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Dhakate M, Goswami D, Goswami R, Saha S, Kandasamy D, Arora M. Bone mineral density, vertebral fractures and trabecular bone score in primary ovarian insufficiency. J Endocrinol Invest 2023:10.1007/s40618-023-02045-z. [PMID: 36848018 DOI: 10.1007/s40618-023-02045-z] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 02/15/2023] [Indexed: 03/01/2023]
Abstract
PURPOSE Bone health in primary ovarian insufficiency (POI) is under-investigated. We assessed patients with spontaneous POI for vertebral fractures (VFs) and related parameters of bone health. METHODS 70 cases with spontaneous POI (age 32.5 ± 7.0 years) and an equal number of controls were assessed for BMD, TBS, and VFs. BMD at the lumbar-spine (L1-L4), left hip, non-dominant forearm, and TBS (iNsight software) were measured on a dual-energy X-ray absorptiometry (DXA) machine. VFs were assessed by Genant's classification. Serum FSH, LH, estradiol, T4, TSH, iPTH, serum 25(OH)D, total calcium, and inorganic phosphorus were measured. RESULTS BMD at the lumbar-spine, hip and forearm was reduced by 11.5%, 11.4% and 9.1% in POI as compared to controls (P < 0.001). Degraded or partially degraded microarchitecture on TBS was observed in 66.7% of patients and 38.2% of controls (P = 0.001). 15.7% of the POI patients had VFs, compared to 4.3% of controls (P = 0.045). Age, duration of amenorrhea and duration of HRT use were the significant predictors of TBS (P < 0.01). Serum 25(OH)D was the significant determinant of VFs. TBS abnormalities were higher in patients with POI and VFs. BMD was not significantly different in patients with and without VFs. CONCLUSION Thus, lumbar-spine osteoporosis, impaired TBS and VFs were present in 35.7%, 66.7% and 15.7% of patients with spontaneous POI in their early third decade. This indicates need for rigorous investigations for impaired bone health in these young patients and management with HRT, vitamin-D, and possible need for bisphosphonate therapy.
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Affiliation(s)
- M Dhakate
- Departments of Obstetrics and Gynecology, Maulana Azad Medical College, Bahadur Shah Zafar Marg, New Delhi, 110002, India
| | - D Goswami
- Departments of Obstetrics and Gynecology, Maulana Azad Medical College, Bahadur Shah Zafar Marg, New Delhi, 110002, India.
| | - R Goswami
- Department of Endocrinology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - S Saha
- Department of Endocrinology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - D Kandasamy
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - M Arora
- Department of Dietetics, Maulana Azad Medical College, New Delhi, 110002, India
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Saha S, Mannar V, Kandasamy D, Sreenivas V, Goswami R. Vertebral fractures, trabecular bone score and their determinants in chronic hypoparathyroidism. J Endocrinol Invest 2022; 45:1777-1786. [PMID: 35585296 DOI: 10.1007/s40618-022-01818-2] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 05/03/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Patients with hypoparathyroidism are at risk of vertebral fractures (VFs) despite high bone mineral density (BMD). We investigated this paradox by assessing trabecular bone score (TBS) and hip structural analysis (HSA) in non-surgical chronic hypoparathyroidism (cHypoPT) with and without VFs. METHODS 152 cHypoPT patients (age 40.2 ± 13.4 years, M: F = 81:71) with a median follow-up of 8 (2-13) years were assessed for BMD, VFs, TBS, and HSA and compared with 152 healthy controls. VFs at T7-L4 were assessed by Genant's method. Average serum total calcium and phosphorus during follow-up were assessed. RESULTS The lumbar spine and hip BMD were higher by 25.4 and 13.4% in cHypoPT than controls (P < 0.001). Paradoxically, VFs (30.9 vs.7.9%), including multiple (12.5 vs. 2.6%) were higher in cHypoPT (P < 0.001). Though overall average TBS (1.411 ± 0.091) was normal in cHypoPT, 25.4% of the females had subnormal TBS, more in post than pre-menopausal women (52.3 vs. 14%, P = 0.002) and as compared to males (6.1%, P = 0.001). TBS correlated with menopausal status and follow-up serum calcium-phosphorus product. For every gm/cm2 rise in BMD, TBS increase was only 0.227 in cHypoPT compared to 0.513 in controls. Frequency of VFs increased with declining TBS (P = 0.004). HSA was comparable between cHypoPT with and without VFs. 23.4% of cHypoPT with VFs had subnormal TBS. CONCLUSION 31% of cHypoPT patients had VFs. TBS indicated degraded bone microarchitecture in 50% of the post-menopausal cHypoPT women. However, TBS has limitations to detect abnormal bone microarchitecture in cHypoPT as only one-fourth of patients with VFs showed low TBS.
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Affiliation(s)
- S Saha
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - V Mannar
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - D Kandasamy
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - V Sreenivas
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - R Goswami
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, 110029, India.
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Bakhshi S, Agarwala S, Dhua A, Jain V, Thulkur S, Jana M, Kandasamy D, Tomar S. Treatment and outcome of testicular malignant germ cell tumors (MGCT) - A single institution experience. Pediatric Hematology Oncology Journal 2020. [DOI: 10.1016/j.phoj.2021.04.135] [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: 11/16/2022] Open
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Yadav D, Agarwal S, Sharma A, Malik E, Kandasamy D, Thakar A, Yadav R, Barward A, Kini L. Synovial sarcoma masquerading as medullary thyroid carcinoma. Cytopathology 2018; 29:468-470. [PMID: 29873853 DOI: 10.1111/cyt.12582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2018] [Indexed: 11/29/2022]
Affiliation(s)
- D Yadav
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - S Agarwal
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - A Sharma
- Department of Anatomy, All India Institute of Medical Sciences, New Delhi, India
| | - E Malik
- Department of Anatomy, All India Institute of Medical Sciences, New Delhi, India
| | - D Kandasamy
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - A Thakar
- Department of Otorhinolaryngology, All India Institute of Medical Sciences, New Delhi, India
| | - R Yadav
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - A Barward
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - L Kini
- Clinical Pathologist, CORE Diagnostics, New Delhi, India
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Gupta AK, Kandasamy D. Imaging in endocrine disorders. Indian J Med Res 2018. [PMCID: PMC6022395 DOI: 10.4103/0971-5916.234617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Jyotsna VP, Pal S, Kandasamy D, Gamanagatti S, Garg PK, Raizada N, Sahni P, Bal CS, Tandon N, Ammini AC. Evolving management of insulinoma: Experience at a tertiary care centre. Indian J Med Res 2017; 144:771. [PMID: 28361831 PMCID: PMC5393089 DOI: 10.4103/ijmr.ijmr_1477_14] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND & OBJECTIVES Since our previous study in 2006, several new modalities for localization of cause of endogenous hyperinsulinemic hypoglycaemia such as multiphasic computed tomography (CT), multiphasic magnetic resonance imaging (MRI), endoscopic ultrasound (EUS), intraoperative ultrasound, and intra-arterial calcium infusion with arterial stimulation venous sampling (ASVS) have become available. Therefore, to evaluate the relative usefulness of various imaging modalities to guide future management in terms of diagnosis and patient care, we analyzed presentation and management of patients of endogenous hyperinsulinemic hypoglycaemia. METHODS In this retrospective study, medical records of patients admitted with endogenous hyperinsulinemic hypoglycaemia were retrieved. Data pertaining to clinical features, diagnosis, imaging, surgery and patient outcome were extracted. The localization of insulinoma by preoperative imaging techniques was compared with the findings at surgery to assess the accuracy of localization. RESULTS Fasting hypoglycaemia was present in all, and post-prandial hypoglycaemia (plasma glucose ≤50 mg/dl within four hours of meal) in 25.8 per cent. Mean duration of symptoms before reaching a diagnosis of hyperinsulinemic hypoglycaemia was 3.9 years. Mean duration of provocative fast was 21.8 h (range 6-48 h). Among the currently used imaging modalities, the sensitivity of localizing tumour was 79.3 per cent for multiphasic CT, 85 per cent for multiphasic MRI and 95 per cent for EUS. EUS detected tumour missed by both CT and MRI. All, except one of the operated patients, were cured by surgery. INTERPRETATION & CONCLUSIONS Our results suggest that patients with insulinoma have a varied presentation. Multiphasic contrast-enhanced MRI/CT scan, EUS and ASVS may be complimentary in pre-operative localization.
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Affiliation(s)
- Viveka P Jyotsna
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - Sujoy Pal
- Department of Gastrointestinal Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - D Kandasamy
- Department of Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - S Gamanagatti
- Department of Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - P K Garg
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - N Raizada
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - Peush Sahni
- Department of Gastrointestinal Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - C S Bal
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - N Tandon
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - A C Ammini
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
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Affiliation(s)
- D. Kandasamy
- University of Michigan-Flint, Flint, Michigan,
- University of Colorado-Denver, Denver, Colorado,
| | - D.B. Carr
- Washington University in St. Louis, St. Louis, Missouri,
| | - T.M. Meuser
- University of Missouri-Saint Louis, St. Louis, Missouri
| | - A. Harmon
- Washington University in St. Louis, St. Louis, Missouri,
| | - M. Betz
- University of Colorado-Denver, Denver, Colorado,
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Affiliation(s)
- S. H. Rahaman
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - D. Kandasamy
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - V. P. Jyotsna
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
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Raizada N, Rahaman SH, Kandasamy D, Jyotsna VP. Rare association of insulin autoimmune syndrome with ankylosing spondylitis. Endocrinol Diabetes Metab Case Rep 2015; 2015:150090. [PMID: 26527431 PMCID: PMC4626647 DOI: 10.1530/edm-15-0090] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Accepted: 09/24/2015] [Indexed: 11/12/2022] Open
Abstract
Insulin autoimmune syndrome (IAS) is a rare cause of hyperinsulinemic hypoglycaemia, which is known to occur in association with the use of sulfhydryl-containing drugs and autoimmune disorders. We describe a patient with hitherto an unreported association of IAS with ankylosing spondylitis. We have also performed and described a simplified method of polyethylene glycol (PEG) precipitation of an insulin bound antibody in the serum.
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Affiliation(s)
- Nishant Raizada
- Department of Endocrinology and Metabolism , All India Institute of Medical Sciences , New Delhi , India
| | - S H Rahaman
- Department of Endocrinology and Metabolism , All India Institute of Medical Sciences , New Delhi , India
| | - D Kandasamy
- Department of Radiology , All India Institute of Medical Sciences , New Delhi , India
| | - V P Jyotsna
- Department of Endocrinology and Metabolism , All India Institute of Medical Sciences , New Delhi , India
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Ramkumar S, Jyotsna VP, Mallick S, Kachhawa G, Kandasamy D, Kriplani A, Ammini AC. Bilateral thecoma presenting as premenopausal hirsutism: Laproscopic removal. Indian J Endocrinol Metab 2013; 17:S662-S664. [PMID: 24910832 PMCID: PMC4046596 DOI: 10.4103/2230-8210.123561] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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: 11/25/2022] Open
Abstract
Hyperandrogenism is a common disorder among women in the reproductive age group. One of the rare causes for androgen excess is sex cord- stromal tumors of the ovary. These are usually unilateral. Here we report case of a 48 year old woman who presented with hyperandrogenism due to bilateral ovarian thecoma. Androgen levels normalized following resection of the tumor. This, to the best of our knowledge, is the first case of bilateral thecoma presenting as hirsutism in a premenopausal woman.
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Affiliation(s)
- S. Ramkumar
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - V. P. Jyotsna
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - S. Mallick
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Garima Kachhawa
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - D. Kandasamy
- Department of Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - A. Kriplani
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - A. C. Ammini
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
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Abstract
Central pontinemyelinolysis (CPM) is one of the rare non-inflammatory demyelinating diseases of the pons and very rarely it can involve extrapontine structure as well. The exact etiopathogenesis of this condition is still unclear. Rapid correction of hyponatremia has been attributed as a most common factor, but alcoholism, malnutrition, prolonged use of diuretics, psychogenic polydipsia, post liver transplant and hypokalemia have also been attributed as a causative factor. We describe a case of hyperparathyroidism with concomitant hypercalcemia accompanied by central pontine myelinosis without hyponatremia/hyperosmolality or associated rapid corrections of sodium, which developed as a consequence of severe hypokalaemia.
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Affiliation(s)
- Shyam Kishore
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - D. Kandasamy
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Viveka P. Jyotsna
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
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Rajan RM, Kandasamy D, Kumar PS. Vertical tooth fracture: reunion with a miniature lag screw. N Y State Dent J 2009; 75:44-46. [PMID: 19722482] [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: 05/28/2023]
Abstract
The treatment and prognosis of teeth with crown root fracture are dictated solely by the extent of the fracture line. Vertical tooth fracture, a variant of crown root fracture, presents serious complications in management because of the extent of the fracture line to the full vertical length of the tooth. It is invariably followed by extraction of the entire or a segment of the tooth. Literature recommends various treatment possibilities for vertical tooth fracture, yet no predictable protocol with a long-term prognosis has been described. This case report details a multidisciplinary approach towards reunion of the fractured fragments of maxillary I premolar by providing interfragmentary compression with the use of a miniaturized lag screw.
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Affiliation(s)
- R Mathan Rajan
- Department of Conservative Dentistry and Endodontics, Sri Ramachandra Dental College and Hospital, Chennai, India.
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Speca AN, Karayannis NM, Pytlewski LL, Winters LJ, Kandasamy D. 2,2'-Bipyridine N-oxide chelates with divalent 3d metal perchlorates. Inorg Chem 2002. [DOI: 10.1021/ic50124a002] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kandasamy D, Marimuthu T, Oblisami G, Rajukkannu K, Raghuraj R. A correlation between the dissipation of insecticides and rhizosphere microflora of Abelmoschus esculentus (L.) Moench. Zentralbl Bakteriol Parasitenkd Infektionskr Hyg 1977; 132:340-4. [PMID: 910573 DOI: 10.1016/s0044-4057(77)80024-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
A study to understand the relationship between the dissipation of aldicarb and disulfoton in the rhizosphere region of bhendi and the microbial population revealed a negative correlation between the fungal and Azotobacter population and the residues of both insecticides. However, no definite correlation could be recorded between the populations of bacteria and actinomycetes and the residues of the insecticides.
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Kandasamy D, Prasad NN. Studies on certain factors influencing legume-rhizobia interrelationship. III. Antagonistic soil streptomycetes in the rhizosphere region. Hindustan Antibiot Bull 1975; 17:115-7. [PMID: 1233355] [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: 12/26/2022]
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