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Dutta D, Kumar M, Shivaprasad KS, Kumar A, Sharma M. Impact of semaglutide on biochemical and radiologic measures of metabolic-dysfunction associated fatty liver disease across the spectrum of glycaemia: A meta-analysis. Diabetes Metab Syndr 2022; 16:102539. [PMID: 35709586 DOI: 10.1016/j.dsx.2022.102539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 05/06/2022] [Revised: 06/02/2022] [Accepted: 06/04/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS No meta-analysis has analysed efficacy and safety of semaglutide in metabolic-dysfunction associated fatty-liver disease (MAFLD). METHODS Electronic databases were searched for RCTs involving people with MAFLD and/or type-2 diabetes (T2DM) receiving semaglutide. Primary outcome was to evaluate changes in alanine aminotransferase (ALT). Secondary outcomes were to evaluate alterations in other measures of NAFLD, glycaemia, lipids and adverse-events. RESULTS Data from 4 RCTs (2115 patients) was analysed. A greater lowering with injectable semaglutide 0.4mg/0.5 mg once weekly was seen with regards to ALT [MD -3.89U/L (95%CI: -5.41 to -2.36); P < 0.01; I2 = 0%; 2050 patients], liver stiffness (fibroscan®) [MD -3.19 kPa (95%CI: -3.26 to -3.12); P < 0.01; 162 patients], steatosis [MD -13.40 dB/m (95%CI: 20.56 to -6.24); P < 0.01; 162 patients], triglycerides [MD -21.43 mg/dl (95% CI: 41.63 to -1.23); P = 0.04; I2 = 99%; 2050 patients], total cholesterol [MD -5.53 mg/dl (95% CI: -8.45 to -2.61); P < 0.01; I2 = 0%; 1888 patients], LDL-cholesterol [MD -3.55 mg/dl (95% CI: -5.87 to -1.23); P < 0.01; I2 = 0%; 1888 patients], percent-weight [MD -8.99% (95%CI: -14.64 to -3.34); P = 0.002; I2 = 100%; 2115 patient] and HbA1c [MD -0.77% (95%CI: 1.10 to -0.45); P = 0.002; I2 = 100%; 2115 patients]. Number of patients inadequate to comment on histopathologic measures of MAFLD. Occurrence of treatment-emergent adverse-events [RR 2.31 (95% CI: 0.76-7.06); P = 0.14; I2 = 82%] and severe adverse events [RR 1.07 (95%CI: 0.69-1.65); P = 0.77; I2 = 33%] were comparable. Adverse-events leading to trial discontinuation [RR 2.37 (95% CI: 1.33-4.22); P = 0.003; I2 = 24%], diarrhea [RR 2.05 (95%CI: 1.17-3.60); P = 0.01; I2 = 66%], nausea [RR 4.98 (95%CI: 3.23-7.67); P < 0.001; I2 = 0%] and vomiting [RR 3.90 (95%CI: 1.75-8.68); P < 0.01; I2 = 54%] were higher with semaglutide. CONCLUSION This meta-analysis provides reassuring data on efficacy of low dose semaglutide injections in improving ALT and certain radiologic features in MAFLD. Current conclusions are limited by small number of patients evaluated. Urgent need remains for larger studies focussing on liver biopsy.
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Affiliation(s)
- Deep Dutta
- Department of Endocrinology, Center for Endocrinology Diabetes Arthritis & Rheumatism (CEDAR) Superspeciality Healthcare, Dwarka, New Delhi, India.
| | - Manoj Kumar
- Department of Endocrinology, CEDAR Superspeciality Healthcare, Zirakpur, Punjab, India.
| | - K S Shivaprasad
- Department of Endocrinology, CEDAR Superspeciality Healthcare, Bengaluru, Karnataka, India.
| | - Ashok Kumar
- Department of Endocrinology, CEDAR Superspeciality Healthcare, Panipat, Haryana, India.
| | - Meha Sharma
- Department of Rheumatology, CEDAR Superspeciality Healthcare, Dwarka, New Delhi, India.
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Abstract
The goal of this research was to remove COD, oil and grease (O&G) and color from raw ayurvedic hospital wastewater (AHWW) using a novel electrochemical coagulation (ECC) process. Cell voltage was initially optimized using iron electrodes in bipolar mode for both raw AHWW and ayurvedic hospital therapy room wastewater (AH-TRWW) for a pre-optimized electrolysis time (ET) of 60 min. O&G, COD and color removals for AHWW at 8 V optimized cell voltage were 96, 61 and 96% respectively. Different electrode materials, copper, aluminum, graphite, were used to evaluate relative performances at 8 V. Iron electrodes showed maximum pollutant removal from raw AHWW. The sludge obtained after the ECC process showed good settling and filterability properties compared to graphite and aluminum electrodes. The low SVI value of 146 mL/g was obtained exercising absolute control on sludge volume. Solids flux values showed assurances of compact settling tank design with least spatial footprint. EDX analysis for ECC sludge of AHWW using iron showed gross elements 40.19% C, 48.63% O and 7.92% Fe redefining the fate of sludge. The XRD pattern of the ECC sludge showed an amorphous nature. Post-ECC filtration effluent showed clear water reclamation of 80-82%, proving the effectiveness of the novel ECC treatment process.
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Affiliation(s)
- S Mahesh
- Department of Environmental Engineering, Sri Jayachamarajendra College of Engineering, Constituent College of JSS Science and Technology University (Formerly SJCE), JSSTI Campus, Mysuru, Karnataka State 570006, India E-mail:
| | - K S Shivaprasad
- Department of Environmental Engineering, Sri Jayachamarajendra College of Engineering, Constituent College of JSS Science and Technology University, JSSTI Campus, Mysuru, Karnataka State 570006, India
| | - Mahesh Sanjana
- JSS Ayurveda Medical College, Lalitadripura Road, Alanahalli, Mysuru, Karnataka State 570028, India
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Vishwanath D, Shanmugam A, Sundaresh M, Hariharan A, Saraf S, Bahadur U, Veeramachaneni V, Chandrasekhar N, Pillai V V, Bushan V, Shetty V, Subramaniam N, Kuriakose MA, Shivaprasad KS, Khadilkar K, Suresh A, Sum S, Lakhsmikantha A, Rekha PR, Zaidi SN, Gupta V, Kannan S. Development of a Low-cost NGS Test for the Evaluation of Thyroid Nodules. Indian J Surg Oncol 2022; 13:17-22. [PMID: 35462651 PMCID: PMC8986928 DOI: 10.1007/s13193-019-01000-w] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 09/25/2019] [Indexed: 10/25/2022] Open
Abstract
Ultrasound-guided fine needle aspiration cytology (FNAC) is the preferred method of identifying malignancy in palpable thyroid nodules using the Bethesda reporting system. However, in around 30-40% of FNACs (Bethesda categories III, IV, and V), the results are indeterminate and surgery is required to confirm malignancy. Out of those who undergo surgery, only 10-40% of patients in these categories are found to have malignancies, thus proving surgery to be unnecessary for some patients or to be incomplete in others. While molecular testing on thyroid FNAC material is part of the American Thyroid Association (ATA) guidelines in evaluating thyroid nodules, it is currently unavailable in India due to cost constraints. In this study, we prospectively collected FNAC samples from sixty-nine patients who presented with palpable thyroid nodules. We designed a cost-effective next-generation sequencing (NGS) test to query multiple variants in the DNA and RNA isolated from the fine needle aspirate. The identification of oncogenic variants was considered to be indicative of malignancy, and confirmed by surgical histopathology. The panel showed an overall sensitivity of 81.25% and a specificity of 100%, while in the case of Bethesda categories III, IV, and V, the sensitivity was higher (87.5%) and the specificity was established at 100%. The panel could thereby serve as a rule-in test for the diagnosis of thyroid cancer and therefore help identify patients who require surgery, especially in the indeterminate Bethesda categories III, IV, and V.
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Affiliation(s)
- Divya Vishwanath
- grid.465051.30000 0004 1799 1787Strand Life Sciences Pvt. Ltd., 5th Floor, Kirloskar Business Park, Bellary Road, Hebbal, Bangalore, 560024 India
| | - Ashwini Shanmugam
- grid.465051.30000 0004 1799 1787Strand Life Sciences Pvt. Ltd., 5th Floor, Kirloskar Business Park, Bellary Road, Hebbal, Bangalore, 560024 India
| | - Mahima Sundaresh
- grid.465051.30000 0004 1799 1787Strand Life Sciences Pvt. Ltd., 5th Floor, Kirloskar Business Park, Bellary Road, Hebbal, Bangalore, 560024 India
| | - Arun Hariharan
- grid.465051.30000 0004 1799 1787Strand Life Sciences Pvt. Ltd., 5th Floor, Kirloskar Business Park, Bellary Road, Hebbal, Bangalore, 560024 India
| | - Shradha Saraf
- grid.465051.30000 0004 1799 1787Strand Life Sciences Pvt. Ltd., 5th Floor, Kirloskar Business Park, Bellary Road, Hebbal, Bangalore, 560024 India
| | - Urvashi Bahadur
- grid.465051.30000 0004 1799 1787Strand Life Sciences Pvt. Ltd., 5th Floor, Kirloskar Business Park, Bellary Road, Hebbal, Bangalore, 560024 India
| | - Vamsi Veeramachaneni
- grid.465051.30000 0004 1799 1787Strand Life Sciences Pvt. Ltd., 5th Floor, Kirloskar Business Park, Bellary Road, Hebbal, Bangalore, 560024 India
| | - Naveen Chandrasekhar
- grid.416504.20000 0004 1796 819XDepartment of Head & Neck Surgical Oncology & Endocrinology, Narayana Health City, 258/A, Bommasandra Industrial Area Anekal Taluk, Hosur Rd, Bangalore, 560099 India
| | - Vijay Pillai V
- grid.416504.20000 0004 1796 819XDepartment of Head & Neck Surgical Oncology & Endocrinology, Narayana Health City, 258/A, Bommasandra Industrial Area Anekal Taluk, Hosur Rd, Bangalore, 560099 India
| | - Vidhya Bushan
- grid.416504.20000 0004 1796 819XDepartment of Head & Neck Surgical Oncology & Endocrinology, Narayana Health City, 258/A, Bommasandra Industrial Area Anekal Taluk, Hosur Rd, Bangalore, 560099 India
| | - Vivek Shetty
- grid.416504.20000 0004 1796 819XDepartment of Head & Neck Surgical Oncology & Endocrinology, Narayana Health City, 258/A, Bommasandra Industrial Area Anekal Taluk, Hosur Rd, Bangalore, 560099 India
| | - Narayana Subramaniam
- grid.416504.20000 0004 1796 819XDepartment of Head & Neck Surgical Oncology & Endocrinology, Narayana Health City, 258/A, Bommasandra Industrial Area Anekal Taluk, Hosur Rd, Bangalore, 560099 India
| | - Moni Abraham Kuriakose
- grid.416504.20000 0004 1796 819XDepartment of Head & Neck Surgical Oncology & Endocrinology, Narayana Health City, 258/A, Bommasandra Industrial Area Anekal Taluk, Hosur Rd, Bangalore, 560099 India
| | - K. S. Shivaprasad
- grid.416504.20000 0004 1796 819XDepartment of Head & Neck Surgical Oncology & Endocrinology, Narayana Health City, 258/A, Bommasandra Industrial Area Anekal Taluk, Hosur Rd, Bangalore, 560099 India
| | - Kranti Khadilkar
- grid.416504.20000 0004 1796 819XDepartment of Head & Neck Surgical Oncology & Endocrinology, Narayana Health City, 258/A, Bommasandra Industrial Area Anekal Taluk, Hosur Rd, Bangalore, 560099 India
| | - Amritha Suresh
- grid.506019.bMazumdar Shaw Medical Foundation, 258/A, Hosur Road Anekal, Taluk, Bommasandra Industrial Area, Bangalore, Karnataka 560099 India
| | - Sum Sum
- grid.506019.bMazumdar Shaw Medical Foundation, 258/A, Hosur Road Anekal, Taluk, Bommasandra Industrial Area, Bangalore, Karnataka 560099 India
| | - Akhila Lakhsmikantha
- grid.416504.20000 0004 1796 819XDepartment of Pathology & Laboratory Services, Narayana Health City, 258/A, Bommasandra Industrial Area Anekal Taluk, Hosur Rd, Bangalore, 560099 India
| | - Pobbisetty Radhakrishnagupta Rekha
- grid.416504.20000 0004 1796 819XDepartment of Pathology & Laboratory Services, Narayana Health City, 258/A, Bommasandra Industrial Area Anekal Taluk, Hosur Rd, Bangalore, 560099 India
| | - Shaesta Naseem Zaidi
- grid.416504.20000 0004 1796 819XDepartment of Pathology & Laboratory Services, Narayana Health City, 258/A, Bommasandra Industrial Area Anekal Taluk, Hosur Rd, Bangalore, 560099 India
| | - Vaijayanti Gupta
- grid.465051.30000 0004 1799 1787Strand Life Sciences Pvt. Ltd., 5th Floor, Kirloskar Business Park, Bellary Road, Hebbal, Bangalore, 560024 India
| | - Subramanian Kannan
- grid.416504.20000 0004 1796 819XDepartment of Endocrinology, Narayana Health City, 258/A, Bommasandra Industrial Area Anekal Taluk, Hosur Rd, Bangalore, 560099 India
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Shivaprasad KS, Ratnesh, Kannan S, Khadilkar K, Sravani GV, Raju R. Identifying the burden and predictors of diabetes distress among adult Type 2 diabetes mellitus patients. Indian J Community Med 2020; 45:497-500. [PMID: 33623209 PMCID: PMC7877403 DOI: 10.4103/ijcm.ijcm_533_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 08/05/2020] [Indexed: 11/04/2022] Open
Abstract
Background: Objective: Materials and Methods: Results: Conclusions:
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Mehta S, Powle V, Chandrasekhar NH, Pillai V, Bushan V, Shetty V, Kuriakose MA, Sunil HV, Shivaprasad KS, Khadilkar KS, Kannan S. Localization of the Parathyroid Adenoma in Mibi-Negative Cases: The Value of a Dedicated Sonologist. Indian J Endocrinol Metab 2018; 22:863-865. [PMID: 30766838 PMCID: PMC6330850 DOI: 10.4103/ijem.ijem_526_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Sushma Mehta
- Department of Head and Neck Surgical Oncology, Diabetes and Metabolism, Narayana Health City, Bangalore, Karnataka, India
| | - Vidita Powle
- Department of Head and Neck Surgical Oncology, Diabetes and Metabolism, Narayana Health City, Bangalore, Karnataka, India
| | - Naveen H. Chandrasekhar
- Department of Head and Neck Surgical Oncology, Diabetes and Metabolism, Narayana Health City, Bangalore, Karnataka, India
| | - Vijay Pillai
- Department of Head and Neck Surgical Oncology, Diabetes and Metabolism, Narayana Health City, Bangalore, Karnataka, India
| | - Vidya Bushan
- Department of Head and Neck Surgical Oncology, Diabetes and Metabolism, Narayana Health City, Bangalore, Karnataka, India
| | - Vivek Shetty
- Department of Head and Neck Surgical Oncology, Diabetes and Metabolism, Narayana Health City, Bangalore, Karnataka, India
| | - Moni A. Kuriakose
- Department of Head and Neck Surgical Oncology, Diabetes and Metabolism, Narayana Health City, Bangalore, Karnataka, India
| | - H. V. Sunil
- Department of Nuclear Medicine, Diabetes and Metabolism, Narayana Health City, Bangalore, Karnataka, India
| | - K. S. Shivaprasad
- Department of Endocrinology, Diabetes and Metabolism, Narayana Health City, Bangalore, Karnataka, India
| | - Kranti S. Khadilkar
- Department of Endocrinology, Diabetes and Metabolism, Narayana Health City, Bangalore, Karnataka, India
| | - Subramanian Kannan
- Department of Endocrinology, Diabetes and Metabolism, Narayana Health City, Bangalore, Karnataka, India
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Dutta D, Shivaprasad KS, Das RN, Ghosh S, Chowdhury S. Primitive neuroectodermal tumor of adrenal: clinical presentation and outcomes. J Cancer Res Ther 2014; 9:709-11. [PMID: 24518722 DOI: 10.4103/0973-1482.126459] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Primitive neuroectodermal tumor (PNET) of adrenal is an extremely rare tumor of neural crest origin. A nonfunctional left adrenal mass (14.6 × 10.5 × 10.0 cm) on computed tomography (CT) was detected in a 40-year-old lady with abdominal pain, swelling, and left pleural effusion. She underwent left adrenalectomy and left nephrectomy with retroperitoneal resection. Histopathology revealed sheets and nest of oval tumor cells with hyperchromatic nuclei, prominent nucleoli, scanty cytoplasm, brisk mitotic activity, necrosis, lymphovascular invasion, capsular invasion, and extension to the surrounding muscles; staining positive for Mic-2 (CD-99 antigen), vimentin, synaptophysin, and Melan-A. Thoracocentesis, pleural fluid study, and pleural biopsy did not show metastasis. She responded well to vincristine, adriamycin, and cyclophosphamide followed by ifosfamide and etoposide (IE). This is the first report of adrenal peripheral PNET (pPNET) from India. This report intends to highlight that pPNET should be suspected in a patient presenting with huge nonfunctional adrenal mass which may be confused with adrenocortical carcinoma.
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Affiliation(s)
- Deep Dutta
- Department of Endocrinology and Metabolism, Institute of Post Graduate Medical Education and Research and Seth Sukhlal Karnani Memorial Hospital, Kolkata, India
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Shivaprasad KS, Dutta D, Jain R, Kumar M, Maisnam I, Biswas D, Ghosh S, Mukhopadhyay S, Chowdhury S. Huge bilateral ovarian cysts in adulthood as the presenting feature of Van Wyk Grumbach syndrome due to chronic uncontrolled juvenile hypothyroidism. Indian J Endocrinol Metab 2013; 17:S164-S166. [PMID: 24251145 PMCID: PMC3830291 DOI: 10.4103/2230-8210.119559] [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: 11/21/2022] Open
Abstract
Juvenile primary hypothyroidism causing cystic ovaries and pseudoprecocious puberty (Van-Wyk Grumbach syndrome (VWGS)) is well documented in literature. There are only a few reports of primary hypothyroidism presenting as ovarian cysts in adults. Here we present a case of huge bilateral ovarian cysts in adulthood as the presenting feature of VWGS due to chronic uncontrolled juvenile hypothyroidism. Large uniloculor right ovarian cyst (119 × 81 × 90 mm) and a multicystic left ovary (55 × 45 × 49 mm) were detected in a 24 year lady with secondary amenorrhea, galactorrhea, and palpable abdominal mass with history of neonatal jaundice, delayed milestones, short stature, and precocious menarche at age of 7.5 years age. She had elevated levels of cancer antigen (CA)-125 which normalized post levothyroxine supplementation. Elevated CA-125 may lead to misdiagnosis of ovarian carcinoma and inadvertent treatment. Bilateral ovarian cysts in adults are a rare presentation of juvenile hypothyroidism. It is necessary to screen for primary hypothyroidism in patients presenting with bilateral ovarian cysts to prevent unnecessary evaluation and treatment.
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Affiliation(s)
- K. S. Shivaprasad
- Department of Endocrinology and Metabolism, Institute of Post Graduate Medical Education and Research and Seth Sukhlal Karnani Memorial Hospital, Kolkata, West Bengal, India
| | - Deep Dutta
- Department of Endocrinology and Metabolism, Institute of Post Graduate Medical Education and Research and Seth Sukhlal Karnani Memorial Hospital, Kolkata, West Bengal, India
| | - Rajesh Jain
- Department of Endocrinology and Metabolism, Institute of Post Graduate Medical Education and Research and Seth Sukhlal Karnani Memorial Hospital, Kolkata, West Bengal, India
| | - Manoj Kumar
- Department of Endocrinology and Metabolism, Institute of Post Graduate Medical Education and Research and Seth Sukhlal Karnani Memorial Hospital, Kolkata, West Bengal, India
| | - Indira Maisnam
- Department of Endocrinology and Metabolism, Institute of Post Graduate Medical Education and Research and Seth Sukhlal Karnani Memorial Hospital, Kolkata, West Bengal, India
| | - Dibakar Biswas
- Department of Endocrinology and Metabolism, Institute of Post Graduate Medical Education and Research and Seth Sukhlal Karnani Memorial Hospital, Kolkata, West Bengal, India
| | - Sujoy Ghosh
- Department of Endocrinology and Metabolism, Institute of Post Graduate Medical Education and Research and Seth Sukhlal Karnani Memorial Hospital, Kolkata, West Bengal, India
| | - Satinath Mukhopadhyay
- Department of Endocrinology and Metabolism, Institute of Post Graduate Medical Education and Research and Seth Sukhlal Karnani Memorial Hospital, Kolkata, West Bengal, India
| | - Subhankar Chowdhury
- Department of Endocrinology and Metabolism, Institute of Post Graduate Medical Education and Research and Seth Sukhlal Karnani Memorial Hospital, Kolkata, West Bengal, India
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Dutta D, Shivaprasad KS, Kumar M, Biswas D, Ghosh S, Mukhopadhyay P, Mukhopadhyay S, Chowdhury S. Conservative management of severe bilateral emphysematous pyelonephritis: Case series and review of literature. Indian J Endocrinol Metab 2013; 17:S329-S332. [PMID: 24251204 PMCID: PMC3830350 DOI: 10.4103/2230-8210.119631] [Citation(s) in RCA: 8] [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: 11/21/2022] Open
Abstract
Emphysematous pyelonephritis (EPN) is a life-threatening condition most commonly observed in diabetes, with nephrectomy believed to be the treatment of choice. However, nephrectomy in EPN is associated with increased risk of complications secondary to associated hemodynamic instability and may result in lifelong hemodialysis in case of bilateral EPN. We present three patients of severe bilateral EPN and one patient of unilateral EPN with diabetic ketoacidosis (DKA) successfully managed conservatively. Patient 1 (severe bilateral EPN) and patient 4 (unilateral EPN with DKA) responded to aggressive broad spectrum antibiotics, whereas patients 2 and 3 (severe bilateral EPN) responded to broad spectrum antibiotics along with percutaneous catheter drainage (PCD). PCD resulted in initial drainage of 300 and 200 ml of pus, respectively. All patients had associated uncontrolled hyperglycemia, poor glycemic control (HbA1c >8.5%), prerenal and intrinsic renal failure, leukocytosis, and dyselectrolytemia which responded to aggressive supportive management and insulin. There are several reports of successful medical management of severe bilateral EPN. Nephrectomy might no longer be the preferred treatment of severe bilateral EPN and may be reserved for patients' refractory to antibiotics and PCD. Urgent randomized controlled trials are warranted in EPN to optimize the treatment protocols.
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Affiliation(s)
- Deep Dutta
- Department sof Endocrinology and Metabolism, The Institute of Post-Graduate Medical Education and Research and Seth Sukhlal Karnani Memorial Hospital, Bose Road, Kolkata, West Bengal, India
| | - K. S. Shivaprasad
- Department sof Endocrinology and Metabolism, The Institute of Post-Graduate Medical Education and Research and Seth Sukhlal Karnani Memorial Hospital, Bose Road, Kolkata, West Bengal, India
| | - Manoj Kumar
- Department sof Endocrinology and Metabolism, The Institute of Post-Graduate Medical Education and Research and Seth Sukhlal Karnani Memorial Hospital, Bose Road, Kolkata, West Bengal, India
| | - Dibakar Biswas
- Department sof Endocrinology and Metabolism, The Institute of Post-Graduate Medical Education and Research and Seth Sukhlal Karnani Memorial Hospital, Bose Road, Kolkata, West Bengal, India
| | - Sujoy Ghosh
- Department sof Endocrinology and Metabolism, The Institute of Post-Graduate Medical Education and Research and Seth Sukhlal Karnani Memorial Hospital, Bose Road, Kolkata, West Bengal, India
| | - Pradip Mukhopadhyay
- Department sof Endocrinology and Metabolism, The Institute of Post-Graduate Medical Education and Research and Seth Sukhlal Karnani Memorial Hospital, Bose Road, Kolkata, West Bengal, India
| | - Satinath Mukhopadhyay
- Department sof Endocrinology and Metabolism, The Institute of Post-Graduate Medical Education and Research and Seth Sukhlal Karnani Memorial Hospital, Bose Road, Kolkata, West Bengal, India
| | - Subhankar Chowdhury
- Department sof Endocrinology and Metabolism, The Institute of Post-Graduate Medical Education and Research and Seth Sukhlal Karnani Memorial Hospital, Bose Road, Kolkata, West Bengal, India
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Kumar M, Dutta D, Shivaprasad KS, Jain R, Sen A, Biswas D, Mukhopadhyay M, Ghosh S, Mukhopadhyay S, Chowdhury S. Diabetes insipidus as a presenting manifestation of Rathke's cleft cyst. Indian J Endocrinol Metab 2013; 17:S127-S129. [PMID: 24251131 PMCID: PMC3830277 DOI: 10.4103/2230-8210.119529] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [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: 11/16/2022] Open
Abstract
Rathke's cleft cysts (RCC) are cystic sellar and suprasellar lesions derived from remnants of Rathke's pouch, lined by cuboidal or columnar epithelium. RCC are usually asymptomatic but can present with headache, visual impairment, panhypopituitarism and hypothalamic dysfunction. Diabetes Insipidus as a presenting symptom of RCC is reported, but rare. We present a case of a 48-year-old male presenting with polyuria and on investigations found to have central diabetes insipidus due to a sellar RCC. Patient underwent transsphenoidal surgery with complete excision with resolution of his symptoms. His polyuria resolved post-surgery without vasopressin replacement, which has never been reported.
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Affiliation(s)
- Manoj Kumar
- Department of Endocrinology and Metabolism, IPGMER and SSKM Hospital, Kolkata, West Bengal, India
| | - Deep Dutta
- Department of Endocrinology and Metabolism, IPGMER and SSKM Hospital, Kolkata, West Bengal, India
| | - K. S. Shivaprasad
- Department of Endocrinology and Metabolism, IPGMER and SSKM Hospital, Kolkata, West Bengal, India
| | - Rajesh Jain
- Department of Endocrinology and Metabolism, IPGMER and SSKM Hospital, Kolkata, West Bengal, India
| | - Ankita Sen
- Department of Pathology, IPGMER and SSKM Hospital, Kolkata, West Bengal, India
| | - Dibakar Biswas
- Department of Endocrinology and Metabolism, IPGMER and SSKM Hospital, Kolkata, West Bengal, India
| | | | - Sujoy Ghosh
- Department of Endocrinology and Metabolism, IPGMER and SSKM Hospital, Kolkata, West Bengal, India
| | - Satinath Mukhopadhyay
- Department of Endocrinology and Metabolism, IPGMER and SSKM Hospital, Kolkata, West Bengal, India
| | - Subhankar Chowdhury
- Department of Endocrinology and Metabolism, IPGMER and SSKM Hospital, Kolkata, West Bengal, India
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Shivaprasad KS, Dutta D, Jain R, Ghosh S, Mukhopadhyay S, Chowdhury S. Familial glucocorticoid deficiency presenting with generalized hyperpigmentation in adolescence. Report of three siblings. Indian J Endocrinol Metab 2012; 16:S382-S384. [PMID: 23565437 PMCID: PMC3603085 DOI: 10.4103/2230-8210.104101] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [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
BACKGROUND Familial glucocorticoid deficiency (FGD) is a rare autosomal recessive disorder characterized by glucocorticoid deficiency, high ACTH levels and normal mineralocorticoid levels. FGD is caused due to defects in adrenocorticotropic hormone (ACTH) signaling. The defect can be caused by mutations in genes encoding the ACTH receptor (melanocortin 2 receptor) or its accessory protein. PATIENTS Here we report three siblings with FGD. The second in order of siblings presented at an age of 15 years with history of diffuse hyperpigmentation since childhood. Their parents were non consanguineous. The patients were hyperpigmented and taller compared with their parents. None of the siblings had ambiguous genitalia or neurological abnormalities. There was no history of tuberculosis in the family. Biochemical investigations revealed low serum cortisol (<1 μg/dl) and elevated plasma ACTH (>1250 pg/ml). Serum electrolytes, aldosterone, and plasma renin activity was normal. Based on the above mentioned data, a provisional diagnosis of FGD was made after ruling out the common causes of glucocorticoid deficiency. CONCLUSION FGD is a rare autosomal recessive disorder which causes isolated glucocorticoid deficiency. Unawareness about the condition may lead to delayed diagnosis and treatment, which are associated with high rates of morbidity and mortality. Once a diagnosis is made it is easily treatable.
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Affiliation(s)
- K. S. Shivaprasad
- Department of Endocrinology & Metabolism, IPGMER & SSKM Hospital, Kolkata, India
| | - Deep Dutta
- Department of Endocrinology & Metabolism, IPGMER & SSKM Hospital, Kolkata, India
| | - Rajesh Jain
- Department of Endocrinology & Metabolism, IPGMER & SSKM Hospital, Kolkata, India
| | - Sujoy Ghosh
- Department of Endocrinology & Metabolism, IPGMER & SSKM Hospital, Kolkata, India
| | | | - Subhankar Chowdhury
- Department of Endocrinology & Metabolism, IPGMER & SSKM Hospital, Kolkata, India
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Abstract
Adrenal myelolipoma is a benign metaplastic collection of reticuloendothelial cells and adipose tissue, believed to be secondary to chronic stimulation of the adrenals. Keratoconus is the most common corneal ectasia of unknown pathogenesis. Altered expression of proteinases, proteinases inhibitors, and cytokines are believed to have a role. We report for the first time, the occurrence of adrenal myelolipoma in a 52-year-old man with bilateral keratoconus with right corneal scarring for 13 years, who had presented with abdominal pain and heaviness for 4 weeks. Computerized tomography abdomen revealed 7.4 × 7.0 × 6.6 cm hypo-dense variegated left adrenal mass [-71 to -51 Hounsfield Unit (HU)] with smooth borders and poor contrast uptake, suggestive of adrenal myelolipoma, which was biochemically non-functional in view of normal overnight dexamethasone suppressed cortisol (1.4 mcg/dl), 24 h urinary fractionated metanephrines [metanephrines 57 mcg/day (53-341); normetanephrines 95 mcg/day (88-444)], androgen levels [dehydroepiandrostenedione-sulphate 112 mcg/dl (21-123); testosterone 542 ng/dl (275-1200)] with normal visualization of the contralateral adrenal. The cause of this association could not be determined. However, it may be hypothesized that altered adrenal steroid metabolism may have some role in the development of myelolipoma in our patient with keratoconus; in view of increased occurrence of myelolipoma in patients with congenital adrenal hyperplasia (CAH), isolated report of keratoconus in twins with CAH and mice model of keratoconus demonstrating the role of androgens in the development of keratoconus.
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Affiliation(s)
- Deep Dutta
- Department of Endocrinology & Metabolism, IPGMER & SSKM Hospital, 244 AJC Bose Road, Kolkata, India
| | - KS Shivaprasad
- Department of Endocrinology & Metabolism, IPGMER & SSKM Hospital, 244 AJC Bose Road, Kolkata, India
| | - Sujoy Ghosh
- Department of Endocrinology & Metabolism, IPGMER & SSKM Hospital, 244 AJC Bose Road, Kolkata, India
| | - Satinath Mukhopadhyay
- Department of Endocrinology & Metabolism, IPGMER & SSKM Hospital, 244 AJC Bose Road, Kolkata, India
| | - Subhankar Chowdhury
- Department of Endocrinology & Metabolism, IPGMER & SSKM Hospital, 244 AJC Bose Road, Kolkata, India
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Jain R, Dutta D, Shivaprasad KS, Maisnam I, Ghosh S, Mukhopadhyay S, Chowdhury S. Acromegaly presenting as hirsuitism: Uncommon sinister aetiology of a common clinical sign. Indian J Endocrinol Metab 2012; 16:S297-S299. [PMID: 23565405 PMCID: PMC3603053 DOI: 10.4103/2230-8210.104066] [Citation(s) in RCA: 4] [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: 11/24/2022] Open
Abstract
Hirsuitism though not uncommon (24%), is not considered to be a prominent feature of acromegaly because of its lack of specificity and occurrence. Hirsuitism is very common in women of reproductive age (5-7%) and has been classically associated with polycystic ovarian syndrome (PCOS). Twenty-eight year lady with 3 year duration of hirsuitism (Modified Ferriman Gallwey score-24/36), features of insulin resistance (acanthosis), subtle features of acromegaloidism (woody nose and bulbous lips) was diagnosed to have acromegaly in view of elevated IGF-1 (1344 ng/ml; normal: 116-358 ng/ml), basal (45.1 ng/ml) and post glucose growth hormone (39.94 ng/ml) and MRI brain showing pituitary macroadenoma. Very high serum androstenedione (>10 ng/ml; normal 0.5-3.5 ng/ml), elevated testosterone (0.91 ng/ml, normal <0.8) and normal dehydroepiandrosterone sulphate (DHEAS) (284 mcg/dl, normal 35-430 mcg/dl) along with polycystic ovaries on ultrasonography lead to diagnosis of associated PCOS. She was also diagnosed to have diabetes. This case presentation intends to highlight that hirsuitism may rarely be the only prominent feature of acromegaly. A lookout for subtle features of acromegaly in all patients with hirsuitism and going for biochemical evaluation (even at the risk of investigating many patients of insulin resistance and acromegloidism) may help us pick up more patients of acromegaly at an earlier stage thus help in reducing disease morbidity.
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Affiliation(s)
- Rajesh Jain
- Department of Endocrinology and Metabolism, IPGMER and SSKM Hospital, Kolkata, India
| | - Deep Dutta
- Department of Endocrinology and Metabolism, IPGMER and SSKM Hospital, Kolkata, India
| | - KS Shivaprasad
- Department of Endocrinology and Metabolism, IPGMER and SSKM Hospital, Kolkata, India
| | - Indira Maisnam
- Department of Endocrinology and Metabolism, IPGMER and SSKM Hospital, Kolkata, India
| | - Sujoy Ghosh
- Department of Endocrinology and Metabolism, IPGMER and SSKM Hospital, Kolkata, India
| | - Satinath Mukhopadhyay
- Department of Endocrinology and Metabolism, IPGMER and SSKM Hospital, Kolkata, India
| | - Subhankar Chowdhury
- Department of Endocrinology and Metabolism, IPGMER and SSKM Hospital, Kolkata, 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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Dutta D, Shivaprasad KS, Das RN, Ghosh S, Chatterjee U, Chowdhury S, Dasgupta R. Ovotesticular disorder of sexual development due to 47,XYY/46,XY/45,X mixed gonadal dysgenesis in a phenotypic male presenting as cyclical haematuria: clinical presentation and assessment of long-term outcomes. Andrologia 2012; 46:191-3. [PMID: 23163819 DOI: 10.1111/and.12048] [Citation(s) in RCA: 12] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2012] [Indexed: 11/25/2022] Open
Abstract
Ovotesticular disorder of sexual differentiation (OTDSD) is a rare cause of disorder of sexual differentiation predominantly having 46,XX karyotype, female phenotype and ambiguous genitalia. We report a 15-year-old having male body habitus, axillary and pubic hair, well-developed penis and right-descended testis with history of penoscrotal hypospadias correction, presenting with three episodes of cyclical haematuria, who biochemically had normal serum testosterone (338 ng dl(-1) ) which increased following hCG stimulation (614 ng dl(-1) ), elevated estradiol (17.35 pg ml(-1) ) along with elevated luteinising hormone (11.3 mIU l(-1) ) and follicle-stimulating hormone (31 mIU l(-1) ). Ultrasonography followed by micturating cystourethrogram and cystoscopy confirmed the presence of prostate, uterus, cervix and vagina draining into the urogenital sinus continuing till the penile urethra and left intra-abdominal gonad. Patient underwent hysterectomy and left gonadectomy. Histopathologic study of resected gonad confirmed presence of ovotestis. Low estradiol (1.2 pg ml(-1) ) following gonadectomy confirmed the ovotestis origin of estradiol. Chromosomal analysis revealed complex karyotype predominant being 47,XYY (50%) followed by 46,XY (26%) and 45,X (24%). This is perhaps the first report of 47,XYY/46,XY/45,X causing OTDSD in a phenotypic male.
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Affiliation(s)
- D Dutta
- Department of Endocrinology & Metabolism, IPGMER & SSKM Hospital, Kolkata, India
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