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Chakraborty PP, Derby MM. Analysis of Drying Front Propagation and Coupled Heat and Mass Transfer During Evaporation From Additively Manufactured Porous Structures Under a Solar Flux. ASME J Heat Mass Transf 2024; 146:021602. [PMID: 38111632 PMCID: PMC10726472 DOI: 10.1115/1.4063766] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 09/25/2023] [Indexed: 12/20/2023]
Abstract
Drying front propagation and coupled heat and mass transfer analysis from porous media is critical for soil-water dynamics, electronics cooling, and evaporative drying. In this study, de-ionized water was evaporated from three 3D printed porous structures (with 0.41 mm, 0.41 mm, and 0.16 mm effective radii, respectively) created out of acrylonitrile butadiene styrene (ABS) plastic using stereolithography technology. The structures were immersed in water until all the pores were invaded and then placed on the top of a sensitive scale to record evaporative mass loss. A 1000 W/m2 heat flux was applied with a solar simulator to the top of each structure to accelerate evaporation. The evaporative mass losses were recorded at 15 min time intervals and plotted against time to compare evaporation rates from the three structures. The evaporation phenomena were captured with a high-speed camera from the side of the structures to observe the drying front propagation during evaporation, and a high-resolution thermal camera was used to capture images to visualize the thermal gradients during evaporation. The 3D-structure with the smallest effective pore radius (i.e., 0.16 mm) experienced the sharpest decrease in the mass loss as the water evaporated from 0.8 g to 0.1 g within 180 min. The designed pore structures influenced hydraulic linkages, and therefore, evaporation processes. A coupled heat-and-mass-transfer model modeled constant rate evaporation, and the falling rate period was modeled through the normalized evaporation rate.
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Affiliation(s)
- Partha Pratim Chakraborty
- Alan Levin Department of Mechanical and Nuclear Engineering, Kansas State University, 3002 Rathbone Hall, 1701B Platt Street, Manhattan, KS 66506
| | - Melanie M. Derby
- Alan Levin Department of Mechanical and Nuclear Engineering, Kansas State University, 3002 Rathbone Hall, 1701B Platt Street, Manhattan, KS 66506
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Chakraborty PP, Bhattacharjee R, Roy A, Chowdhury S. Marked increase in bone mineral density with oral phosphate and calcitriol in tumour-induced osteomalacia. BMJ Case Rep 2023; 16:e255355. [PMID: 38056928 DOI: 10.1136/bcr-2023-255355] [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] [Subscribe] [Scholar Register] [Indexed: 12/08/2023] Open
Abstract
Patients with osteomalacia have a low bone mineral density (BMD) and are often misdiagnosed as osteoporosis. A marked increase in BMD is noticed following successful treatment of osteomalacia. The biochemical hallmark of tumour-induced osteomalacia (TIO) is hypophosphatemia. Patients with TIO often have severe hypophosphatemic osteomalacia and dual-energy X-ray absorptiometry may demonstrate low BMD. Surgical removal of the phosphatonin-secreting lesion restores serum phosphate, corrects osteomalacia and is associated with a dramatic increase in BMD. We report two patients with TIO and low BMD, who were treated with oral phosphate and calcitriol supplementation. The percentage increase in BMD at 33 months was as high as 94.3% in areas with the lowest BMD at baseline. The BMD at 33 months was higher than the +2SD of the population-specific reference ranges, a finding not reported in surgically treated patients with TIO. An intermittent rise in parathyroid hormone following oral phosphate supplementation might have resulted in such findings.
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Affiliation(s)
| | - Rana Bhattacharjee
- Endocrinology and Metabolism, Medical College and Hospital Kolkata, Kolkata, West Bengal, India
| | - Ajitesh Roy
- Endocrinology and Metabolism, Vivekananda Institute of Medical Sciences, Kolkata, West Bengal, India
| | - Subhankar Chowdhury
- Endocrinology and Metabolism, IPGME&R/SSKM Hospital, Kolkata, West Bengal, India
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Chakraborty PP, Nemzer LR, Kassen R. Experimental evidence that network topology can accelerate the spread of beneficial mutations. Evol Lett 2023; 7:447-456. [PMID: 38045727 PMCID: PMC10693003 DOI: 10.1093/evlett/qrad047] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 07/26/2023] [Accepted: 09/28/2023] [Indexed: 12/05/2023] Open
Abstract
Whether and how the spatial arrangement of a population influences adaptive evolution has puzzled evolutionary biologists. Theoretical models make conflicting predictions about the probability that a beneficial mutation will become fixed in a population for certain topologies like stars, in which "leaf" populations are connected through a central "hub." To date, these predictions have not been evaluated under realistic experimental conditions. Here, we test the prediction that topology can change the dynamics of fixation both in vitro and in silico by tracking the frequency of a beneficial mutant under positive selection as it spreads through networks of different topologies. Our results provide empirical support that meta-population topology can increase the likelihood that a beneficial mutation spreads, broaden the conditions under which this phenomenon is thought to occur, and points the way toward using network topology to amplify the effects of weakly favored mutations under directed evolution in industrial applications.
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Affiliation(s)
| | - Louis R Nemzer
- Department of Chemistry and Physics, Halmos College of Arts and Sciences, Nova Southeastern University, Ft. Lauderdale, FL, United States
| | - Rees Kassen
- Department of Biology, University of Ottawa, Ottawa, ON, Canada
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Singhania P, Dhar A, Deshpande A, Das D, Agrawal N, Chakraborty PP, Bhattacharjee R, Roy A. Rickets in proximal renal tubular acidosis: a case series of six distinct etiologies. J Pediatr Endocrinol Metab 2023; 36:879-885. [PMID: 37434360 DOI: 10.1515/jpem-2023-0155] [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: 04/08/2023] [Accepted: 06/23/2023] [Indexed: 07/13/2023]
Abstract
OBJECTIVES Proximal renal tubular acidosis (pRTA) is characterized by a defect in the ability of the proximal convoluted tubule to reabsorb bicarbonate. The biochemical hallmark of pRTA is hyperchloremic metabolic acidosis with a normal anion gap, accompanied by appropriate acidification of the urine (simultaneous urine pH <5.3). Isolated defects in bicarbonate transport are rare, and pRTA is more often associated with Fanconi syndrome (FS), which is characterized by urinary loss of phosphate, uric acid, glucose, amino acids, low-molecular-weight proteins, and bicarbonate. Children with pRTA may present with rickets, but pRTA is often overlooked as an underlying cause of this condition. CASE PRESENTATION We report six children with rickets and short stature due to pRTA. One case was idiopathic, while the remaining five had a specific underlying condition: Fanconi-Bickel syndrome, Dent's disease, nephropathic cystinosis, type 1 tyrosinemia, and sodium-bicarbonate cotransporter 1-A (NBC1-A) defect. CONCLUSIONS Five of these six children had features of FS, while the one with NBC1-A defect had isolated pRTA.
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Affiliation(s)
- Pankaj Singhania
- Department of Endocrinology and Metabolism, Institute of Postgraduate Medical Education and Research, Kolkata, West Bengal, India
| | - Abhranil Dhar
- Department of Endocrinology and Metabolism, Institute of Postgraduate Medical Education and Research, Kolkata, West Bengal, India
| | - Aditya Deshpande
- Department of Endocrinology and Metabolism, Institute of Postgraduate Medical Education and Research, Kolkata, West Bengal, India
| | - Debaditya Das
- Department of Endocrinology and Metabolism, Institute of Postgraduate Medical Education and Research, Kolkata, West Bengal, India
| | - Neeti Agrawal
- Department of Endocrinology, Medical College Kolkata, Kolkata, India
| | | | | | - Ajitesh Roy
- Department of Endocrinology, Vivekananda Institute of Medical Sciences, Kolkata, West Bengal, India
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Awasthi A, Chakraborty PP, Agrawal N, Sinha A, Pandey AK, Maiti A. Effect of morning versus night-time administration of proton pump inhibitor (pantoprazole) on thyroid function test in levothyroxine-treated primary hypothyroidism: a prospective cross-over study. Thyroid Res 2023; 16:15. [PMID: 37259094 DOI: 10.1186/s13044-023-00156-6] [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: 01/04/2023] [Accepted: 04/12/2023] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND One of the common causes of suboptimal control of thyroid stimulating hormone (TSH) in levothyroxine-treated hypothyroidism is coadministration of proton pump inhibitors (PPIs). Morning administration of pantoprazole has been shown to suppress intragastric pH to a greater extent. We therefore aimed to determine the effect of pantoprazole at different time points of the day on thyroid function test (TFT) in levothyroxine-treated overt primary hypothyroidism. METHODS In this single centre, hospital based, prospective, two arm cross-over study (AB, BA), participants were randomized into 2 groups based on morning (6:00 am - 7:00 am simultaneously with the scheduled levothyroxine tablet) (group M) and evening (30 min before dinner) intake of 40 mg pantoprazole tablet (group N). After the initial 6 weeks (period 1), a washout period of 1 week for pantoprazole was given, and then both the groups crossed over for another 6 weeks (period 2). Patients were instructed to continue the same brand of levothyroxine tablet at empty stomach 1-hour before breakfast. Serum TSH was measured at baseline, week 6, and week 13. RESULTS Data from 30 patients, who completed the study with 100% compliance, were analysed. Mean TSH values of the study participants were significantly higher both at week 6 and week 13 compared to the baseline. Mean baseline serum TSH concentrations for groups M and N were 2.70 (± 1.36), and 2.20 (± 1.06) µlU/mL, respectively. Mean serum TSH concentrations at the end periods 1 and 2 for group M were 3.78 (± 4.29), and 3.76 (± 2.77) while the levels in group N were 3.30 (± 1.90), and 4.53 (± 4.590) µlU/mL, respectively. There was a significant rise in serum TSH concentration across periods 1 and 2 in both the groups (F2, 58 = 3.87, p = 0.03). Within group changes in TSH across periods 1 and 2 were not statistically significant. Similarly difference in TSH between the groups, either at 6 weeks or at 13 weeks, were also not statistically significant. CONCLUSIONS Concomitant use of pantoprazole, even for 6 weeks, leads to significant elevation in serum TSH in levothyroxine-treated patients who are biochemically euthyroid, irrespective of timing of pantoprazole intake. Early morning and night-time administration of pantoprazole have similar effect on TFT in these patients.
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Affiliation(s)
- Avivar Awasthi
- Department of Endocrinology, Kasturba Medical College, Manipal, Karnataka, India
| | - Partha Pratim Chakraborty
- Department of Endocrinology & Metabolism, Medical College, Kolkata, MCH 4th floor, 88 College Street, Kolkata, West Bengal, 700073, India.
| | - Neeti Agrawal
- Department of Endocrinology & Metabolism, Medical College, Kolkata, MCH 4th floor, 88 College Street, Kolkata, West Bengal, 700073, India
| | - Anirban Sinha
- Department of Endocrinology & Metabolism, Medical College, Kolkata, MCH 4th floor, 88 College Street, Kolkata, West Bengal, 700073, India
| | - Anuj Kumar Pandey
- Department of Paediatrics, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Animesh Maiti
- Department of Endocrinology & Metabolism, Medical College, Kolkata, MCH 4th floor, 88 College Street, Kolkata, West Bengal, 700073, India
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Raja MR, Chatterjee S, Agrawal N, Chakraborty PP. Short stature, cubitus varus, foot deformity and intellectual disability with sexual infantilism: clinical clues to 49,XXXXY variant of Klinefelter syndrome. BMJ Case Rep 2023; 16:16/1/e253799. [PMID: 36720515 PMCID: PMC9890750 DOI: 10.1136/bcr-2022-253799] [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] [Indexed: 02/02/2023] Open
Affiliation(s)
- Md Ramiz Raja
- Endocrinology & Metabolism, Medical College and Hospital Kolkata, Kolkata, West Bengal, India
| | - Subhankar Chatterjee
- Endocrinology & Metabolism, Medical College and Hospital Kolkata, Kolkata, West Bengal, India
| | - Neeti Agrawal
- Endocrinology & Metabolism, Medical College and Hospital Kolkata, Kolkata, West Bengal, India
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Baidya A, Basu AK, Bhattacharjee R, Biswas D, Biswas K, Chakraborty PP, Chatterjee P, Chowdhury S, Dasgupta R, Ghosh A, Ghosh S, Giri D, Goswami S, Maisnam I, Maiti A, Mondal S, Mukhopadhyay P, Mukhopadhyay S, Mukhopadhyay S, Pal SK, Pandit K, Ray S, Chowdhury BR, Raychaudhuri M, Raychaudhuri P, Roy A, Sahana PK, Sanyal D, Sanyal T, Saraogi RK, Sarkar D, Sengupta N, Singh AK, Sinha A. Diagnostic approach in 46, XY DSD: an endocrine society of bengal (ESB) consensus statement. J Pediatr Endocrinol Metab 2023; 36:4-18. [PMID: 36424806 DOI: 10.1515/jpem-2022-0515] [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: 05/30/2022] [Accepted: 10/31/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVES 46, XY difference/disorder of sex development (DSD) is a relatively uncommon group of heterogeneous disorders with varying degree of underandrogenization of male genitalia. Such patients should be approached systematically to reach an aetiological diagnosis. However, we lack, at present, a clinical practice guideline on diagnostic approach in 46, XY DSD from this part of the globe. Moreover, debate persists regarding the timing and cut-offs of different hormonal tests, performed in these cases. The consensus committee consisting of 34 highly experienced endocrinologists with interest and experience in managing DSD discussed and drafted a consensus statement on the diagnostic approach to 46, XY DSD focussing on relevant history, clinical examination, biochemical evaluation, imaging and genetic analysis. CONTENT The consensus was guided by systematic reviews of existing literature followed by discussion. An initial draft was prepared and distributed among the members. The members provided their scientific inputs, and all the relevant suggestions were incorporated. The final draft was approved by the committee members. SUMMARY The diagnostic approach in 46, XY DSD should be multidisciplinary although coordinated by an experienced endocrinologist. We recommend formal Karyotyping, even if Y chromosome material has been detected by other methods. Meticulous history taking and thorough head-to-toe examination should initially be performed with focus on external genitalia, including location of gonads. Decision regarding hormonal and other biochemical investigations should be made according to the age and interpreted according to age-appropriate norms Although LC-MS/MS is the preferred mode of steroid hormone measurements, immunoassays, which are widely available and less expensive, are acceptable alternatives. All patients with 46, XY DSD should undergo abdominopelvic ultrasonography by a trained radiologist. MRI of the abdomen and/or laparoscopy may be used to demonstrate the Mullerian structure and/or to localize the gonads. Genetic studies, which include copy number variation (CNV) or molecular testing of a candidate gene or next generation sequencing then should be ordered in a stepwise manner depending on the clinical, biochemical, hormonal, and radiological findings. OUTLOOK The members of the committee believe that patients with 46, XY DSD need to be approached systematically. The proposed diagnostic algorithm, provided in the consensus statement, is cost effective and when supplemented with appropriate genetic studies, may help to reach an aetiological diagnosis in majority of such cases.
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Affiliation(s)
- Arjun Baidya
- Department of Endocrinology, Nil Ratan Sircar Medical College and Hospital, Kolkata, India
| | - Asish Kumar Basu
- Department of Endocrinology & Metabolism, Medical College, Kolkata, West Bengal, India
| | - Rana Bhattacharjee
- Department of Endocrinology & Metabolism, Medical College, Kolkata, West Bengal, India
| | - Dibakar Biswas
- Department of Endocrinology & Metabolism, IPGME&R/SSKM Hospital, Kolkata, India
| | | | | | | | - Subhankar Chowdhury
- Department of Endocrinology & Metabolism, IPGME&R/SSKM Hospital, Kolkata, India
| | - Ranen Dasgupta
- Department of Endocrinology, Nil Ratan Sircar Medical College and Hospital, Kolkata, India
| | - Amritava Ghosh
- Department of Endocrinology, All India Institute of Medical Sciences, Raipur, India
| | - Sujoy Ghosh
- Department of Endocrinology & Metabolism, IPGME&R/SSKM Hospital, Kolkata, India
| | | | - Soumik Goswami
- Department of Endocrinology, Nil Ratan Sircar Medical College and Hospital, Kolkata, India
| | - Indira Maisnam
- Department of Endocrinology & Metabolism, IPGME&R/SSKM Hospital, Kolkata, India
| | - Animesh Maiti
- Department of Endocrinology & Metabolism, Medical College, Kolkata, West Bengal, India
| | - Sunetra Mondal
- Department of Endocrinology & Metabolism, IPGME&R/SSKM Hospital, Kolkata, India
| | - Pradip Mukhopadhyay
- Department of Endocrinology & Metabolism, IPGME&R/SSKM Hospital, Kolkata, India
| | | | | | - Salil Kumar Pal
- Department of Medicine, Calcutta National Medical College, Kolkata, India
| | - Kaushik Pandit
- Department of Endocrinology & Metabolism, IPGME&R/SSKM Hospital, Kolkata, India
| | - Sayantan Ray
- Department of Endocrinology, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Bibek Roy Chowdhury
- Department of Endocrinology & Metabolism, IPGME&R/SSKM Hospital, Kolkata, India
| | | | - Pradip Raychaudhuri
- Department of Endocrinology & Metabolism, Medical College, Kolkata, West Bengal, India
| | - Ajitesh Roy
- Department of Endocrinology, Vivekananda Institute of Medical Sciences, Kolkata, India
| | - Pranab Kumar Sahana
- Department of Endocrinology & Metabolism, IPGME&R/SSKM Hospital, Kolkata, India
| | - Debmalya Sanyal
- Department of Endocrinology, KPC Medical College, Kolkata, India
| | - Trinanjan Sanyal
- Department of Biochemistry, Malda Medical College & Hospital, Malda, India
| | | | - Dasarathi Sarkar
- Department of Endocrinology, G.D Hospital & Diabetes Institute, Kolkata, India
| | - Nilanjan Sengupta
- Department of Endocrinology, Nil Ratan Sircar Medical College and Hospital, Kolkata, India
| | | | - Anirban Sinha
- Department of Endocrinology & Metabolism, Medical College, Kolkata, West Bengal, India
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Agrawal N, Awasthi A, Chakraborty PP, Maiti A. Hypoplastic amelogenesis imperfecta, bilateral nephrolithiasis and FGF-23-mediated hypophosphataemia: a triad of FAM20A-related enamel renal syndrome. BMJ Case Rep 2022; 15:15/11/e250514. [DOI: 10.1136/bcr-2022-250514] [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: 11/11/2022] Open
Abstract
Enamel renal syndrome (ERS) due to loss of function (LOF) mutation of FAM20A gene typically consists of hypoplastic amelogenesis imperfecta (AI) and bilateral nephrolithiasis/nephrocalcinosis. Recent evidence suggests that FAM20A interacts with FAM20C and increases its activity; thus LOF mutation of FAM20A leads to impaired FAM20C action. FAM20C, a golgi casein kinase, phosphorylates fibroblast growth factor (FGF)-23, prevents its glycosylation and makes it more susceptible to degradation by furine proteases. Consequently, inactivating mutations of FAM20C lead to increased concentration of bioactive and intact FGF-23 in circulation and resultant hypophosphataemia. LOF mutation of FAM20A, thus, might also be associated with FGF-23-mediated hypophosphataemia; however, such an association has never been reported in the literature. We describe, for the first time, a triad of AI, bilateral nephrolithiasis and FGF-23-mediated hypophosphataemia in LOF mutation of FAM20A. We suggest that serum phosphate should be measured in all patients with ERS to avoid metabolic and skeletal complications of undiagnosed, hence untreated hypophosphataemia.
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Awasthi A, Agrawal N, Chakraborty PP, Maiti A. Phenytoin toxicity. BMJ Case Rep 2022; 15:15/11/e253250. [DOI: 10.1136/bcr-2022-253250] [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: 11/13/2022] Open
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Agrawal N, Mahata R, Chakraborty PP, Basu K. Secondary distal renal tubular acidosis and sclerotic metabolic bone disease in seronegative spondyloarthropathy. BMJ Case Rep 2022; 15:e248712. [PMID: 35292549 PMCID: PMC8928265 DOI: 10.1136/bcr-2021-248712] [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] [Subscribe] [Scholar Register] [Accepted: 02/25/2022] [Indexed: 11/03/2022] Open
Abstract
Adults with distal renal tubular acidosis (dRTA) commonly present with hypokalaemia (with/without paralysis), nephrolithiasis/nephrocalcinosis and vague musculoskeletal symptoms. All adults with dRTA should be thoroughly evaluated for systemic diseases, certain medications and toxins. The leading cause of acquired or secondary dRTA in adults is primary Sjögren syndrome (SS); however, other collagen vascular diseases (CVDs) including seronegative spondyloarthropathy (SSpA) may at times give rise to secondary dRTA. Metabolic bone disease is often encountered in adults with dRTA, and the list includes osteomalacia and secondary osteoporosis; sclerotic metabolic bone disease is an extremely rare manifestation of dRTA. Coexistence of dRTA and sclerotic bone disease is seen in primary dRTA due to mutation in CA2 gene and acquired dRTA secondary to systemic fluorosis. Primary SS and SSpA, rarely if ever, may also lead to both secondary dRTA and osteosclerosis. Circulating autoantibodies against carbonic anhydrase II and possibly calcium sensing receptor may explain both these features in patients with CVD.
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Affiliation(s)
- Neeti Agrawal
- Endocrinology & Metabolism, Medical College and Hospital Kolkata, Kolkata, West Bengal, India
| | - Rahin Mahata
- Endocrinology & Metabolism, Medical College and Hospital Kolkata, Kolkata, West Bengal, India
| | | | - Kaushik Basu
- General Medicine & Rheumatology, Medical College and Hospital Kolkata, Kolkata, West Bengal, India
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Mishra A, Chakraborty PP, Jana S, Saha TN, Roy K. Histopathological Evidence of Thyroid Dermopathy and its Correlation with Thyroid-Associated Orbitopathy in Patients with Graves' Disease having Normally Appearing Pretibial Skin: A Case-Control Study. Indian J Endocrinol Metab 2022; 26:141-148. [PMID: 35873939 PMCID: PMC9302423 DOI: 10.4103/ijem.ijem_504_21] [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] [Received: 12/14/2021] [Revised: 02/07/2022] [Accepted: 03/30/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Thyroid dermopathy (TD), reportedly encountered in less than 5% of patients with Graves' disease (GD), is supposed to coexist only with thyroid-associated orbitopathy (TAO). However, clinically inapparent TD, detected non-invasively by thermal imaging or ultrasonography, seems to be present in a larger proportion of GD. Histopathological examination (HPE), though considered as gold standard for detecting TD, has not been performed widely to identify subclinical TD in GD. MATERIALS AND METHODS In this single-centre, cross-sectional, case-control study, 50 patients with GD (cases) and normal appearing pretibial skin were compared with 45 age- and sex-matched individuals (39 healthy volunteers, 3 with toxic multinodular goitre and 3 with solitary toxic nodule) (control). All patients were evaluated clinically for presence of TAO. Punch biopsy specimens were obtained from the pretibial skin in all 95 participants. Tissue sections were examined under light microscopy for mucin deposition, splitting of collagen fibrils and perivascular lymphocytic infiltration. RESULTS Sixty per cent of patients with GD demonstrated at least one of the above three histological features, while 52% had any combination of two features and 46% harboured all the three features. Mucin deposition, splitting of collagen fibrils and lymphocytic infiltration were found overall in 52%, 54% and 52% of GD, respectively; 4.4-11.1% of controls also had some evidence of TD on HPE. Subclinical TD was not related to age, duration of disease and TAO in our study. CONCLUSIONS TD, particularly in its subclinical form, Seems to be widely prevalent in GD (46-60%) and exists even in absence of TAO. HPE, though more sensitive than the various non-invasive tests, is not specific (ranges from 89% to 95%) for TD. However, HPE can accurately diagnose TD in appropriate clinical background.
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Affiliation(s)
- Abhijit Mishra
- Department of Medicine, Midnapore Medical College and Hospital, Midnapore, West Bengal, India
| | - Partha Pratim Chakraborty
- Department of Medicine Pathology, Midnapore Medical College and Hospital, Midnapore, West Bengal, India
| | - Sayantan Jana
- Department of Endocrinology and Metabolism, Medical College, Kolkata, West Bengal, India
| | - Tarak Nath Saha
- Department of Endocrinology and Metabolism, Medical College, Kolkata, West Bengal, India
| | - Krishnendu Roy
- Department of Medicine, Midnapore Medical College and Hospital, Midnapore, West Bengal, India
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Agrawal N, Awasthi A, Chakraborty PP, Maiti A. Desmopressin treatment in dipsogenic form of primary polydipsia: keep serum osmolality marginally below thirst threshold for symptomatic relief. BMJ Case Rep 2022; 15:e247488. [PMID: 35110290 PMCID: PMC8811574 DOI: 10.1136/bcr-2021-247488] [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] [Subscribe] [Scholar Register] [Accepted: 12/31/2021] [Indexed: 11/04/2022] Open
Abstract
Dipsogenic polydipsia (DP), a distinct variety of primary polydipsia, is characterised by selective diminution of osmotic threshold for thirst leading to polydipsia and subsequent hypotonic polyuria. Seen in patients without underlying psychiatric illness, DP closely mimics central diabetes insipidus (CDI), making it difficult for clinicians to discriminate these two conditions from each other. Carefully performed osmotic stimulation study, incorporating objective assessment of threshold for thirst and arginine vasopressin (AVP) release is the key to differentiate DP from CDI or psychogenic polydipsia, also termed compulsive water drinking (CWD). Low thirst threshold and high AVP release threshold separate DP from CDI and CWD, respectively. Unlike CWD, desmopressin may be successfully used in DP without concomitant risk of hyponatremia. We describe a child, in whom an initial diagnosis of partial CDI was subsequently revised to DP based on osmotic stimulation test. The child was treated successfully with desmopressin therapy with a target to keep serum osmolality close to thirst threshold.
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Affiliation(s)
- Neeti Agrawal
- Endocrinology & Metabolism, Medical College and Hospital Kolkata, Kolkata, West Bengal, India
| | - Avivar Awasthi
- Endocrinology & Metabolism, Medical College and Hospital Kolkata, Kolkata, West Bengal, India
| | | | - Animesh Maiti
- Endocrinology & Metabolism, Medical College and Hospital Kolkata, Kolkata, West Bengal, India
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Awasthi A, Agrawal N, Chakraborty PP, Maiti A. Petrified ears due to auricular ossification: an underreported clinical sign in acromegaly. BMJ Case Rep 2022; 15:e247186. [PMID: 35039372 PMCID: PMC8768937 DOI: 10.1136/bcr-2021-247186] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2021] [Indexed: 11/03/2022] Open
Affiliation(s)
- Avivar Awasthi
- Endocrinology & Metabolism, Medical College and Hospital Kolkata, Kolkata, West Bengal, India
| | - Neeti Agrawal
- Endocrinology & Metabolism, Medical College and Hospital Kolkata, Kolkata, West Bengal, India
| | | | - Animesh Maiti
- Endocrinology & Metabolism, Medical College and Hospital Kolkata, Kolkata, West Bengal, India
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Singhania P, Bhattacharjee R, Pratim Chakraborty P, Chowdhury S. Leydig Cell Tumor-Induced Gonadotropin-Independent Precocious Puberty Progressing to Gonadotropin-Dependent Precocious Puberty Post Orchiectomy: Out of the Frying Pan Into the Fire. Cureus 2022; 14:e21165. [PMID: 35165615 PMCID: PMC8831234 DOI: 10.7759/cureus.21165] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2022] [Indexed: 11/12/2022] Open
Abstract
Many pathologies can cause gonadotropin-independent precocious puberty (GIPP) in prepubertal boys. Leydig cell tumor is one rare cause of this presentation. Here we present a six-year-old boy with features of isosexual precocious puberty, high testosterone levels, low gonadotropin levels, and bone age advancement. Testicular USG revealed a left-sided testicular tumor. The left testis was removed surgically, and the Leydig cell tumor was confirmed on histopathology. Post orchiectomy, the boy had elevated testosterone levels with raised luteinizing hormone (LH) levels. A diagnosis of gonadotropin-dependent precocious puberty (GDPP) was made. He has been initiated on monthly gonadotropin-releasing hormone (GnRH) agonist therapy.
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15
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Ghosh S, Chakraborty PP, Bankura B, Maiti A, Biswas R, Das M. Different Growth Responses to Recombinant Human Growth Hormone in Three Siblings with Isolated Growth Hormone Deficiency Type 1A due to a 6.7Kb Deletion in the GH1 Gene. J Clin Res Pediatr Endocrinol 2021; 13:456-460. [PMID: 32936763 PMCID: PMC8638633 DOI: 10.4274/jcrpe.galenos.2020.2020.0005] [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: 12/01/2022] Open
Abstract
Isolated growth hormone deficiency (IGHD) type 1A is a rare, autosomal recessive disorder caused by deletion of the GH1 gene and characterized by early onset severe short stature and typical phenotype. Lack of exposure to GH during fetal life often leads to formation of anti-GH antibody following exposure even the least immunogenic recombinant human GH (rhGH). Some patients with circulating anti-GH antibodies demonstrate lack of growth response to GH while others do not. However, the clinical significance of this antibody is unclear; hence testing is not routinely recommended. Three siblings, born of a consanguineous union, were referred with severe short stature. They were evaluated and IGHD was diagnosed in all of them. Genetic analysis revealed that all three had homozygous 6.7 Kb deletion in GH1 gene, while their parents displayed a pattern of heterozygous 6.7 Kb deletions. rhGH was started at 10, 6 and 1.58 years of age, respectively. Growth and hormonal parameters were monitored throughout the course of treatment. The eldest sibling demonstrated expected growth velocity (9.5 cm/year) for the first year of rhGH that rapidly waned thereafter (2.5 cm/year). The youngest sibling experienced excellent growth response even after the third year (10.3 cm/year) while the middle sibling displayed sub-optimal response from rhGH initiation (6.3 cm/year). Change of rhGH brand did not work in the two elder sisters. Such a different growth response with rhGH in three siblings harbouring similar genetic abnormality has not been described previously.
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Affiliation(s)
- Sayan Ghosh
- Medical College Kolkata, Department of Endocrinology and Metabolism, Kolkata, India
| | - Partha Pratim Chakraborty
- Medical College Kolkata, Department of Endocrinology and Metabolism, Kolkata, India,* Address for Correspondence: Medical College Kolkata, Department of Endocrinology and Metabolism, Kolkata, India Phone: +91 98300 92947 E-mail:
| | - Biswabandhu Bankura
- Calcutta University Faculty of Medicine, Department of Zoology, Kolkata, India
| | - Animesh Maiti
- Medical College Kolkata, Department of Endocrinology and Metabolism, Kolkata, India
| | - Rajkrishna Biswas
- Calcutta University Faculty of Medicine, Department of Zoology, Kolkata, India
| | - Madhusudan Das
- Calcutta University Faculty of Medicine, Department of Zoology, Kolkata, India
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16
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Gupta AP, Chakraborty PP, Halder R, Sahoo A, Roy K. Post-usual meal C-peptide as a reliable and practical alternative to C-peptide following glucagon or standardized mixed-meal for β-cell reserve: a comparative study between three stimulatory methods in different types of diabetes. Int J Diabetes Dev Ctries 2021. [DOI: 10.1007/s13410-021-00987-9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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17
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Chakraborty M, Gupta MK, Roy SS, Chakraborty PP. Multiple opportunistic central nervous system coinfections in HIV: Diagnostic and therapeutic difficulties. Indian J Sex Transm Dis AIDS 2021; 42:78-79. [PMID: 34765944 PMCID: PMC8579587 DOI: 10.4103/ijstd.ijstd_12_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 12/05/2019] [Accepted: 08/18/2020] [Indexed: 11/17/2022] Open
Affiliation(s)
- Mandira Chakraborty
- Department of Microbiology, Medical College Kolkata, Kolkata, West Bengal, India
| | - Manoj Kumar Gupta
- Department of Gastroenterology, Medical College Kolkata, Kolkata, West Bengal, India
| | - Sukalyan Saha Roy
- Department of Pharmacology, Calcutta School of Tropical Medicine, Kolkata, West Bengal, India
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Sharma A, Chakraborty PP. Carbonates from the Palaeoproterozoic Sleemanabad Formation, Mahakoshal Basin, Central India. CURR SCI INDIA 2021. [DOI: 10.18520/cs/v121/i3/414-421] [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: 11/15/2022]
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19
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Singh AK, Singh R, Chakraborty PP. Diabetes Monotherapies versus Metformin-Based Combination Therapy for the Treatment of Type 2 Diabetes. Int J Gen Med 2021; 14:3833-3848. [PMID: 34335049 PMCID: PMC8318007 DOI: 10.2147/ijgm.s295459] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 07/13/2021] [Indexed: 02/05/2023] Open
Abstract
Step-wise addition of antihyperglycemic agents (AHA) after the initiation of metformin monotherapy has been the traditional approach for the treatment of type 2 diabetes mellitus (T2DM) world-wide. Emerging evidence increasingly suggests that metformin-based combination therapy, especially with the newer AHA that lowers HbA1c glucose-dependently and do not potentiate hypoglycemia, could be a potentially better option for durable glycemic control with good tolerability compared to diabetes monotherapy. In this review, we descriptively analyzed the evidence available from the systematic reviews and meta-analyses of randomized head-to-head trials that reported the efficacy and safety outcomes of diabetes monotherapy, metformin-based combination therapies, and monotherapy versus metformin-based combination therapies.
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Affiliation(s)
- Awadhesh K Singh
- Department of Diabetes & Endocrinology, G.D Hospital & Diabetes Institute, Kolkata, India
| | - Ritu Singh
- Department of Diabetes & Endocrinology, G.D Hospital & Diabetes Institute, Kolkata, India
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Agrawal N, Awasthi A, Mahata R, Chakraborty PP. Continuous and progressive 'wash-in' without 'wash-out' of contrast in adrenal mass: a useful feature of ganglioneuroma. BMJ Case Rep 2021; 14:14/5/e241661. [PMID: 34011673 DOI: 10.1136/bcr-2021-241661] [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] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Computed tomography (CT) scan is a useful and widely performed diagnostic modality to evaluate adrenal masses. Nature of the mass determines the degree of attenuation both in unenhanced and in different phases of contrast enhancement. Benign neurogenic tumours like ganglioneuroma mimicks pheochromocytoma and adrenocortical carcinoma in non-contrast CT scan. The 'adrenal protocol' routinely calculates the wash-out pattern at delayed venous phase (DVP) (15 min) following contrast administration to differentiate majority of benign masses from the malignant ones. Ganglioneuromas typically exhibit continuous wash-in of contrast where enhancement gradually increases to attain its peak in DVP. Such wash-in pattern is different from the wash-out pattern observed in pheochromocytomas or adrenocortical adenomas or carcinomas. Presence of this wash-in pattern provides a useful clue to the clinician for underlying ganglioneuroma in hormonally inactive adrenal masses with suspicious morphological appearances. This wash-in pattern also effectively rules out any malignant potential of ganglioneuroma, and thus helps in preoperative decision-making.
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Affiliation(s)
- Neeti Agrawal
- Endocrinology and Metabolism, Medical College and Hospital Kolkata, Kolkata, West Bengal, India
| | - Avivar Awasthi
- Endocrinology and Metabolism, Medical College and Hospital Kolkata, Kolkata, West Bengal, India
| | - Rahin Mahata
- Endocrinology and Metabolism, Medical College and Hospital Kolkata, Kolkata, West Bengal, India
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21
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Mahata R, Chakraborty M, Chakraborty PP, Maiti A. Splenic abscess by Cutibacterium propionicum in poorly controlled type 2 diabetes. BMJ Case Rep 2021; 14:e241106. [PMID: 33795281 PMCID: PMC8023628 DOI: 10.1136/bcr-2020-241106] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2021] [Indexed: 11/03/2022] Open
Affiliation(s)
- Rahin Mahata
- Endocrinology and Metabolism, Medical College and Hospital Kolkata, Kolkata, West Bengal, India
| | - Mandira Chakraborty
- Microbiology, Medical College and Hospital Kolkata, Kolkata, West Bengal, India
| | | | - Animesh Maiti
- Endocrinology and Metabolism, Medical College and Hospital Kolkata, Kolkata, West Bengal, India
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22
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Chakraborty PP, Bhattacharjee R, Patra S, Roy A, Gantait K, Chowdhury S. Clinical and Biochemical Characteristics of Patients with Renal Tubular Acidosis in Southern Part of West Bengal, India: A Retrospective Study. Indian J Endocrinol Metab 2021; 25:121-128. [PMID: 34660240 PMCID: PMC8477733 DOI: 10.4103/ijem.ijem_785_20] [Citation(s) in RCA: 1] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 01/30/2021] [Accepted: 06/29/2021] [Indexed: 01/25/2023] Open
Abstract
PURPOSE OF THE STUDY Reversible proximal tubular dysfunction associated with distal renal tubular acidosis (dRTA) mimics type 3 RTA, a condition classically associated with features of both proximal RTA (pRTA) and dRTA. Proximal tubulopathy has been reported in children with primary dRTA, but the data in adults are lacking. STUDY DESIGN In this hospital record-based retrospective study, data from 66 consecutive cases of RTA, between January 2016 to December 2018, were retrieved and analyzed. RESULTS Mean age of the study population was 25.3 years (range: 3 months to 73 years). Six (9.1%) of them had pRTA, 58 (87.9%) had dRTA, 1 (1.5%) had type 3 RTA, and the remaining 1 (1.5%) had type 4 RTA. Ten patients (17.2%) with dRTA and 3 patients of pRTA (50%) had underlying secondary etiologies. Data on proximal tubular dysfunction were available for 30 patients with dRTA, of whom 1 had isolated dRTA, and the rest 29 patients had accompanying completely reversible proximal tubular dysfunction. Among the 10 cases of secondary dRTA, 6 were not evaluated for proximal tubular dysfunction. Of the remaining 4, 3 had reversible form of proximal tubular abnormality. Fifty-two patients with dRTA came from a population, indigenous to the "Rarh" region of India. CONCLUSIONS Proximal tubular dysfunction often accompanies dRTA; 75% of the children with primary dRTA, at least 29% of adults with primary dRTA, and at least 30% of adults with secondary dRTA manifest such completely reversible form of proximal tubulopathy. "Rarh' region of India probably is a hotspot for endemic dRTA.
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Affiliation(s)
- Partha Pratim Chakraborty
- Department of Medicine, Midnapore Medical College and Hospital, Midnapore, Kolkata, West Bengal, India
| | - Rana Bhattacharjee
- Department of Endocrinology and Metabolism, IPGME and R/SSKM Hospital, Kolkata, West Bengal, India
| | - Shinjan Patra
- Department of Medicine, Midnapore Medical College and Hospital, Midnapore, Kolkata, West Bengal, India
| | - Ajitesh Roy
- Department of Endocrinology and Metabolism, IPGME and R/SSKM Hospital, Kolkata, West Bengal, India
| | - Kripasindhu Gantait
- Department of Medicine, Midnapore Medical College and Hospital, Midnapore, Kolkata, West Bengal, India
| | - Subhankar Chowdhury
- Department of Endocrinology and Metabolism, IPGME and R/SSKM Hospital, Kolkata, West Bengal, India
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Gupta AP, Halder R, Chakraborty M, Chakraborty PP. Isolated splenic abscess due to melioidosis in type 1 diabetes mellitus: laboratory diagnosis of Burkholderia pseudomallei in resource-restricted setting. BMJ Case Rep 2021; 14:14/2/e238985. [PMID: 33541991 PMCID: PMC7868293 DOI: 10.1136/bcr-2020-238985] [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] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Diabetes mellitus, type 1 in particular, is a well-recognised risk factor for melioidosis, a disease caused by Burkholderia pseudomallei Melioidosis is endemic in Southeast Asia and in northern Australia and has a variety of clinical presentation, isolated splenic abscess being one of them. B. pseudomallei, however, is an uncommon aetiology of splenic abscess. The diagnosis of melioidosis is often overlooked unless the clinician and the microbiologist are suspicious of the condition. Multiple splenic abscesses and perisplenic collection were noted in CT scan of the abdomen in a patient of type 1 diabetes, presenting with fever for preceding 4 weeks. B. pseudomallei was isolated from the splenic aspirate and the diagnosis was made based on gram stain and routine biochemical tests. He was successfully treated with antibiotics. We postulate that the likely route of infection was inoculation through skin, the integrity of which was compromised by multiple subcutaneous insulin injections.
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Affiliation(s)
| | - Ratan Halder
- Medicine, Midnapore Medical College and Hospital, Midnapore, West Bengal, India
| | - Mandira Chakraborty
- Microbiology, Medical College and Hospital Kolkata, Kolkata, West Bengal, India
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24
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Roy A, Maiti A, Sinha A, Baidya A, Basu AK, Sarkar D, Sanyal D, Biswas D, Maisnam I, Pandit K, Raychaudhuri M, Sengupta N, Chakraborty PP, Mukhopadhyay P, Raychaudhuri P, Sahana PK, Chatterjee P, Bhattacharjee R, Dasgupta R, Saraogi RK, Pal SK, Mukhopadhyay S, Mukhopadhyay S, Goswami S, Chowdhury S, Ghosh S. Kidney Disease in Type 2 Diabetes Mellitus and Benefits of Sodium-Glucose Cotransporter 2 Inhibitors: A Consensus Statement. Diabetes Ther 2020; 11:2791-2827. [PMID: 33025397 PMCID: PMC7644753 DOI: 10.1007/s13300-020-00921-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Indexed: 12/28/2022] Open
Abstract
Diabetic kidney disease (DKD) occurs in approximately 20-40% of patients with type 2 diabetes mellitus. Patients with DKD have a higher risk of cardiovascular and all-cause mortality. Angiotensin-converting enzyme inhibitors or angiotensin receptor blockers and antihyperglycemic drugs form the mainstay of DKD management and aim to restrict progression to more severe stages of DKD. Sodium-glucose cotransporter 2 inhibitors (SGLT2i) control hyperglycemia by blocking renal glucose reabsorption in addition to preventing inflammation, thereby improving endothelial function and reducing oxidative stress; consequently, this class of prescription medicines is emerging as an important addition to the therapeutic armamentarium. The EMPA-REG OUTCOME, DECLARE TIMI 58, and CANVAS trials demonstrated the renoprotective effects of SGLT2i, such as restricting decline in glomerular filtration rate, in the progression of albuminuria, and in death due to renal causes. The renoprotection provided by SGLT2i was further confirmed in the CREDENCE study, which showed a 30% reduction in progression of chronic kidney disease, and in the DELIGHT study, which demonstrated a reduction in albuminuria with dapagliflozin compared with placebo (- 21.0%, confidence interval [CI] - 34.1 to - 5.2, p = 0.011). Furthermore, a meta-analysis demonstrated a reduced risk of dialysis, transplantation, or death due to kidney disease (relative risk 0.67; 95% CI 0.52-0.86; p = 0.0019) and a 45% risk reduction in worsening of renal function, end-stage renal disease, or renal death (hazard ratio 0.55, CI 0.48-0.64, p < 0.0001) with SGLT2i, irrespective of baseline estimated glomerular filtration rate. Thus, there is emerging evidence that SGLT2i may be used to curb the mortality and improve the quality of life in patients with DKD. However, clinicians need to effectively select candidates for SGLT2i therapy. In this consensus statement, we have qualitatively synthesized evidence demonstrating the renal effects of SGLT2i and proposed recommendations for optimal use of SGLT2i to effectively manage and delay progression of DKD.
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Affiliation(s)
- Ajitesh Roy
- Department of Endocrinology, Ramakrishna Mission Seva Pratishthan, Calcutta, West Bengal, India
| | - Animesh Maiti
- Department of Endocrinology and Metabolism, Medical College and Hospital, Calcutta, West Bengal, India
| | - Anirban Sinha
- Department of Endocrinology and Metabolism, Medical College and Hospital, Calcutta, West Bengal, India
| | - Arjun Baidya
- Department of Endocrinology and Metabolism, Nil Ratan Sircar Medical College and Hospital, Calcutta, West Bengal, India
| | - Asish Kumar Basu
- Department of Endocrinology and Metabolism, Medical College and Hospital, Calcutta, West Bengal, India
| | | | - Debmalya Sanyal
- Department of Endocrinology, KPC Medical College and Hospital, Calcutta, West Bengal, India
| | - Dibakar Biswas
- Department of Endocrinology, IPGMER and SSKM Hospital, Calcutta, West Bengal, India
| | - Indira Maisnam
- Department of Endocrinology, RG Kar Medical College and Hospital, Calcutta, West Bengal, India
| | - Kaushik Pandit
- Department of Endocrinology, Belle Vue Clinic, Calcutta, West Bengal, India
| | - Moutusi Raychaudhuri
- Department of Endocrinology, Institute of Child Health, Calcutta, West Bengal, India
| | - Nilanjan Sengupta
- Department of Endocrinology and Metabolism, Nil Ratan Sircar Medical College and Hospital, Calcutta, West Bengal, India
| | - Partha Pratim Chakraborty
- Department of Endocrinology and Metabolism, Medical College and Hospital, Calcutta, West Bengal, India
| | - Pradip Mukhopadhyay
- Department of Endocrinology, IPGMER and SSKM Hospital, Calcutta, West Bengal, India
| | | | - Pranab Kumar Sahana
- Department of Endocrinology and Metabolism, Nil Ratan Sircar Medical College and Hospital, Calcutta, West Bengal, India
| | | | - Rana Bhattacharjee
- Department of Endocrinology, IPGMER and SSKM Hospital, Calcutta, West Bengal, India
| | - Ranen Dasgupta
- Rittik Clinic & Laboratory, Calcutta, West Bengal, India
| | | | - Salil Kumar Pal
- Department of Medicine, Calcutta National Medical College, Calcutta, West Bengal, India
| | | | | | - Soumik Goswami
- Department of Endocrinology and Metabolism, Nil Ratan Sircar Medical College and Hospital, Calcutta, West Bengal, India
| | - Subhankar Chowdhury
- Department of Endocrinology, IPGMER and SSKM Hospital, Calcutta, West Bengal, India
| | - Sujoy Ghosh
- Department of Endocrinology, IPGMER and SSKM Hospital, Calcutta, West Bengal, India.
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25
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Majumder S, Chakraborty PP, Ghosh PC, Bera M. Cushing’s syndrome in early infancy due to isolated sporadic bilateral micronodular adrenocortical disease associated with myosin heavy chain 8 mutation: diagnostic challenges, too many! BMJ Case Rep 2020; 13:13/10/e236850. [DOI: 10.1136/bcr-2020-236850] [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: 11/03/2022] Open
Abstract
Endogenous Cushing’s syndrome (CS) is rare in infancy. Bilateral micronodular adrenocortical disease (BMAD), either primary pigmented nodular adrenocortical disease or the non-pigmented isolated micronodular adrenocortical disease is an important aetiology of CS in this age group, which requires bilateral adrenalectomy for cure. BMAD may be isolated, or a component of Carney complex. Isolated sporadic BMAD without other systemic manifestations poses a diagnostic challenge. Paradoxical cortisol response to dexamethasone suggests, while adrenal histopathology and mutational analysis of the culprit genes confirm BMAD. BMAD was suspected in 6-year-old infant with midnormal adrenocorticotrophic hormone, inconclusive adrenal and pituitary imaging and paradoxical increase in cortisol following high dose of dexamethasone. Exome sequencing revealed heterozygous c.354+1G>C (5′ splice site) variant in the myosin heavy chain gene (MYH8), located in chromosome 17. This particular variant has not been reported in the literature. In view of suspected phenotype and its absence in the population databases, the variant was classified as pathogenic.
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26
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Agrawal N, Chakraborty PP, Sinha A, Maiti A. False elevation of serum cortisol in chemiluminescence immunoassay by Siemens Advia Centaur XP system in 21-hydroxylase deficiency: an ‘endocrine laboma’. BMJ Case Rep 2020; 13:13/9/e235450. [DOI: 10.1136/bcr-2020-235450] [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: 11/03/2022] Open
Abstract
Liquid chromatography–mass spectrometry, the gold standard method for cortisol measurement, is expensive and not widely available in the developing countries. Chemiluminescent immunoassay, commonly used for cortisol measurement is prone to clinically meaningful inter-assay variability in some analysers. This occurs due to non-specific nature of anticortisol antibodies used in different platforms, having cross reactivity with structurally similar cortisol precursors like 17α-hydroxyprogesterone (17OHP), 11-deoxycortisol and 21-deoxycortisol. In patients with 21-hydroxylase deficiency, where 17OHP and 21-deoxycortisol are significantly elevated, older generation machines like Siemens Advia Centaur XP provide spuriously high cortisol concentration compared with values measured by Roche Cobas e 411 or Siemens Immulite 1000. Diagnosis of potentially life-threatening salt-wasting 21-hydroxylase deficiency may be missed and treatment may be delayed due to such interference. Two children with classic 21-hydroxylase deficiency are being reported here, in whom high cortisol values were observed in Siemens Advia Centaur XP system.
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27
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Mishra A, Chakraborty PP, Dey S. Dispersal evolution diminishes the negative density dependence in dispersal. Evolution 2020; 74:2149-2157. [PMID: 32725620 DOI: 10.1111/evo.14070] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 06/07/2020] [Revised: 07/15/2020] [Accepted: 07/26/2020] [Indexed: 12/17/2022]
Abstract
In many organisms, dispersal varies with the local population density. Such patterns of density-dependent dispersal (DDD) are expected to shape the dynamics, spatial spread, and invasiveness of populations. Despite their ecological importance, empirical evidence for the evolution of DDD patterns remains extremely scarce. This is especially relevant because rapid evolution of dispersal traits has now been empirically confirmed in several taxa. Changes in DDD of dispersing populations could help clarify not only the role of DDD in dispersal evolution, but also the possible pattern of subsequent range expansion. Here, we investigate the relationship between dispersal evolution and DDD using a long-term experimental evolution study on Drosophila melanogaster. We compared the DDD patterns of four dispersal-selected populations and their non-selected controls. The control populations showed negative DDD, which was stronger in females than in males. In contrast, the dispersal-selected populations showed DDD, where neither males nor females exhibited DDD. We compare our results with previous evolutionary predictions that focused largely on positive DDD, and highlight how the direction of evolutionary change depends on the initial DDD pattern of a population. Finally, we discuss the implications of DDD evolution for spatial ecology and evolution.
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Affiliation(s)
- Abhishek Mishra
- Population Biology Laboratory, Biology Division, Indian Institute of Science Education and Research, Pune, Pune, 411 008, India
| | - Partha Pratim Chakraborty
- Population Biology Laboratory, Biology Division, Indian Institute of Science Education and Research, Pune, Pune, 411 008, India.,Current Address: Department of Biology, University of Ottawa, Ottawa, ON, K1N 6N5, Canada
| | - Sutirth Dey
- Population Biology Laboratory, Biology Division, Indian Institute of Science Education and Research, Pune, Pune, 411 008, India
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28
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Mahata R, Chakraborty PP, Sinha A, Maiti A. Paradoxical Cortisol Response to Dexamethasone in Corticotroph Microadenoma: A Useful Feature of Underlying Cyclic Hormonogenesis. Indian J Endocrinol Metab 2020; 24:220-222. [PMID: 32699797 PMCID: PMC7333752 DOI: 10.4103/ijem.ijem_95_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Received: 02/25/2020] [Accepted: 03/03/2020] [Indexed: 11/12/2022] Open
Affiliation(s)
- Rahin Mahata
- Department of Endocrinology and Metabolism, Medical College, Kolkata, 88 College Street, Kolkata 73, West Bengal, India
| | - Partha Pratim Chakraborty
- Department of Endocrinology and Metabolism, Medical College, Kolkata, 88 College Street, Kolkata 73, West Bengal, India
| | - Anirban Sinha
- Department of Endocrinology and Metabolism, Medical College, Kolkata, 88 College Street, Kolkata 73, West Bengal, India
| | - Animesh Maiti
- Department of Endocrinology and Metabolism, Medical College, Kolkata, 88 College Street, Kolkata 73, West Bengal, India
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Chakraborty PP, Barkat R. A status report on age, depositional motif and stratigraphy of Chhattisgarh, Indravati, Kurnool and Bhima basins, Peninsular India. PINSA 2020. [DOI: 10.16943/ptinsa/2020/49801] [Citation(s) in RCA: 3] [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: 11/13/2022]
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Majumder S, Chakraborty PP, Ghosh PC, Bera M. Differentiating 11β-hydroxylase deficiency from primary glucocorticoid resistance syndrome in male precocity: real challenge in low-income countries. BMJ Case Rep 2020; 13:13/2/e233722. [DOI: 10.1136/bcr-2019-233722] [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: 11/03/2022] Open
Abstract
Congenital adrenal hyperplasia due to 11β-hydroxylase deficiency (11-BHD) and primary glucocorticoid resistance syndrome (PGRS) are two relatively uncommon causes of gonadotropin-releasing hormone-independent isosexual male precocity; PGRS, however, is considerably rarer than 11-BHD. Other than serum and urinary cortisol, which are elevated in PGRS and low/low–normal in 11-BHD, both of these conditions are indistinguishable by clinical, biochemical or radiological parameters. In 11-BHD, oxidation of 11-deoxycortisol (11-DOC) to cortisol is impaired, resulting in accumulation of 11-DOC and other cortisol precursors. 11-DOC shares structural homology with cortisol, and falsely elevated serum cortisol values are observed in older generation immunoassays (Siemens ADVIA Centaur) due to antibody cross-reactivity. 11-BHD, thus, may be misdiagnosed as PGRS. Structure-based cortisol assays are not widely available in low-income countries. Hence, immunoassays using highly specific antibodies against cortisol are required to ensure assay selectivity. Newer generation analysers probably are effective alternatives to liquid chromatography–tandem mass spectrometry in conditions associated with 11β-hydroxylase defect.
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Agrawal SS, Mishra CK, Agrawal C, Chakraborty PP. Rickets with hypophosphatemia, hypokalemia and normal anion gap metabolic acidosis: not always an easy diagnosis. BMJ Case Rep 2020; 13:13/1/e233350. [DOI: 10.1136/bcr-2019-233350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Rickets other than those associated with advanced kidney disease, isolated distal renal tubular acidosis (dRTA) and hypophosphatasia (defective tissue non-specific alkaline phosphatase) are associated with hypophosphatemia due to abnormal proximal tubular reabsorption of phosphate. dRTA, however, at times is associated with completely reversible proximal tubular dysfunction. On the other hand, severe hypophosphatemia of different aetiologies may also interfere with both distal tubular acid excretion and proximal tubular functions giving rise to transient secondary renal tubular acidosis (distal and/or proximal). Hypophosphatemia and non-anion gap metabolic acidosis thus pose a diagnostic challenge occasionally. A definitive diagnosis and an appropriate management of the primary defect results in complete reversal of the secondary abnormality. A child with vitamin D resistant rickets was thoroughly evaluated and found to have primary dRTA with secondary proximal tubular dysfunction in the form of phosphaturia and low molecular weight proteinuria. The child was treated only with oral potassium citrate. A complete clinical, biochemical and radiological improvement was noticed in follow-up.
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Agrawal SS, Chakraborty PP, Sinha A, Maiti A. Child with ‘46, XX’ disorder of sex development: clues to diagnose aromatase deficiency. BMJ Case Rep 2019; 12:12/12/e232575. [DOI: 10.1136/bcr-2019-232575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A diagnosis of congenital adrenal hyperplasia (CAH) in a ‘46, XX’ newborn with ambiguous genitalia is like a ‘knee jerk reaction’ of the paediatrician because of its higher frequency and life-threatening consequences if remain undiagnosed and hence untreated. Aromatase deficiency (AD), a rare cause of ‘46, XX’ disorder of sex development, mimics virilising CAH in many aspects; thus, the disease is often overlooked. Diagnosis of AD in women is much easier around puberty due to the presence of primary amenorrhoea, undeveloped breasts, androgen excess and tall stature with eunuchoid proportions. Diagnosing AD with confidence immediately after birth or during early childhood is a challenging task without genetic analysis. In resource-restricted settings, AD remains a diagnosis of exclusion particularly in this age group and history of maternal virilisation, non-progressive genital ambiguity, elevated gonadotrophins (follicle-stimulating hormone >>luteinising hormone), mildly delayed bone age with/without enlarged polycystic ovaries serve as important clues to the underlying AD.
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Mishra A, Tung S, Shreenidhi PM, Aamir Sadiq M, Shree Sruti VR, Chakraborty PP, Dey S. Sex differences in dispersal syndrome are modulated by environment and evolution. Philos Trans R Soc Lond B Biol Sci 2019; 373:rstb.2017.0428. [PMID: 30150226 DOI: 10.1098/rstb.2017.0428] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [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: 07/28/2018] [Indexed: 11/12/2022] Open
Abstract
Dispersal syndromes (i.e. suites of phenotypic correlates of dispersal) are potentially important determinants of local adaptation in populations. Species that exhibit sexual dimorphism in their life history or behaviour may exhibit sex-specific differences in their dispersal syndromes. Unfortunately, there is little empirical evidence of sex differences in dispersal syndromes and how they respond to environmental change or dispersal evolution. We investigated these issues using two same-generation studies and a long-term (greater than 70 generations) selection experiment on laboratory populations of Drosophila melanogaster There was a marked difference between the dispersal syndromes of males and females, the extent of which was modulated by nutrition availability. Moreover, dispersal evolution via spatial sorting reversed the direction of dispersal×sex interaction in one trait (desiccation resistance), while eliminating the sex difference in another trait (body size). Thus, we show that sex differences obtained through same-generation trait-associations ('ecological dispersal syndromes') are probably environment-dependent. Moreover, even under constant environments, they are not good predictors of the sex differences in 'evolutionary dispersal syndrome' (i.e. trait-associations shaped during dispersal evolution). Our findings have implications for local adaptation in the context of sex-biased dispersal and habitat-matching, as well as for the use of dispersal syndromes as a proxy of dispersal.This article is part of the theme issue 'Linking local adaptation with the evolution of sex differences'.
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Affiliation(s)
- Abhishek Mishra
- Population Biology Laboratory, Biology Division, Indian Institute of Science Education and Research Pune, Dr Homi Bhabha Road, Pune, Maharashtra 411 008, India
| | - Sudipta Tung
- Population Biology Laboratory, Biology Division, Indian Institute of Science Education and Research Pune, Dr Homi Bhabha Road, Pune, Maharashtra 411 008, India
| | - P M Shreenidhi
- Population Biology Laboratory, Biology Division, Indian Institute of Science Education and Research Pune, Dr Homi Bhabha Road, Pune, Maharashtra 411 008, India
| | - Mohammed Aamir Sadiq
- Population Biology Laboratory, Biology Division, Indian Institute of Science Education and Research Pune, Dr Homi Bhabha Road, Pune, Maharashtra 411 008, India
| | - V R Shree Sruti
- Population Biology Laboratory, Biology Division, Indian Institute of Science Education and Research Pune, Dr Homi Bhabha Road, Pune, Maharashtra 411 008, India
| | - Partha Pratim Chakraborty
- Population Biology Laboratory, Biology Division, Indian Institute of Science Education and Research Pune, Dr Homi Bhabha Road, Pune, Maharashtra 411 008, India
| | - Sutirth Dey
- Population Biology Laboratory, Biology Division, Indian Institute of Science Education and Research Pune, Dr Homi Bhabha Road, Pune, Maharashtra 411 008, India
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Abstract
Thyrotoxicosis factitia, a disorder frequently seen in young or middle-aged women with psychological disorders, most commonly results from surreptitious ingestion of excess thyroid hormones. In most patients, diagnosis is relatively straightforward and depends on the demonstration of biochemical thyrotoxicosis, suppressed endogenous thyroid function and absence of clinical features of underlying thyroid disease. However, at times, confounding factors can make the diagnosis particularly challenging and necessitate the investigating physician to don the detective's cap to get to the root of the problem. We discuss a patient whose diagnosis was reached with ingenuity after considerable effort from four endocrinologists having a total experience of 37 years in their field.
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Affiliation(s)
| | - Soumik Goswami
- Endocrinology, Nil Ratan Sircar Medical College, Kolkata, West Bengal, India
| | - Rana Bhattacharjee
- Endocrinology and Metabolism, IPGME&R and SSKM Hospital, Kolkata, West Bengal, India
| | - Subhankar Chowdhury
- Endocrinology and Metabolism, IPGME&R and SSKM Hospital, Kolkata, West Bengal, India
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Chakraborty PP, Mishra A, Molla K, Halder R. Near absent carrying angles: a clinical clue to underlying SHOX overdosage. BMJ Case Rep 2019; 12:12/3/e228933. [PMID: 30936359 DOI: 10.1136/bcr-2018-228933] [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] [Indexed: 11/04/2022] Open
Affiliation(s)
| | - Abhijit Mishra
- Department of Medicine, Midnapore Medical College & Hospital, Midnapore, West Bengal, India
| | - Kalimujjaman Molla
- Department of Medicine, Midnapore Medical College & Hospital, Midnapore, West Bengal, India
| | - Ratan Halder
- Department of Medicine, Midnapore Medical College & Hospital, Midnapore, West Bengal, India
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Affiliation(s)
| | - Sugata Narayan Biswas
- Department of Medicine, Midnapore Medical College and Hospital, Midnapore, West Bengal, India
| | - Himanshu Barman
- Department of Medicine, Midnapore Medical Collge and Hospital, Midnapore, West Bengal, India
| | - Tuhin Subhra Sarkar
- Department of Medicine, Midnapore Medical Collge and Hospital, Midnapore, West Bengal, India
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Singh AK, Chakraborty PP, Sarkar S. Redox Structure of Vindhyan Hydrosphere:Clues from Total Organic Carbon, Transition Metal (Mo, Cr) Concentrations and Stable Isotope (δ 13 C) Chemistry. CURR SCI INDIA 2018. [DOI: 10.18520/cs/v115/i7/1334-1341] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Biswas SN, Barman H, Sarkar TS, Chakraborty PP. Physiological pituitary hyperplasia misinterpreted and treated as lymphocytic hypophysitis. BMJ Case Rep 2018; 2018:bcr-2018-225996. [PMID: 30139788 DOI: 10.1136/bcr-2018-225996] [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] [Indexed: 11/04/2022] Open
Affiliation(s)
- Sugata Narayan Biswas
- Department of Medicine, Midnapore Medical College and Hospital, Midnapore, West Bengal, India
| | - Himanshu Barman
- Department of Medicine, Midnapore Medical College and Hospital, Midnapore, West Bengal, India
| | - Tuhin Subhra Sarkar
- Department of Medicine, Midnapore Medical College and Hospital, Midnapore, West Bengal, India
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Patra S, Chakraborty PP, Biswas SN, Barman H. Etiological Search and Epidemiological Profile in Patients Presenting with Hypokalemic Paresis: An Observational Study. Indian J Endocrinol Metab 2018; 22:397-404. [PMID: 30090734 PMCID: PMC6063177 DOI: 10.4103/ijem.ijem_633_17] [Citation(s) in RCA: 1] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Hypokalemia is associated with increased morbidity and at times mortality. "Hypokalemic paralysis", particularly if recurrent, has often been considered synonymous with "hypokalemic periodic paralysis (HPP)"; however, diseases such as Gitelman syndrome (GS), Bartter syndrome (BS), and renal tubular acidosis (RTA) can have identical presentation. We have tried to explore the etiological spectrum along with epidemiological and certain clinical, biochemical, and electrophysiological features in patients with hypokalemic paralysis. MATERIALS AND METHODS In this observational study, 200 appropriate patients with hypokalemic paralysis (serum K+ <3.5 mmol/L) were evaluated for transcellular shift, extra-renal or renal loss of K+ as the underlying etiology of hypokalemia. We took urinary potassium >25 mmol/day as the cutoff for inappropriate renal loss of potassium in presence of hypokalemia. Serum and urinary osmolality along with arterial blood gas analysis were performed in all patients with renal loss of potassium. Serum and urinary sodium, potassium, calcium, magnesium, chloride, and creatinine were measured in normotensive patients with metabolic alkalosis. Hypertensive patients were evaluated with plasma aldosterone and renin activity. RESULTS Probable GS topped the list involving 28% individuals of the entire cohort while probable BS, distal RTA, and HPP were diagnosed in 20%, 22%, and 19% cases, respectively. Rural tribal population (61%) and age group of 30-40 years suffered the most (48%) with concentration of cases in hot and humid summer months. CONCLUSIONS We suggest that patients with hypokalemic paresis should be evaluated thoroughly to unmask the underlying etiology that may have a different therapeutic and prognostic connotations and not to use the term "periodic" in cases of recurrent hypokalemic paralysis.
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Affiliation(s)
- Shinjan Patra
- Department of Medicine, Midnapore Medical College and Hospital, Medinipur, West Bengal, India
| | | | - Sugata Narayan Biswas
- Department of Medicine, Midnapore Medical College and Hospital, Medinipur, West Bengal, India
| | - Himanshu Barman
- Department of Medicine, Midnapore Medical College and Hospital, Medinipur, West Bengal, India
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Chakraborty PP, Patra S, Biswas SN, Barman H. Primary male factor infertility due to asthenospermia in maturity-onset diabetes of the young type 5 (MODY 5): uncommon presentation of an uncommon disease. BMJ Case Rep 2018; 2018:bcr-2017-223723. [PMID: 29574432 DOI: 10.1136/bcr-2017-223723] [Citation(s) in RCA: 1] [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] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Mutations in hepatocyte nuclear factor-1β gene result in a multisystemic syndrome where a monogenic form of diabetes (maturity-onset diabetes of young type 5; MODY 5) and renal anomalies, usually bilateral multiple cysts are the most characteristic findings. Many of them have pancreatic structural abnormalities as well. A plethora of extrapancreatic manifestations like altered liver function tests, hypomagnesaemia, hyperuricaemia with/without gout and urogenital malformations, particularly in females are also components of the syndrome. Structural malformation of male urogenital tract is rare in MODY 5, even rarer is asthenospermia. We encountered a young non-obese individual having insulin-requiring diabetes following secondary oral agent failure with primary male factor infertility secondary to asthenospermia. A suggestive family history, lack of acanthosis, negative pancreatic autoimmunity, hypomagnesaemia, bilateral renal and epididymal cysts, and absence of body and tail of pancreas pointed towards underlying MODY 5.
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Affiliation(s)
| | - Shinjan Patra
- Department of Medicine, Midnapore Medical College, Midnapore, West Bengal, India
| | | | - Himanshu Barman
- Department of Medicine, Midnapore Medical College, Midnapore, West Bengal, India
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Chakraborty PP, Patra S, Biswas SN, Barman H. Attenuated form of type II mucopolysaccharidoses (Hunter syndrome): pitfalls and potential clues in diagnosis. BMJ Case Rep 2018; 2018:bcr-2018-224392. [DOI: 10.1136/bcr-2018-224392] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Affiliation(s)
| | - Hasina Banu
- Department of Microbiology, R G Kar Medical College and Hospital, Kolkata, India
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Biswas SN, Ray S, Ball S, Chakraborty PP. Bruns nystagmus: an important clinical clue for cerebellopontine angle tumours. BMJ Case Rep 2018; 2018:bcr-2017-223378. [DOI: 10.1136/bcr-2017-223378] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Patra S, Biswas SN, Datta J, Chakraborty PP. Hypersomatotropism induced secondary polycythaemia leading to spontaneous pituitary apoplexy resulting in cure of acromegaly and remission of polycythaemia: 'The virtuous circle'. BMJ Case Rep 2017; 2017:bcr-2017-222669. [PMID: 29222208 DOI: 10.1136/bcr-2017-222669] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
A young man with subtle clinical features suggestive of hypersomatotropism presented with acute-onset severe headache. Relevant investigations confirmed polycythaemia and growth hormone (GH)-secreting pituitary macroadenoma with apoplexy. Secondary polycythaemia and myeloproliferative disorders were ruled out. At follow-up after 3 months, resolution of polycythaemia and acromegaly was observed, evident on normal haemoglobin levels, a normocellular marrow, and normal insulin-like growth factor-1 (IGF-1) with glucose-suppressed GH levels. Direct mitogenic properties of GH-IGF-1 axis on bone marrow progenitor cells may very rarely lead to erythroid hyperplasia and subsequent polycythaemia, reversible with successful therapy of acromegaly. In this case, polycythaemia secondary to hypersomatotropism likely resulted in pituitary apoplexy with subsequent remission of both acromegaly and resultant polycythaemia.
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Affiliation(s)
- Shinjan Patra
- Department of Medicine, Midnapore Medical College and Hospital, Midnapore, West Bengal, India
| | - Sugata Narayan Biswas
- Department of Medicine, Midnapore Medical College and Hospital, Midnapore, West Bengal, India
| | - Joydip Datta
- Department of Medicine, Midnapore Medical College and Hospital, Midnapore, West Bengal, India
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Chakraborty PP, Bhattacharjee R, Mukhopadhyay S, Chowdhury S. Split hand/foot malformation: a potential clue to underlying FGFR1 mutation in patients with isolated congenital hypogonadotropic hypogonadism. Postgrad Med J 2017; 94:180-181. [DOI: 10.1136/postgradmedj-2017-135260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 10/22/2017] [Accepted: 11/03/2017] [Indexed: 11/04/2022]
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Biswas SN, Patra S, Chakraborty PP, Barman H. Mucopolysaccharidosis type IVA (Morquio A): a close differential diagnosis of spondylo-epiphyseal dysplasia. BMJ Case Rep 2017; 2017:bcr-2017-221156. [PMID: 29054894 DOI: 10.1136/bcr-2017-221156] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Patients with mucopolysaccharidoses (MPS) have a plethora of multisystemic manifestations depending on the particular type, and atypical presentations are not uncommon. MPS type IVA (Morquio A syndrome) has predominant musculoskeletal system involvement and corneal clouding with normal intelligence and can be misdiagnosed as primary skeletal disorders in clinical practice. The absence of corneal clouding with normal urinary glycosaminoglycans (GAGs) level in a proportion of patients with MPS IVA makes the correct diagnosis even more challenging for physicians. Healthcare providers across specialties should have a high degree of suspicion for MPS IVA in all patients with suspected spondylo-epiphyseal dysplasia as early diagnosis and early treatment significantly improve the clinical outcome and activity of daily living.
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Affiliation(s)
- Sugata Narayan Biswas
- Department of Medicine, Midnapore Medical College and Hospital, Midnapore, West Bengal, India
| | - Shinjan Patra
- Department of Medicine, Midnapore Medical College and Hospital, Midnapore, West Bengal, India
| | | | - Himanshu Barman
- Department of Medicine, Midnapore Medical College and Hospital, Midnapore, West Bengal, India
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Chakraborty PP, Ray S, Mukhopadhyay S, Chowdhury S. New-onset hyperglycemia: A potential clue to detect early pancreatic cancer. Clinical Diabetology 2017. [DOI: 10.5603/dk.2017.0019] [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: 11/25/2022] Open
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Chakraborty PP, Patra S, Biswas SN, Bhattacharjee R. Adrenal myelolipoma(s) as presenting manifestation of subclinical Cushing's disease (eutopic ACTH-dependent Cushing's syndrome). BMJ Case Rep 2017; 2017:bcr-2017-221674. [PMID: 28814582 DOI: 10.1136/bcr-2017-221674] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Primary adrenal myelolipomas, relatively rare benign tumours of the adrenal cortex are typically unilateral, hormonally inactive and asymptomatic, hence often diagnosed as 'adrenal incidentaloma'. Bilateral adrenal myelolipomas, in particular, may be associated with underlying endocrinopathies associated with elevated circulating adrenocorticotropic hormone (ACTH) concentration. Subclinical cortisol hypersecretion, irrespective of its ACTH dependency, does not manifest typical clinical phenotype of hypercortisolemia, and thus termed subclinical Cushing's syndrome. In this article, hormonal evaluation in a middle-aged woman with diabetes, hypertension and incidentally discovered unilateral adrenal myelolipoma revealed underlying subclinical Cushing's disease. Abdominal CT revealed another tiny focus in the contralateral adrenal gland, probably representing incipient myelolipoma.
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Affiliation(s)
| | - Shinjan Patra
- Department of Medicine, Midnapore Medical College and Hospital, Midnapore, West Bengal, India
| | - Sugata Narayan Biswas
- Department of Medicine, Midnapore Medical College and Hospital, Midnapore, West Bengal, India
| | - Rana Bhattacharjee
- Department of Endocrinology and Metabolism, IPGME&R/SSKM Hospital, Kolkata, West Bengal, India
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Affiliation(s)
| | - Mitali Bera
- Paediatrics, Midnapore Medical College and Hospital, Midnapore, West Bengal, India
| | - Shinjan Patra
- Medicine, Midnapore Medical College and Hospital, Midnapore, West Bengal, India
| | - Suman Roy
- Paediatrics, Midnapore Medical College and Hospital, Midnapore, West Bengal, India
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Chakraborty PP, Patra S, Barman H, Biswas SN. Cranial neuropathies in uncontrolled diabetes: May not always be due to diabetic microangiopathy. BMJ Case Rep 2017; 2017:bcr-2017-220054. [PMID: 28551600 DOI: 10.1136/bcr-2017-220054] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
| | - Shinjan Patra
- Department of Medicine, Midnapore Medical College & Hospital, Midnapore, West Bengal, India
| | - Himanshu Barman
- Department of Medicine, Midnapore Medical College & Hospital, Midnapore, West Bengal, India
| | - Sugata Narayan Biswas
- Department of Medicine, Midnapore Medical College & Hospital, Midnapore, West Bengal, India
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