Paul VK, Sakariah A, Dolma, Agarwal R. Reliability of transcutaneous bilirubinometry from shielded skin in neonates receiving phototherapy: a prospective cohort study. J Perinatol 2017; 37:182-187. [PMID: 27763628 DOI: 10.1038/jp.2016.189] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 07/26/2016] [Accepted: 08/15/2016] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To determine the agreement between transcutaneous bilirubin (TcB) measured from shielded skin and serum total bilirubin (STB) in infants (34 to 41 weeks of gestation) with hyperbilirubinemia receiving phototherapy (PT). STUDY DESIGN In this prospective cohort study, we shielded a small area of skin on sternum using a commercial photo-opaque patch (BilEclipseTM, Philips Respironics, Murrysville, PA, USA). The TcB from the shielded skin (TcBs) and STB were measured at four time points-before initiation, 12 and 24 h during and once after (12 h) cessation of PT. TcB was measured using multiwavelength transcutaneous bilirubinometer (BiliChek, Philips Children's Medical Ventures, Monroeville, PA, USA). The STB was measured in triplicate by spectrophotometry (Apel BR 5100, APEL, Japan). Bland and Altman plots were drawn to determine agreement between the TcBs and STB. RESULTS The gestation and birth weight of enrolled neonates were 37.0 (1.0) weeks and 2750 (458) g, respectively. The age at initiation and duration of PT were 75 (27 to 312) and 25.3 (4.4) h, respectively. Bland and Altman plot showed poor agreement between TcBs and STB at all time points. The gradient (median, range) between TcBs and STB at 0, 12, 24 h and 12 h after cessation of PT were -0.2 (-4.9 to 3.5), 1.4 (-4.7 to 4.0), 1.5 (-3.8 to 9.4) and 2 (-2.9 to 5.8) mg dl-1. The proportions of TcBs values outside ±1.5 mg dl-1 of STB ranged from 47 to 64% at four time points. CONCLUSION TcBs does not appear to be reliable for estimating serum bilirubin in late preterm and term neonates receiving PT.
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Affiliation(s)
- L Murli
- Department of Pediatrics, Division of Neonatology, Newborn Health Knowledge Centre, WHO Collaborating Centre For Training and Research in Neonatal Care, ICMR Centre for Advanced Research in Newborn Health, All India Institute of Medical Sciences, New Delhi, India
| | - A Thukral
- Department of Pediatrics, Division of Neonatology, Newborn Health Knowledge Centre, WHO Collaborating Centre For Training and Research in Neonatal Care, ICMR Centre for Advanced Research in Newborn Health, All India Institute of Medical Sciences, New Delhi, India
| | - M J Sankar
- Department of Pediatrics, Division of Neonatology, Newborn Health Knowledge Centre, WHO Collaborating Centre For Training and Research in Neonatal Care, ICMR Centre for Advanced Research in Newborn Health, All India Institute of Medical Sciences, New Delhi, India
| | - S Vishnubhatla
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - A K Deorari
- Department of Pediatrics, Division of Neonatology, Newborn Health Knowledge Centre, WHO Collaborating Centre For Training and Research in Neonatal Care, ICMR Centre for Advanced Research in Newborn Health, All India Institute of Medical Sciences, New Delhi, India
| | - V K Paul
- Department of Pediatrics, Division of Neonatology, Newborn Health Knowledge Centre, WHO Collaborating Centre For Training and Research in Neonatal Care, ICMR Centre for Advanced Research in Newborn Health, All India Institute of Medical Sciences, New Delhi, India
| | - A Sakariah
- Department of Pediatrics, Division of Neonatology, Newborn Health Knowledge Centre, WHO Collaborating Centre For Training and Research in Neonatal Care, ICMR Centre for Advanced Research in Newborn Health, All India Institute of Medical Sciences, New Delhi, India
| | - Dolma
- Department of Pediatrics, Division of Neonatology, Newborn Health Knowledge Centre, WHO Collaborating Centre For Training and Research in Neonatal Care, ICMR Centre for Advanced Research in Newborn Health, All India Institute of Medical Sciences, New Delhi, India
| | - R Agarwal
- Department of Pediatrics, Division of Neonatology, Newborn Health Knowledge Centre, WHO Collaborating Centre For Training and Research in Neonatal Care, ICMR Centre for Advanced Research in Newborn Health, All India Institute of Medical Sciences, New Delhi, India
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Bhattacharjee R, Thukral A, Chakraborty PP, Roy A, Goswami S, Ghosh S, Mukhopadhyay P, Mukhopadhyay S, Chowdhury S. Effects of thyroid status on glycated hemoglobin. Indian J Endocrinol Metab 2017; 21:26-30. [PMID: 28217494 PMCID: PMC5240076 DOI: 10.4103/2230-8210.196017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Glycated hemoglobin (HbA1c) can be altered in different conditions. We hypothesize that HbA1c levels may change due to altered thyroid status, possibly due to changes in red blood cell (RBC) turnover. OBJECTIVES The objective of this study was to determine the effects of altered thyroid status on HbA1c levels in individuals without diabetes, with overt hyper- and hypo-thyroidism, and if present, whether such changes in HbA1c are reversed after achieving euthyroid state. METHODS Euglycemic individuals with overt hypo- or hyper-thyroidism were selected. Age- and sex-matched controls were recruited. Baseline HbA1c and reticulocyte counts (for estimation of RBC turnover) were estimated in all the patients and compared. Thereafter, stable euthyroidism was achieved in a randomly selected subgroup and HbA1c and reticulocyte count was reassessed. HbA1c values and reticulocyte counts were compared with baseline in both the groups. RESULTS Hb A1c in patients initially selected was found to be significantly higher in hypothyroid group. HbA1c values in hyperthyroid patients were not significantly different from controls. HbA1c reduction and rise in reticulocyte count were significant in hypothyroid group following treatment without significant change in glucose level. Hb A1c did not change significantly following treatment in hyperthyroid group. The reticulocyte count, however, decreased significantly. CONCLUSION Baseline HbA1c levels were found to be significantly higher in hypothyroid patients, which reduced significantly after achievement of euthyroidism without any change in glucose levels. Significant baseline or posttreatment change was not observed in hyperthyroid patients. Our study suggests that we should be cautious while interpreting HbA1c data in patients with hypothyroidism.
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Affiliation(s)
- Rana Bhattacharjee
- Department of Endocrinology and Metabolism, IPGME and R and SSKM Hospital, Kolkata, West Bengal, India
| | - Anubhav Thukral
- Department of Endocrinology and Metabolism, IPGME and R and SSKM Hospital, Kolkata, West Bengal, India
| | - Partha Pratim Chakraborty
- Department of Endocrinology and Metabolism, IPGME and R and SSKM Hospital, Kolkata, West Bengal, India
| | - Ajitesh Roy
- Department of Endocrinology and Metabolism, IPGME and R and SSKM Hospital, Kolkata, West Bengal, India
| | - Soumik Goswami
- Department of Endocrinology and Metabolism, IPGME and R and SSKM Hospital, Kolkata, West Bengal, India
| | - Sujoy Ghosh
- Department of Endocrinology and Metabolism, IPGME and R and SSKM Hospital, Kolkata, West Bengal, India
| | - Pradip Mukhopadhyay
- Department of Endocrinology and Metabolism, IPGME and R and SSKM Hospital, Kolkata, West Bengal, India
| | - Satinath Mukhopadhyay
- Department of Endocrinology and Metabolism, IPGME and R and SSKM Hospital, Kolkata, West Bengal, India
| | - Subhankar Chowdhury
- Department of Endocrinology and Metabolism, IPGME and R and SSKM Hospital, Kolkata, West Bengal, India
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Selvan C, Dutta D, Thukral A, Nargis T, Kumar M, Mukhopadhyay S, Chowdhury S. Neck height ratio is an important predictor of metabolic syndrome among Asian Indians. Indian J Endocrinol Metab 2016; 20:831-837. [PMID: 27867888 PMCID: PMC5105569 DOI: 10.4103/2230-8210.192927] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND AND AIMS The predictive potential of neck circumference (NC) based indices (a measure of upper body fat distribution) for predicting metabolic syndrome (MetS) and its components among Indians is not known. This study aimed to evaluate the role of NC and neck height ratio (NHtR) as independent predictors of MetS and its components as compared to traditional anthropometric indices. MATERIALS AND METHODS A total of 451 individuals from 867 screened individuals, 30-80 years age, without any co-morbid state who gave informed written consent underwent clinical, anthropometric, and biochemical assessment. RESULTS Patients with MetS in both the sexes had significantly higher NC, NHtR, glycated hemoglobin, fasting glucose, and dyslipidemia (higher triglycerides, total cholesterol/high-density lipoprotein cholesterol (HDL-C) ratio, low-density lipoprotein cholesterol/HDL-C ratio, and lower HDL-C). In both sexes, individuals in the highest tertile of NC had significantly greater central and generalized obesity, lower HDL-C, and significantly higher MetS. Receiver operating characteristic analysis revealed waist circumference (WC) to have the largest area under the curve for predicting MetS in both sexes, followed by NHtR, NC, and body mass index. NC and NHtR of >34.9 cm (sensitivity 78.6%; specificity 59.3%) and >21.17 cm/m (sensitivity 80.7% and specificity 64.6%) respectively for men and >31.25 cm (sensitivity 72.3%; specificity 64.4%) and >20.48 cm/m (sensitivity 80.4% and specificity 60%) respectively for women were the best values for identifying MetS. Increased NC and NHtR had odds ratio of 1.52 (95% confidence interval [CI]: 1.37-1.68; P < 0.001) and 1.96 (95% CI: 1.67-2.29; P < 0.001) respectively in identifying MetS. CONCLUSION NC and NHtR are good predictors of MetS and cardiovascular risk factors in Asian Indians. NHtR is reliable and perhaps an even better index than NC with regards to cardiovascular risk prediction.
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Affiliation(s)
- Chitra Selvan
- Department of Endocrinology, MS Ramaiah Medical College, Bengaluru, Karnataka, India
| | - Deep Dutta
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Anubhav Thukral
- Department of Endocrinology, Institute of Post Graduate Institute of Medical Education and Research, Seth Sukhlal Karnani Memorial Hospital, Kolkata, West Bengal, India
| | - Titli Nargis
- PhD Scholar, Indian Institute of Chemical Biology, Kolkata, West Bengal, India
| | - Manoj Kumar
- Department of Endocrinology, Institute of Post Graduate Institute of Medical Education and Research, Seth Sukhlal Karnani Memorial Hospital, Kolkata, West Bengal, India
| | - Satinath Mukhopadhyay
- Department of Endocrinology, Institute of Post Graduate Institute of Medical Education and Research, Seth Sukhlal Karnani Memorial Hospital, Kolkata, West Bengal, India
| | - Subhankar Chowdhury
- Department of Endocrinology, Institute of Post Graduate Institute of Medical Education and Research, Seth Sukhlal Karnani Memorial Hospital, Kolkata, West Bengal, India
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Kumar V, Sharma A, Bhardwaj R, Thukral A. Monitoring and Characterization of Soils from River Bed of Beas, India, Using Multivariate and Remote Sensing Techniques. ACTA ACUST UNITED AC 2016. [DOI: 10.9734/bjast/2016/21611] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Kumar M, Thukral A, Jain R, Chaudhary S, Mukherjee S, Chowdhury S. Comments on 'Effect of pioglitazone on testosterone in eugonadal men with type 2 diabetes mellitus: a randomized double-blind placebo controlled study'. Clin Endocrinol (Oxf) 2014; 80:157. [PMID: 23550924 DOI: 10.1111/cen.12214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Manoj Kumar
- Department of Endocrinology, IPGME&R, Kolkata, India.
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Selvan C, Dutta D, Maisnam I, Thukral A, Chakraborthy PP, Roy A, Arora R, Dutta S, Baidya A, Ghosh S, Mukhopadhyay S, Chowdhury S. Thyroid associated orbitopathy with ocular myasthenia in primary hypothyroidism: Keep those eyes open. Indian J Endocrinol Metab 2013; 17:S657-S659. [PMID: 24910830 PMCID: PMC4046593 DOI: 10.4103/2230-8210.123559] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Thyroid associated orbitopathy, although seen most commonly with thyrotoxicosis, is also known to occur in primary hypothyroidism. Myasthenia gravis is an autoimmune condition with an established association with autoimmune thyroid disease. We report the case of a patient who presented with recent onset unilateral ptosis that was fatigable with a history of proptosis since a year. On examination, she had a goiter, bilateral proptosis, restriction of upward gaze and adduction both eyes and normal pupils. Investigations revealed primary hypothyroidism with anti-thyroid peroxidase positive and anti-acetylcholine receptor antibody positive. Computerized tomography orbit showed thickening of medial and inferior rectus characteristic of thyroid orbitopathy. A diagnosis of primary hypothyroidism with thyroid orbitopathy with ocular myasthenia gravis was made. Patient is on Levothyroxine and anticholinesterase medications and is on follow-up. We present this case to highlight that the presence of ptosis in a patient with thyroid orbitopathy should alert the clinician to the possible coexistence of myasthenia gravis.
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Affiliation(s)
- Chitra Selvan
- Departments of Endocrinology and Metabolism, IPGMER and SSKM Hospital, Kolkata, West Bengal, India
| | - Deep Dutta
- Departments of Endocrinology and Metabolism, IPGMER and SSKM Hospital, Kolkata, West Bengal, India
| | - Indira Maisnam
- Departments of Endocrinology and Metabolism, IPGMER and SSKM Hospital, Kolkata, West Bengal, India
| | - Anubhav Thukral
- Departments of Endocrinology and Metabolism, IPGMER and SSKM Hospital, Kolkata, West Bengal, India
| | - P. P. Chakraborthy
- Departments of Endocrinology and Metabolism, IPGMER and SSKM Hospital, Kolkata, West Bengal, India
| | - Ajitesh Roy
- Departments of Endocrinology and Metabolism, IPGMER and SSKM Hospital, Kolkata, West Bengal, India
| | - Rakesh Arora
- Departments of Endocrinology and Metabolism, IPGMER and SSKM Hospital, Kolkata, West Bengal, India
| | - Soumik Dutta
- Departments of Endocrinology and Metabolism, IPGMER and SSKM Hospital, Kolkata, West Bengal, India
| | - Arjun Baidya
- Departments of Endocrinology and Metabolism, IPGMER and SSKM Hospital, Kolkata, West Bengal, India
| | - Sujoy Ghosh
- Departments of Endocrinology and Metabolism, IPGMER and SSKM Hospital, Kolkata, West Bengal, India
| | - Satinath Mukhopadhyay
- Departments of Endocrinology and Metabolism, IPGMER and SSKM Hospital, Kolkata, West Bengal, India
| | - Subhankar Chowdhury
- Departments of Endocrinology and Metabolism, IPGMER and SSKM Hospital, Kolkata, West Bengal, India
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Chaudhary S, Thukral A, Kataria M, Ghosh S, Mukherjee S, Chowdhury S. Comment on: Besser et al. Lessons from the mixed-meal tolerance test: use of 90-minute and fasting C-peptide in pediatric diabetes. Diabetes Care 2013;36:195-201. Diabetes Care 2013; 36:e221. [PMID: 24265390 PMCID: PMC3836108 DOI: 10.2337/dc13-0369] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Abstract
INTRODUCTION Vitamin D deficiency is expected to be higher in patients with diabetes and pulmonary tuberculosis (TB). Studies estimating prevalence in the subset of patients with both diabetes and pulmonary TB are scarce. MATERIALS AND METHODS A total of 155 subjects were recruited; 46 patients with type 2 diabetes, 39 non-diabetic healthy controls, 30 patients of pulmonary TB and 40 patients with both pulmonary TB and type 2 diabetes. Vitamin D level (25 OH vitamin D) levels were done for all the 4 groups. RESULTS Mean vitamin D levels were not different between groups with TB, diabetes mellitus or combination of both, but the prevalence of severe vitamin D deficiency was higher in the group with both diabetes and TB (45%) as compared with the group with only TB (26.66%) and diabetes (17.39%) and healthy controls (7.69%). CONCLUSION The prevalence of patients with severe vitamin D deficiency is higher in patients with dual affection of TB and diabetes mellitus as compared with either disorder alone implying that patients with type 2 diabetes with the most severe vitamin D deficiency are the one of the most predisposed to pulmonary TB.
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Affiliation(s)
- Sandeep Chaudhary
- Department of Endocrinology, IPGME and R, SSKM Hospital, Kolkata, West Bengal, India
| | - Anubhav Thukral
- Department of Endocrinology, IPGME and R, SSKM Hospital, Kolkata, West Bengal, India
| | - Shalbha Tiwari
- Institute of Medical sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Daliparthy D Pratyush
- Institute of Medical sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Surya Kumar Singh
- Institute of Medical sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
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Affiliation(s)
- Anubhav Thukral
- Department of Endocrinology, IPGME&R, 242 AJC Bose Road, Kolkata, West Bengal 700020, India.
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Goswami S, Chakraborty PP, Bhattacharjee R, Roy A, Thukral A, Selvan C, Ghosh S, Mukhopadhyay S, Chowdhury S. Precocious puberty: A blessing in disguise! Indian J Endocrinol Metab 2013; 17:S111-S113. [PMID: 24251126 PMCID: PMC3830272 DOI: 10.4103/2230-8210.119522] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Germ cell tumors may lead to incomplete isosexual male precocity and are commonly located in the pineal gland. Germinomas of the basal ganglia are almost always unilateral and precocious puberty is a rare manifestation in them. We report a 9.5-year-old boy who presented with incomplete isosexual precocity due to bilateral basal ganglia germinoma.
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Affiliation(s)
- Soumik Goswami
- Department of Endocrinology and Metabolism, IPGME and R and SSKM Hospital, Kolkata, West Bengal, India
| | - Partha Pratim Chakraborty
- Department of Endocrinology and Metabolism, IPGME and R and SSKM Hospital, Kolkata, West Bengal, India
| | - Rana Bhattacharjee
- Department of Endocrinology and Metabolism, IPGME and R and SSKM Hospital, Kolkata, West Bengal, India
| | - Ajitesh Roy
- Department of Endocrinology and Metabolism, IPGME and R and SSKM Hospital, Kolkata, West Bengal, India
| | - Anubhav Thukral
- Department of Endocrinology and Metabolism, IPGME and R and SSKM Hospital, Kolkata, West Bengal, India
| | - Chitra Selvan
- Department of Endocrinology and Metabolism, IPGME and R and SSKM Hospital, Kolkata, West Bengal, India
| | - Sujoy Ghosh
- Department of Endocrinology and Metabolism, IPGME and R and SSKM Hospital, Kolkata, West Bengal, India
| | - Satinath Mukhopadhyay
- Department of Endocrinology and Metabolism, IPGME and R and SSKM Hospital, Kolkata, West Bengal, India
| | - Subhankar Chowdhury
- Department of Endocrinology and Metabolism, IPGME and R and SSKM Hospital, Kolkata, West Bengal, India
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Abstract
A 16-year-old person, reared as female presented with complaints of genital ambiguity and primary amenorrhoea along with lack of secondary sexual characters, but without short stature and Turner's stigmata. She was taking steroids after being misdiagnosed as congenital adrenal hyperplasia (CAH). Karyotype analysis revealed 46XY karyotype. There was no evidence of hypocortisolemia (cortisol 9.08 μg/dl, adrenocorticotropic hormone [ACTH] 82.5 pg/ml) or elevated level of 17-OH-progesterone (0.16 ng/ml). Pooled luteinizing hormone (LH) was 11.79 mIU/ml and follicle-stimulating hormone (FSH) was 66.37 mIU/ml. Serum estradiol level was 25 pg/ml (21-251). Basal and 72 h post beta-human chorionic gonadotropin (hCG) levels of androstenedione and testosterone levels were done (basal testosterone of 652 ng/dl and basal androstenedione of 1.17 ng/ml; 72 h post hCG testosterone of 896 ng/dl and androstenedione of 1.34 ng/ml). Magnetic resonance imaging (MRI) pelvis (with ultrasonogrphy [USG] correlation) revealed uterus didelphys with obstructed right moiety and bilateral ovarian-like structures. Right sided gonads and adjacent tubal structures were visualized laparoscopically and removed. Left sided gonads were not visualized and Mullerian remnants were adhered to sigmoid colon. Histopathological examination revealed presence of testicular tissue showing atrophic seminiferous tubules with hyperplasia of Leydig cells. No ovarian tissue was seen. Based on these results a diagnosis of 46XY mixed gonadal dysgenesis (MGD) was made, which is rare and is difficult to distinguish from 46XY ovotesticular disorder of sexual differentiation (OT-DSD). The patient was managed with a multidisciplinary approach and fertility issues discussed with the patient's caregivers.
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Affiliation(s)
- Rakesh Arora
- Department of Endocrinology, Institute of Post-Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - Saumik Datta
- Department of Endocrinology, Institute of Post-Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - Anubhav Thukral
- Department of Endocrinology, Institute of Post-Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - Partha Chakraborty
- Department of Endocrinology, Institute of Post-Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - Sujoy Ghosh
- Department of Endocrinology, Institute of Post-Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - Satinath Mukhopadhyay
- Department of Endocrinology, Institute of Post-Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - Subhankar Chowdhury
- Department of Endocrinology, Institute of Post-Graduate Medical Education and Research, Kolkata, West Bengal, India
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Abstract
Thyroid ectopia (TE) is an embryological aberration of the thyroid gland migration most commonly observed in the lingual region followed by the sublingual, hyoid, and mediastinal regions. TE is often complicated by local compressive symptoms resulting in dysphagia, dysphonia, and dyspnea. Surgical removal of TE is frequently complicated by difficulties in intubation, increased perioperative bleeding, and severe primary hypothyroidism; on the other hand, I131 ablation is limited by high doses needed and the concern for long-term effects especially in children. We report three children with TE who all presented with compressive symptoms and were managed conservatively with levothyroxine resulting in resolution of compressive symptoms and favorable outcomes. Levothyroxine supplementation is effective and has an important role in managing TE, not only in correcting the associated hypothyroidism but also in resolving the associated compressive symptoms by reducing the size of the ectopic thyroid tissue.
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Affiliation(s)
- Deep Dutta
- PGMER and SSKM Hospital, Department of Endocrinology and Metabolism, Bose Road, Calcutta, India. E-mail:
| | - Manoj Kumar
- IPGMER & SSKM Hospital, Department of Endocrinology & Metabolism, Bose Road, Calcutta, India
| | - Anubhav Thukral
- IPGMER & SSKM Hospital, Department of Endocrinology & Metabolism, Bose Road, Calcutta, India
| | - Dibakar Biswas
- IPGMER & SSKM Hospital, Department of Endocrinology & Metabolism, Bose Road, Calcutta, India
| | - Rajesh Jain
- IPGMER & SSKM Hospital, Department of Endocrinology & Metabolism, Bose Road, Calcutta, India
| | - Sujoy Ghosh
- IPGMER & SSKM Hospital, Department of Endocrinology & Metabolism, Bose Road, Calcutta, India
| | - Satinath Mukhopadhyay
- IPGMER & SSKM Hospital, Department of Endocrinology & Metabolism, Bose Road, Calcutta, India
| | - Subhankar Chowdhury
- IPGMER & SSKM Hospital, Department of Endocrinology & Metabolism, Bose Road, Calcutta, India
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Das A, Arora J, Rana T, Porwal C, Kaushik A, Gaur G, Thukral A, Verma S, Kabra SK, Singh UB. Congenital tuberculosis: the value of laboratory investigations in diagnosis. ACTA ACUST UNITED AC 2013; 28:137-41. [DOI: 10.1179/146532808x302161] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Dwivedi AND, Srivastava V, Thukral A, Tripathi K. A rare case of Balo concentric sclerosis showing unusual clinical improvement and response with oral prednisolone. Int J Appl Basic Med Res 2013; 2:136-8. [PMID: 23776828 PMCID: PMC3678695 DOI: 10.4103/2229-516x.106358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
The present report is a rare case of Balo Concentric Sclerosis. Most cases have either been diagnosed post mortem or have succumbed to the disease after being diagnosed ante mortem. In our case, the patient showed a dramatic response to treatment, and after a one-year follow-up, he was asymptomatic, with no relapses or residual effect of the illness.
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Affiliation(s)
- Amit Nandan D Dwivedi
- Department of Radiodiagnosis and Imaging, Institute of Medical Sciences, BHU, Varansai, Uttar Pradesh, India
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Dutta D, Jain R, Kumar M, Thukral A, Chowdhury S, Mukhopadhyay S. Solitary median maxillary central incisor, a clinical predictor of hypoplastic anterior pituitary, ectopic neurohypophysis and growth hormone deficiency. J Pediatr Endocrinol Metab 2013; 26:809-10. [PMID: 23729612 DOI: 10.1515/jpem-2013-0128] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Accepted: 04/22/2013] [Indexed: 11/15/2022]
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Abstract
INTRODUCTION Tuberculosis is the most common cause of Addison's disease in India. The exact status of adrenal reserve in tuberculosis is still an enigma and recovery of adrenal function is unpredictable. OBJECTIVE We report a case with a pre-Addisonian state and unchanged adrenal size after 1 year treatment. MATERIALS AND METHODS A 31-year patient with adrenal tuberculosis was diagnosed and treated with anti tubercular drugs (ATDs) and steroid. RESULTS A 31-year male, presented with fever and weight loss for 3½ months with anorexia, nausea, hyperpigmentation of skin, and buccal mucosa and weakness with past h/o adequately treated pulmonary tuberculosis at 3 years of age. On examination, the patient was anemic. A non-tender, firm right (Rt.) submandibular lymphnode was palpable. Investigations revealed: High erythrocyte sedimentation rate (ESR), negative HIV, and sputum for acid fast bacilli (AFB). Initial cortisol was high but subsequently became low with negative short synacthin test (SST). Computed tomography showed bilateral (B/L) enlarged hypodense adrenal mass with inconclusive fine needle aspiration cytology (FNAC) and negative AFB culture. Rt. submandibular lymph node FNAC showed caseating granuloma. ATDs and steroids were started, the lymphadenopathy regressed and symptoms subsided. However, after 1 year of treatment steroid withdrawal failed and adrenal size remained the same. CONCLUSION The adrenal has considerable capacity to regenerate during active infection and ultimately become normal or smaller in size. However, in the case reported here, they failed to regress. Reversal of adrenal function following ATD is a controversial issue. Some studies have shown normalization following therapy, while others have contradicted it similar to the finding in our case.
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Affiliation(s)
- Ajitesh Roy
- Department of Endocrinology & Metabolism, IPGME&R and SSKM Hospital, 244 AJC Bose Road, Kolkata, India
| | - Rana Bhattacharjee
- Department of Endocrinology & Metabolism, IPGME&R and SSKM Hospital, 244 AJC Bose Road, Kolkata, India
| | - Soumik Goswami
- Department of Endocrinology & Metabolism, IPGME&R and SSKM Hospital, 244 AJC Bose Road, Kolkata, India
| | - Anubhav Thukral
- Department of Endocrinology & Metabolism, IPGME&R and SSKM Hospital, 244 AJC Bose Road, Kolkata, India
| | - S Chitra
- Department of Endocrinology & Metabolism, IPGME&R and SSKM Hospital, 244 AJC Bose Road, Kolkata, India
| | - Partha Pratim Chakraborty
- Department of Endocrinology & Metabolism, IPGME&R and SSKM Hospital, 244 AJC Bose Road, Kolkata, India
| | - Dayanidhi Meher
- Department of Endocrinology & Metabolism, IPGME&R and SSKM Hospital, 244 AJC Bose Road, Kolkata, India
| | - Sujoy Ghosh
- Department of Endocrinology & Metabolism, IPGME&R and SSKM Hospital, 244 AJC Bose Road, Kolkata, India
| | - Satinath Mukhopadhyay
- Department of Endocrinology & Metabolism, IPGME&R and SSKM Hospital, 244 AJC Bose Road, Kolkata, India
| | - Subhankar Chowdhury
- Department of Endocrinology & Metabolism, IPGME&R and SSKM Hospital, 244 AJC Bose Road, Kolkata, India
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Selvan C, Thukral A, Chakraborthy PP, Bhattacharya R, Roy A, Goswani S, Meher D, Ghosh S, Mukhopadhyay S, Chowdhury S. Refractory rickets due to Fanconi's Syndrome secondary to Wilson's disease. Indian J Endocrinol Metab 2012; 16:S399-S401. [PMID: 23565442 PMCID: PMC3603090 DOI: 10.4103/2230-8210.104107] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Renal tubular disorders are an important cause of refractory rickets. Wilson's disease, an inherited disorder of copper metabolism has varied presentations. We present a case of refractory rickets due to Fanconi's syndrome attributable to Wilson's disease. An adolescent girl presented with pain in the hip and knee joints and a knock-knee deformity since six years. She had received multiple doses of cholecalciferol with little improvement. There was no history of seizures, polyuria, jaundice, intake of drugs, or similar complaints in the family. Examination revealed a severely short stature with widening of the wrist joint and genu valgum. Examination of the central nervous system (CNS) was normal. Skeletal radiographs showed features suggestive of rickets at the hip and knee joints. Routine biochemistry was normal, 25-hydroxyvitamin D [25(OH)D] was adequate (57.1 ng/dL), with normal corrected calcium (9.24 mg/dL), low phosphate (2.76 mg/dL), elevated bone-specific alkaline phosphatase, and normal renal functions. Twenty-four-hour urine revealed phosphaturia, kaliuresis, and glucosuria with normal blood sugars and aminoaciduria. Blood gas analysis revealed normal anion gap metabolic acidosis with a urine pH of 7. Ammonium chloride (NH4CL) challenge test revealed proximal tubular acidosis. A search for causes revealed Kayser-Fleischer rings. The diagnosis of Wilson's disease was confirmed by low serum ceruloplasmin levels (6.5 mg/dL; normal: 18-35 mg/dL) with high 24-hour urine copper levels (433 mcg; normal: 20-50 mcg). She was started on a replacement of alkali, phosphate, calcium, and vitamin D, with zinc acetate for Wilson's disease. Rickets as a presenting feature of Wilson's disease has been reported rarely. Recognition of this entity is important, as treatment of the primary condition may improve tubular function as well.
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Affiliation(s)
- Chitra Selvan
- Department of Endocrinology and Metabolism, IPGMER and SSKM Hospital, 244 AJC Bose Road, Kolkata, India
| | - Anubhav Thukral
- Department of Endocrinology and Metabolism, IPGMER and SSKM Hospital, 244 AJC Bose Road, Kolkata, India
| | - Partha P. Chakraborthy
- Department of Endocrinology and Metabolism, IPGMER and SSKM Hospital, 244 AJC Bose Road, Kolkata, India
| | - Rana Bhattacharya
- Department of Endocrinology and Metabolism, IPGMER and SSKM Hospital, 244 AJC Bose Road, Kolkata, India
| | - Ajitesh Roy
- Department of Endocrinology and Metabolism, IPGMER and SSKM Hospital, 244 AJC Bose Road, Kolkata, India
| | - Soumik Goswani
- Department of Endocrinology and Metabolism, IPGMER and SSKM Hospital, 244 AJC Bose Road, Kolkata, India
| | - Dayanidhi Meher
- Department of Endocrinology and Metabolism, IPGMER and SSKM Hospital, 244 AJC Bose Road, Kolkata, India
| | - Sujoy Ghosh
- Department of Endocrinology and Metabolism, IPGMER and SSKM Hospital, 244 AJC Bose Road, Kolkata, India
| | - Satinath Mukhopadhyay
- Department of Endocrinology and Metabolism, IPGMER and SSKM Hospital, 244 AJC Bose Road, Kolkata, India
| | - Subhankar Chowdhury
- Department of Endocrinology and Metabolism, IPGMER and SSKM Hospital, 244 AJC Bose Road, Kolkata, India
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Thukral A, Chitra S, Chakraborty PP, Roy A, Goswami S, Bhattacharjee R, Dutta D, Maisnam I, Ghosh S, Mukherjee S, Chowdhury S. De morseir syndrome presenting as ambiguous genitalia. Indian J Endocrinol Metab 2012; 16:S509-S511. [PMID: 23565482 PMCID: PMC3603130 DOI: 10.4103/2230-8210.104151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND A 10-year-old boy presented with genital ambiguity, poor linear growth, and delayed milestones. The aim and to highlight that although rare but congenital, hypogonadotropic hypogonadism may rarely present as ambiguity. MATERIALS AND METHODS The patient was found to have bilateral cryptorchidism with proximal penile hypospadias, microphallus with a proportionate dwarfism with mildly delayed bone age, and karyotype 46XY. Euthyroid with normal steroid axis, growth hormone insufficient as suggested by auxology, low IGF1, and poor response to clonidine stimulation. MRI brain shows hypoplastic corpus callosum, hypoplastic anterior pituitary, and ectopic posterior pituitary bright spot. RESULTS The patient underwent laparoscopic removal of right intrabdominal testis and orchidoplexy was performed on the left one. Testicular biopsy revealed no malignancy and growth hormone replacement was initiated. The patient awaits definitive repair of hypospadias. CONCLUSION As a provisional diagnosis of combined growth hormone and gonadotropin deficiency, most probable diagnosis is septo-optic dysplasia or de moseir syndrome leading to genital ambiguity.
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Affiliation(s)
- Anubhav Thukral
- Department of Endocrinology, IPGME and R, 242 AJC Bose Road, Kolkata, West Bengal, India
| | - S Chitra
- Department of Endocrinology, IPGME and R, 242 AJC Bose Road, Kolkata, West Bengal, India
| | - Partho P. Chakraborty
- Department of Endocrinology, IPGME and R, 242 AJC Bose Road, Kolkata, West Bengal, India
| | - Ajitesh Roy
- Department of Endocrinology, IPGME and R, 242 AJC Bose Road, Kolkata, West Bengal, India
| | - Soumik Goswami
- Department of Endocrinology, IPGME and R, 242 AJC Bose Road, Kolkata, West Bengal, India
| | - Rana Bhattacharjee
- Department of Endocrinology, IPGME and R, 242 AJC Bose Road, Kolkata, West Bengal, India
| | - Deep Dutta
- Department of Endocrinology, IPGME and R, 242 AJC Bose Road, Kolkata, West Bengal, India
| | - Indira Maisnam
- Department of Endocrinology, IPGME and R, 242 AJC Bose Road, Kolkata, West Bengal, India
| | - Sujoy Ghosh
- Department of Endocrinology, IPGME and R, 242 AJC Bose Road, Kolkata, West Bengal, India
| | - Satinath Mukherjee
- Department of Endocrinology, IPGME and R, 242 AJC Bose Road, Kolkata, West Bengal, India
| | - Subhankar Chowdhury
- Department of Endocrinology, IPGME and R, 242 AJC Bose Road, Kolkata, West Bengal, India
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Goswami S, Roy A, Bhattacharjee R, Shivaprasad KS, Chakraborty PP, Selvan C, Thukral A, Biswas K, Ghosh S, Mukhopadhyay S, Chowdhury S. The "Double A" phenotype: Portending Allgrove's syndrome and averting adrenal crisis. Indian J Endocrinol Metab 2012; 16:S367-S368. [PMID: 23565431 PMCID: PMC3603079 DOI: 10.4103/2230-8210.104095] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Allgrove's syndrome is a rare autosomal-recessive disorder with only about 70 cases reported thus far and is characterized by alacrima, achalasia, and ACTH insensitivity among other clinical features. However, it has a widely variable clinical presentation, which may result in such cases remaining undiagnosed. OBJECTIVE To report a patient with impending Allgrove's syndrome and to highlight the importance of clinical suspicion in diagnosing the same. MATERIALS AND METHODS A 2.5-year-old girl was diagnosed with impending Allgrove's syndrome on the basis of clinical presentation, barium swallow study, Schirmer's test, and hormonal evaluation. RESULTS A 2.5-year-old girl, born of non-consanguineous marriage, presented with failure to thrive and developmental delay with occasional vomiting on taking solid or semi-solid food for past 6 months. Examination revealed stunted weight (SDS of -4.4) and height (SDS of -4.76), and barium swallow showed presence of achalasia. On direct questioning, her mother mentioned presence of decreased tears on crying since birth, and Schirmer's test confirmed the presence of dry eyes. Baseline ACTH was slightly elevated with normal basal and post-ACTH stimulation serum cortisol. Based on these findings, impending Allgrove's syndrome was diagnosed with a plan for follow-up study of adrenal function. CONCLUSIONS Allgrove's syndrome may be an under diagnosed disorder as aclarima is often overlooked. However, a high index of clinical suspicion may help in avoiding adrenal crisis by diagnosing the condition early.
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Affiliation(s)
- Soumik Goswami
- Department of Endocrinology, SSKM and IPGMER Kolkata, India
| | - Ajitesh Roy
- Department of Endocrinology, SSKM and IPGMER Kolkata, India
| | | | | | | | - Chitra Selvan
- Department of Endocrinology, SSKM and IPGMER Kolkata, India
| | | | - Kaushik Biswas
- Department of Endocrinology, SSKM and IPGMER Kolkata, India
| | - Sujoy Ghosh
- Department of Endocrinology, SSKM and IPGMER Kolkata, India
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Thukral A, Ghosh S, Mukhurjee S, Chowdhury S. Comment on: Jeffery et al. Age before stage: insulin resistance rises before the onset of puberty: a 9-year longitudinal study (EarlyBird 26). Diabetes care 2012;35:536-541. Diabetes Care 2012; 35:e68; author reply e69. [PMID: 22923688 PMCID: PMC3425007 DOI: 10.2337/dc12-0615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Anubhav Thukral
- From the Department of Endocrinology, Institute of Post Graduate Medical Education and Research, Kolkata, India
| | - Sujoy Ghosh
- From the Department of Endocrinology, Institute of Post Graduate Medical Education and Research, Kolkata, India
| | - Satinath Mukhurjee
- From the Department of Endocrinology, Institute of Post Graduate Medical Education and Research, Kolkata, India
| | - Subhankar Chowdhury
- From the Department of Endocrinology, Institute of Post Graduate Medical Education and Research, Kolkata, India
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Thukral A, Tiwari DN, Sharma N, Tripathi K. Carcinoma of bronchus presenting as hydropneumothorax. J Assoc Physicians India 2012; 60:56. [PMID: 23029744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Anubhav Thukral
- Department of General Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh
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Varyani N, Tripathi S, Thukral A, Mishra M, Garg S, Tripathi K, Dwivedi AND. Correlation of Serum Endothelial Dysfunction Markers with CT Angiographic Findings in Ischemic Stroke. Asian Pacific Journal of Tropical Disease 2012. [DOI: 10.1016/s2222-1808(12)60115-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Thukral A, Metz J, Hwang WT, O'Dwyer P, Plastaras J, Both S, Bar-Ad V, Ad VB. Toxicity data for preoperative concurrent chemoradiotherapy with oxaliplatin and continuous infusion 5-fluorouracil for locally advanced esophageal cancer. Dis Esophagus 2011; 24:330-6. [PMID: 21143694 DOI: 10.1111/j.1442-2050.2010.01145.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The purpose of this retrospective analysis was to characterize the feasibility and tolerability of oxaliplatin/5-fluorouracil (5-FU) given concurrently with radiotherapy for patients with locally advanced esophageal cancer. Between July 2005 and March 2009, 15 patients with clinical stage T3/T4 and/or N1/M1a lower esophageal or gastroesophageal junction adenocarcinoma were treated with preoperative chemoradiotherapy using oxaliplatin every 2 weeks and continuous infusion 5-FU. The main treatment-related toxicities were oral mucositis and dysphagia. During the first 2 weeks of treatment, 20% of patients presented with grade 1-2 oral mucositis, and one patient developed grade 1 dysphagia. In weeks 3-4, 53% of the patients experienced grade 1-2 mucositis, and 40% experienced grade 1-2 dysphagia. One patient only experienced grade 3 mucositis in week 4. Three patients (20%) had grade 3-4 dysphagia in weeks 3-4 and were continued on intravenous fluids and pain medications. During the last 2 weeks of chemoradiotherapy, 53% of patients reported grade 1-2 oral mucositis, mostly grade 1 and 73% of patients experienced grade 1-2 dysphagia and 26% patients experienced grade 3-4 dysphagia. Other toxicities included fatigue, nausea, neuropathy, and diarrhea. Only one patient experienced > 10% weight loss. The whole group was treated with aggressive supportive care during radiotherapy. Five (33%) patients achieved a pathological complete response. No patients developed locoregional failure. Sixty percent of the patients developed distant metastases and the 2-year disease-free survival was 53%. The median survival was 3.2 years with the 2-year overall survival of 73%. Preoperative oxaliplatin/5-FU-based chemoradiotherapy for locally advanced esophageal cancer is feasible, but associated with substantial gastrointestinal toxicity. A careful attention to nutrition and hydration throughout the course of therapy is required.
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Affiliation(s)
- A Thukral
- Department of Radiation OncologyDepartment of Biostatistics and EpidemiologyDepartment of Hematology-Oncology, University of Pennsylvania, Philadelphia, USA
| | - J Metz
- Department of Radiation OncologyDepartment of Biostatistics and EpidemiologyDepartment of Hematology-Oncology, University of Pennsylvania, Philadelphia, USA
| | - W-T Hwang
- Department of Radiation OncologyDepartment of Biostatistics and EpidemiologyDepartment of Hematology-Oncology, University of Pennsylvania, Philadelphia, USA
| | - P O'Dwyer
- Department of Radiation OncologyDepartment of Biostatistics and EpidemiologyDepartment of Hematology-Oncology, University of Pennsylvania, Philadelphia, USA
| | - J Plastaras
- Department of Radiation OncologyDepartment of Biostatistics and EpidemiologyDepartment of Hematology-Oncology, University of Pennsylvania, Philadelphia, USA
| | - S Both
- Department of Radiation OncologyDepartment of Biostatistics and EpidemiologyDepartment of Hematology-Oncology, University of Pennsylvania, Philadelphia, USA
| | - V Bar-Ad
- Department of Radiation OncologyDepartment of Biostatistics and EpidemiologyDepartment of Hematology-Oncology, University of Pennsylvania, Philadelphia, USA
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Thukral A, Srivastava V, Dwivedi AND, Mishra M, Tripathi K. An interesting case of Cruveilhier-Baumgarten disease: Persistent left umbilical vein in a 50 year old man. Asian J Med Sci 2011. [DOI: 10.3126/ajms.v2i1.3780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
A middle aged man of 50 years presented with features of portal hypertension without any features of liver decompensation or cirrhosis, found to have abnormal flow pattern in peri-umbilical vein, confirmed by Doppler to have a patent left umbilical vein. This represents a very treatable cause of portal hypertension as ligation of vein may result in complete reversal of disease process. The case also outlines importance of routine general examination like of seeing the direction of flow in periumbilical veins even in obvious cases of portal hypertension that helped us in detection of this case. Key Words: Portal hypertension; Periumbilical vein DOI: 10.3126/ajms.v2i1.3780 Asian Journal of Medical Sciences 2 (2011) 63-64
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Thukral A, Tiwari DN, Tripathi K. Pneumatocele in an adult. J Assoc Physicians India 2011; 59:186-187. [PMID: 21751636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
We report a case of 25-year-old male who presented with high grade fever with cough and expectoration. Chest examination revealed amphoric breath sounds on the right interscapular region. Chest X ray revealed multiple air fluid levels with collapse lung at places. Staph pneumonia with pneumatoceles is common in children but uncommon to in adult population.
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Affiliation(s)
- A Thukral
- Department of General Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi
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Thukral A, Tiwari DN, Kumar K, Tandon R, Tripathi K. Heel pad sign. J Assoc Physicians India 2011; 59:108. [PMID: 21751646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Anubhav Thukral
- Department of General Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh
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Thukral A, Tiwari DN, Tripathi K. Ulcerative colitis presenting as toxic megacolon. J Assoc Physicians India 2010; 58:519. [PMID: 21189707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Thukral A, Tiwari DN, Tripathi K. Extensive pleural calcification. J Assoc Physicians India 2010; 58:314. [PMID: 21117350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- Anubhav Thukral
- Department of General Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, UP
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Affiliation(s)
- Anubhav Thukral
- Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Uttar Pradesh, India.
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Affiliation(s)
- Anubhav Thukral
- Sir Sunderlal Hospital, Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, 221005 Varanasi, India
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Freckmann G, Galley P, Wagner R, Gerber M, Thukral A, Haug C. Semi-closed–loop Algorithmus kontrollierte Therapie unter standardisierter Fahrrad-Ergometer-Belastung. DIABETOL STOFFWECHS 2007. [DOI: 10.1055/s-2007-982329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Thukral A, Bhargava SK, Thukral KK. Diagnostic significance of excretory urography and ultrasonography in renal diseases. J Indian Med Assoc 1997; 95:579-81, 585. [PMID: 9567586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
A comparative study of intravenous urography (IVU) and ultrasonography (USG) was performed in 100 patients of all age groups, having symptoms and signs of various renal diseases. Sonography was found to be 100% sensitive and diagnostic in approximately 74% of renal pathologies included in this study, namely calculous disease (excluding midureteric calculi), obstructive lesions of pelvicalyceal system (PCS), cystic diseases, gross congenital lesions, traumatic lesions and neoplasms. It also provided information about the complications of long standing obstruction to PCS such as non-functional and atrophied kidneys, infection, etc. IVU proved better in midureteric calculi (100%), 88.2% of all congenital lesions including the major as well as minor variations. Both modalities proved to be of poor help in diffuse parenchymal diseases (IVU-40% and USG-50%) and renal tuberculosis (IVU-18.2% and USG-45.5%). Sonography was able to delineate the cause of obstruction to PCS in only 72.3% of cases as compared to 88% by IVU.
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Affiliation(s)
- A Thukral
- Department of Radiology, GTB Hospital, Shahdara, Delhi
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