Androgen Deficiency in Aging Males (ADAM) Score as a Predictor of Total Testosterone Levels in Type 2 Diabetes Mellitus: A Prospective, Cross-sectional Study.

OBJECTIVE: Assessment of Androgen Deficiency in Aging Males (ADAM) questionnaire in predicting serum testosterone levels in type 2 diabetes mellitus (T2DM). MATERIALS AND METHODS: A single centre, prospective, cross-sectional epidemiological study in 250 male individuals with T2DM. ADAM questionnaire and serum total testosterone (TT) levels were analyzed for correlation using a Chi-squared test. Jaccard analysis to evaluate the concordance and dissimilarity between ADAM score and TT levels, providing insights into ADAM's predictive ability for testosterone levels. RESULTS: The mean age of the study population was 49.1 ± 7.8 years. The mean duration of diabetes was 6.2 ± 5.1 years. 27.6% were diagnosed with hypogonadism, while 72.4% were eugonadal. The mean age was 51.1 and 48.4 years in the hypogonadal and eugonadal cohorts, respectively (p < 0.02). The mean TT in the hypogonadal cohort was 220.6 ± 61.3 ng/dL, and in the eugonadal cohort was 475.4 ± 152.9 ng/dL (p < 0.001). The mean body mass index (BMI) in the hypogonadal cohort was 26.5 ± 4.0 kg/m2, and in the eugonadal group was 25.2 ± 3.6 kg/m2 (p < 0.02). Chi-square analysis established a strong positive correlation between the positive ADAM score and hypogonadism (p < 0.011). Of the 69 hypogonadal subjects, 84.05% had a positive ADAM score, yielding a sensitivity of 84.05% in detecting hypogonadism with a specificity of 32.04%. CONCLUSION: The ADAM questionnaire is a practical and cost-effective initial screening tool for identifying symptoms suggestive of testosterone deficiency. It has high sensitivity in identifying men with hypogonadism, while caution must be in place as it has a very low specificity. In resource-poor settings, ADAM score could be a clinical marker of hypogonadism.

Clinical Efficacy and Safety of Remdesivir among Hospitalised Adult Patients with RT PCR Confirmed COVID 19 Requiring ICU Care in Kalyana Karnataka.

BACKGROUND: Despite global efforts, COVID 19 pandemic is still posing a serious challenge with dearth of effective treatment options. Remdesivir has got FDA approval as the first COVID-19 anti-viral agent in adult and paediatric patients (aged ≥12 years and weighing at least 40 kg) requiring hospitalization. OBJECTIVE: The present prospective, observational, cross sectional study was planned to evaluate the impact of early initiation of Remdesivir on clinical outcomes in moderate to severe COVID 19 patients requiring ICU care. Materials and Methods: In this study, 100 consecutive symptomatic RT-PCR positive COVID 19 patients requiring admission to Intensive care unit based on predefined criteria were included for evaluation. All such moderate to severely ill patients were given Remdesivir intravenously as a 200-mg loading dose on day 1, followed by a 100-mg maintenance dose for the next four days along with other standard care. The main outcome measure analysed was the impact of early initiation of Remdesivir on recovery assessed by number of days in hospital, recovery, biochemical improvements and death. Results: Out of total 100 patients, 84 patients recovered with Remdesivir along with supportive treatment and were discharged from the hospital. Mean age of patients at presentation 53.5± 14.8 years with 5:1 male preponderance. Mean duration of hospital stay was 11.6 ± 5.9 days. D-dimer, CRP, Ferritin, IL-6 decreased significantly post treatment with P values <0.05, <0.001, <0.001, <0.01 respectively when compared to values at admission. No significant side effects were seen with remdesivir infusion. CONCLUSION: This real-world experience suggests that in the subset of hospitalized patients with moderate to severe pneumonia, early use of Remdesivir can lead to better clinical outcomes and help in reduction of associated mortality and morbidity of COVID-19.

The Clinical Septet of Van Wyk-Grumbach Syndrome: A Case Series from a Tertiary Care Centre in Kalyana Karnataka, India.

Van Wyk-Grumbach syndrome is a rare, female juvenile hypothyroidism disorder that is characterized by precocious puberty with clinical, radiological and hormonal pathologies. We present a case series of three patients with this unusual condition who were evaluated and followed up over a 3-year period between January 2017 and June 2020. All three patients presented with short stature (<3rd centile), low weight (<3rd centile), absence of goitre, no axillary or pubic hair, delayed bone age by more than 2 years, elevated thyroid-stimulating hormone with low T3 and T4 (primary hypothyroidism), and raised follicle-stimulating hormone with pre-pubertal levels of luteinizing hormone. Abdominal ultrasonography showed bilateral multi-cystic ovaries in two patients and a right-sided bulky ovary in the third patient. One of the patients also had a pituitary 'macroadenoma'. All the patients were successfully managed with levothyroxine. We discuss the pathophysiological mechanisms with a brief literature review.

Clinical, Biochemical, and Radiological Presentation of RT-PCR-Positive vs RT-PCR-Negative SARS-CoV-2 Pneumonia Requiring ICU Care: An Observational, Cross-Sectional, Single-Center Study in Kalaburagi, Kalyana Karnataka.

Introduction Studies have reported similar clinical, biochemical, and radiological features between real-time polymerase chain reaction (RT-PCR)-positive and RT-PCR-negative patients. Therefore, the present study aims to assess differences in RT-PCR-positive versus RT-PCR-negative patients' characteristics. Methods We prospectively included 70 consecutive patients with typical coronavirus disease 2019 (COVID-19)-like clinical features who were either RT-PCR-positive or negative, requiring admission to the intensive care unit. The patients were classified into positive and negative RT-PCR groups and evaluated for clinical features, comorbidities, laboratory findings, and radiologic features. Results Fifty-seven point one percent (57.1%; 40/70) were RT-PCR positive, and 42.9% (30/70) were RT-PCR negative patients. The respiratory rate was higher among negative patients (P = 0.02), whereas the mean duration of fever was longer (3.34 vs 2.5; P = 0.022) among positive patients. At presentation, RT-PCR-negative patients had lower saturation of peripheral oxygen (SpO2) (near significant P = 0.058). Evaluation of co-morbidities revealed no differences. The neutrophil/lymphocyte ratio (NLR) (4.57 vs 6.52; P = 0.048), C-reactive protein (CRP) (9.97 vs 22.7; P = 0.007), and serum ferritin (158 vs 248.52; P = 0.010) were higher in patients who tested negative for RT-PCR. Thrombocytopenia (2.42 vs 1.76; P = 0.009), D-dimer levels (408.91 vs 123.06; P = 0.03), and interleukin (IL-6) levels (219.3 vs 80.81; P = 0.04) were significantly elevated among RT-PCR positive patients. The percentage of lung involvement in negative cases was 42.29+/-22.78 vs 36.21+/-21.8 in positive cases (P=0.23). The CT severity score was similar in both cohorts. Conclusion Both RT-PCR-positive and negative patients have similar clinical, biochemical, and radiological features. Considering that we are amidst a pandemic, it is advisable to have a similar approach irrespective of the RT-PCR report and triage and isolate accordingly. We recommend an RT-PCR-negative intensive care unit (ICU) ward and that the treating physician take a call on the management with a holistic approach driven clinically by the laboratory findings and helped by radiological findings. Stressing only on the RT-PCR report for management can be counterproductive.

Clinical and Biochemical Characteristics and Treatment Outcomes of Ketosis-Prone Diabetes: The Remission Prone Diabetes.

BACKGROUND: Diabetic ketoacidosis (DKA) is one of the severe acute complications of diabetes. It has long been considered a key clinical characteristic of type 1 diabetes mellitus (T1DM) with severe and irreversible deficient insulin levels. Ketosis-prone diabetes (KPD) has pathophysiology close to T2DM but shows signs and symptoms associated with T1DM. In general, patients with ketosis-prone diabetes display elevated glucose and ketone levels; also, a higher hemoglobin A1C than conventional T2DM. OBJECTIVES: The current research aimed to elucidate the clinical presentation and outline a management plan for KPD in the Indian population. METHODS: The present case series is a descriptive, prospective, and observational case series on six unprovoked cases of KPD. They were managed using the standard protocol of DKA management. RESULTS: The recruited cases followed a set pattern of very high insulin requirement at diagnosis. On follow-up, the insulin requirement progressively declined, and all of the cases were able to stop insulin therapy after a mean period of four weeks. None of the cases presented any organ damage at diagnosis. There was no recurrence of DKA during the two-year follow-up. All of the cases had normal liver and renal functions. Autoantibodies were negative in all of the cases. CONCLUSIONS: Ketosis-prone diabetes is the most under-recognized and under-diagnosed among all types of diabetes. Its recognition is of utmost importance as the approach of its treatment varies widely from that of the conventional type of diabetes. Proper follow-up, especially in unprovoked cases of DKA with obese phenotype, could help elucidate this rare entity of KPD where insulin can be stopped and maintain normoglycemia for a substantial period without insulin.