Frequency and Correlates of Hypogonadism in Adult Males with Type 2 Diabetes Mellitus.

BACKGROUND AND AIMS: There is increasing awareness about an association between type 2 diabetes mellitus (T2DM) and male hypogonadism. However, data are sparse and less uniform with respect to factors associated with hypogonadism in males with T2DM. This study aimed to assess the frequency and correlates of hypogonadism in these subjects. MATERIALS AND METHODS: This cross-sectional study included 130 males with T2DM, age 25-60 years. Study subjects were screened for hypogonadal symptoms using androgen deficiency in aging male (ADAM) questionnaire. Serum total testosterone was measured in subjects with positive ADAM score. Hypogonadism was defined as the presence of positive ADAM score and low serum total testosterone (<3 ng/mL). Clinical and biochemical variables were compared between T2DM subjects with and without hypogonadism. RESULTS: Hypogonadism was observed in 26.9% of the study subjects. Hypogonadal symptoms most frequently observed in patients with T2DM and hypogonadism were erectile dysfunction (96.4%), reduced libido (64.3%) and deterioration in work performance (53.6%). Group with T2DM and hypogonadism had higher (i) duration of T2DM (8.9 ± 5.03 vs. 4.8 ± 4.76 years; P = .001), (ii) frequency of diabetic retinopathy (58.3% vs. 27.3%; P = .008), (iii) frequency of diabetic neuropathy (42.9% vs. 19.7%; P = .024), (iv) proportion of subjects on insulin therapy (46.4% vs. 22.4%; P = .027), and (v) HbA1c (10.9 ± 2.63% vs. 9.3 ± 2.42%; P = .006), compared to group without hypogonadism. CONCLUSION: Hypogonadism was present in nearly one-fourth of the study subjects with T2DM. Compared to the subjects without hypogonadism, group with hypogonadism had longer duration of diabetes, higher HbA1c, greater frequencies of diabetic retinopathy and diabetic neuropathy, and more subjects on insulin therapy.

Serum Interleukin-6 is Not Linked with Sleep-Quality, Restless Legs Syndrome, and Depression, But with 6-Month Survival in Hematological Malignancies.

BACKGROUND: Serum interleukin (IL)-6 has been found to be associated with sleep quality, mood, and survival in patients with solid tumors. Results in these studies were confounded by knowledge of diagnosis to study subjects. Moreover, such data among subjects with hematological malignancies and data regarding restless legs syndrome is limited. The present study was, therefore, conducted to assess the sleep quality, depression, and restless leg syndrome in hematological malignancies and to study if there is any role of IL6 associated with it. METHODS: Sixty-six subjects having hematological malignancy were included in this study after excluding the potential confounders. Sleep quality was examined using Pittsburg Sleep Quality Index, depression by the Patient Health Questionnaire-9. Diagnosis of RLS was made through clinical examination. Serum for measurement of IL-6 was collected at baseline and after 1 month of initiation of chemotherapy. Patients were followed up for 6 months. RESULTS: Average age of study subjects was 50.16 years with male predominance. Nearly 22.7% had clinical depression, 28.8% had poor quality sleep, and restless legs syndrome (RLS) was reported in 6.1% cases. Nearly 22.7% patients died at 6 months. Disturbed sleep at baseline was associated with depression (odds ratio [OR] =7.89) and poor 6 months survival. Serum IL-6 did not show any association with sleep quality, restless-legs-syndrome, and depression. However, baseline high level of serum IL-6 (OR = 26.06) and low level after chemotherapy (OR = 0.03) were associated with poor survival at 6 months. CONCLUSION: Poor quality sleep, depression, and RLS are prevalent among adult subjects with hematological malignancies. Sleep disturbance, high pretreatment inflammatory and lowering of inflammatory load after chemotherapy increase likelihood for poor prognosis. Serum IL-6 did not show any association with sleep quality, restless legs syndrome and depression.

Retrospective Analysis of Spectrum of Presentation and Treatment Outcome in Extremity Sarcomas: A Single-Centre Experience.

INTRODUCTION: The most common site for soft tissue sarcoma is extremity. As complete surgical resection is possible in majority, outcome of this subset is relatively better. There is paucity of data regarding extremity soft tissue sarcoma (STS) from sub-Himalayan and hilly geographical regions. MATERIALS AND METHODS: Retrospective analysis was done for extremity STS visiting the study center over a period of 5 years. Data were collected and analyzed for demography, disease characteristics, treatment modalities, and outcome. RESULT: Extremity STS constituted 32.8% of all STS enlisted. Most common subtype noted was pleomorphic STS. Metastatic disease at presentation was noted among 7/43 cases with lung being the most common metastasis site. Wide local excision was done in 37 cases while amputation was required in 5 cases. Adjuvant radiotherapy was given in 27 cases while 18 cases received adjuvant chemotherapy. At median follow-up of 47 months, the overall survival and event-free survival were noted as 47.64% and 41.49%, respectively. CONCLUSION: This study depicts single-center experience of extremity STS. The population analyzed was from sub-Himalayan region with significant lost to follow-up. Pooling of data from different centers has been advocated to derive conclusive results.

Alpha-fetoprotein as a prognostic marker in acute liver failure: a pilot study.

Prognostic markers of acute liver failure (ALF) are based on clinical, laboratory or radiological parameters. Most of the biochemical markers are based on hepatic degeneration. We studied the impact of serial serum alpha-fetoprotein (AFP) levels, a marker of liver regeneration, on the outcome of the patients with ALF. AFP levels were estimated on days 1 and 3 of hospitalisation of 32 patients with ALF and the ratio (AFP day3/day1) was calculated. All subjects were categorised as group A (expired) or group B (survived). The AFP ratio was 0.84 + 0.15 in group A (n = 20) versus 1.55 + 0.70 in group B (n = 10); P < 0.001. However, the absolute initial AFP values were not associated with the outcome, favourable or unfavourable. We conclude that AFP levels change dynamically during ALF and have the potential to be used as a predictor of outcome in isolation or in combination with well-established prognostic markers.

Familial Hepatocellular Carcinoma- First Reported Case from India.

Familial clustering of Hepatocellular Carcinoma (HCC) is commonly observed in various parts of the world including China and Eastern Asia where HBV is endemic while in western world, genetic factors and metabolic disorders may play an important role. In India, HCC is considered to be a rare tumour and till date no case of familial HCC has been reported here. Therefore the present case demonstrates rare occurrence of familial HCC which is being reported for the first time from India on cytology. The case also highlights an unusual feature that it was not associated with any risk factor including HBV, HCV infection, alcoholism, obesity, diabetes or smoking suggesting its independent association with genetic factors. Cytology is uncomplicated diagnostic tool for HCC and may be useful for its early diagnosis. This case also highlights the importance of early surveillance and follow up of blood relatives for every case of HCC so that early diagnosis and management of familial HCC is possible.

Role of Microvessel Density and Vascular Endothelial Growth Factor in Angiogenesis of Hematological Malignancies.

Angiogenesis plays an important role in progression of tumor with vascular endothelial growth factor (VEGF) being key proangiogenic factor. It was intended to study angiogenesis in different hematological malignancies by quantifying expression of VEGF and MVD in bone marrow biopsy along with serum VEGF levels and observing its change following therapy. The study included 50 cases of hematological malignancies which were followed for one month after initial therapy along with 30 controls. All of them were subjected to immunostaining by anti-VEGF and factor VIII antibodies on bone marrow biopsy along with the measurement of serum VEGF levels. Significantly higher pretreatment VEGF scores, serum VEGF levels, and MVD were observed in cases as compared to controls (p < 0.05). The highest VEGF score and serum VEGF were observed in chronic myeloid leukemia and maximum MVD in Non-Hodgkin's Lymphoma. Significant decrease in serum VEGF levels after treatment was observed in all hematological malignancies except for AML. To conclude angiogenesis plays an important role in pathogenesis of all the hematological malignancies as reflected by increased VEGF expression and MVD in bone marrow biopsy along with increased serum VEGF level. The decrease in serum VEGF level after therapy further supports this view and also lays the importance of anti angiogenic therapy.

North Indian state of Uttarakhand: a new hothouse of visceral leishmaniasis.

Visceral leishmaniasis (VL) has been reported in the last decade from the hilly state of Uttarakhand, India. We report 47 cases from the non-endemic Garhwal region of this state which, over the last 10 years, were treated successfully. We conclude that the transmission cycle of VL is established in this region. Effective vector control measures are warranted to prevent the disease becoming a health problem, albeit not a major one given its excellent response to drugs.

Multiple myeloma or metastatic carcinoma breast: diagnostic dilemma in a case presenting with lytic bony lesion.

Carcinoma breast is common tumor which tends to metastasize to different organs but diagnostic difficulty may arise if known case of carcinoma eventually presents with another secondary malignancy with clinical features which closely mimics with metastatic carcinoma. This overlapping of symptoms may lead to delayed diagnosis of secondary malignancy with worsening of the condition of patient due to lack of specific treatment.The present case is being reported where a known case of primary breast carcinoma presented with scapular erosions suggesting metastasis. However, despite treatment her worsening condition necessitated further work up revealing multiple myeloma. The case signifies the pitfall due to overlapping of symptoms and draws attention to the fact that every known case of primary carcinoma suggestive of metastasis should also be investigated in light of another secondary malignancy. Early diagnosis of secondary malignancy followed by specific treatment would be helpful in improved prognosis of the patient.

Therapeutic platelet reduction: Use in postsplenectomy thrombocytosis.

Therapeutic platelet reduction is an effective modality for the reduction of platelet count in patients with treatment of extreme thrombocytosis resulting from a variety of primary and secondary causes of thrombocytosis, which may be associated with thrombotic or hemorrhagic complications of varying degrees. These cases when symptomatic fall into the ASFA Category II indication for therapeutic platelet apheresis procedure. Here, we report a case of postsplenectomy secondary thrombocytosis presenting with extremely high platelet counts and subsequent thrombosis in the shunt and successful treatment after therapeutic platelet reduction. The case is being presented to bring forth the fact that therapeutic platelet reduction is an easy procedure that gives quick and good results and also to bring to the attention of transfusion specialists an associated but as yet unreported procedural finding.

Retrospective analysis of vivax malaria patients presenting to tertiary referral centre of Uttarakhand.

INTRODUCTION: despite the high prevalence of Plasmodium vivax (P vivax) malaria, research into its complications has lagged disproportionately as compared to Plasmodium falciparum (P falciparum) malaria. MATERIAL AND METHODS: the present retrospective observational study was conducted on cases with P vivax mono-infection presenting with severe malaria on the basis of one or more criteria as per the World Health Organization guidelines being used for severe falciparum malaria in children, as well as other manifestations been classified as complicated malaria, during an outbreak of malaria in a single tertiary referral hospital of north India. RESULTS: seventy-four patients of acute malaria presented during the outbreak, of which 50 cases with P vivax mono-infection were included for the study. Complicated malaria was diagnosed in 41/50 cases, with thrombocytopenia being the commonest manifestation. Other presentations of severe malaria in our patients were liver dysfunction (with or without jaundice) 31/50 cases, respiratory involvement 14/50 cases, renal impairment 11/50 cases, circulatory collapse (Shock) 8/50 cases, severe anaemia 3/50 cases and central nervous system (CNS) involvement 2/50 cases. CONCLUSION: the term "benign tertian malaria" no longer holds true for P vivax mono-infection. The authors wish to open a new front for researches on the possible genotypic abnormalities that the parasite or its carrier might have acquired over decades and has transformed into a species with the malignant potential of P falciparum.

Scrub typhus in Uttarakhand, India: a common rickettsial disease in an uncommon geographical region.

Scrub typhus is a commonly encountered rickettsial disease of the Indian subcontinent. Humans are infected accidentally and the case fatality can be significantly high if the disease is not identified in time. We report nine cases of scrub typhus from the Garhwal region of the newly created north Indian state of Uttarakhand, a region not previously known to harbour the vector. Entomological studies are needed to study the density of the vector and to institute vector control measures in order to prevent this relatively benign, yet potentially fatal, clinical entity from spiralling into a major public health issue.