Search

Among the various post-COVID sequelae, thyroid function impairment stands as a significant concern. COVID-19-related primary hypothyroidism has been documented in the literature. This study aimed to determine the number of cases with subclinical hypothyroidism and a history of moderate COVID-19 pneumonia who progressed to clinically overt hypothyroidism at six months. A prospective casecontrol study enrolled adult patients with known subclinical hypothyroidism and a history of moderate COVID-19 pneumonia as cases. Detailed medical history and physical examinations were conducted for all participants. Thyroid profiles, including free T4 and TSH, were measured at baseline and again at six months for all cases. The results revealed that 20% of cases with a history of moderate COVID-19 exhibited low free T4 levels at six months following infection, indicating progression from subclinical to clinical hypothyroidism. The mean TSH level at baseline was 7.29 mU/L, which increased to 8.76 mU/L at six months. New-onset symptoms were more prevalent in these cases compared to the controls. Furthermore, the mean baseline TSH level for cases progressing to clinical hypothyroidism was significantly higher (9.17 ± 0.63 mU/L) compared to those who did not progress (6.82 ± 1.16 mU/L; p<0.001). These findings suggest that patients with subclinical hypothyroidism and a history of moderate to severe COVID-19 pneumonia should undergo periodic monitoring to ensure timely treatment initiation if overt hypothyroidism develops. [ABSTRACT FROM AUTHOR]

Background: Neuropathy is one of the most common long-standing complications of diabetes, affecting over 50% of the diabetic individuals. Managing DPN and its complications involves comprehensive care and a multidisciplinary approach. Besides pharmacological treatments, botanicals and dietary supplements that have also been found to improve symptoms of DPN without affecting glucose control. The possible role of vitamin E in the management of DPN have been postulated in various studies. The present study thus aimed to prospectively assess whether add-on treatment with vitamin E can improve treatment outcomes in diabetic peripheral neuropathy. Methods: The study included newly diagnosed patients with diabetic peripheral neuropathy for a period of initial two months. Patients were randomly allocated to either standard treatment Group (Group A) or the intervention Group (Group B). As a part of intervention, patients received vitamin E 400mg once daily in addition to the standard of care. Efficacy Parameters measured at baseline, 6 months and 12 months included changes in visual analog scoring, mean pain score, brief pain inventory and patient’s global impression of change. Treatment safety, quality of life and treatment adherence was assessed. Data was statistically analysed. Result: The study included a total of 100 patients, 50 patients in each Group. Significantly higher decrease of glycaemic measures was noted for Group B compared to Group A in terms of PPPG and serum creatinine, however, there was comparable change in HbA1c and FPG for both Groups. There was comparable significant reduction in mean VAS scoring at 6 and 12 months for Group B. Considering all the efficacy measures, there was highest reduction for the pain interference in the intervention arm (Group B), in comparison to Group A. (p<0.001). Quality of life measures and mean adherence scoring significantly increased for treatment group B as compared to A at both 6 months and 12 months of study assessments. No major safety concerns were reported during the study period. Conclusion: Our study noted that addition of vitamin E as an added supplementation to the standard of care showed benefits in terms of patient reported reduced pain interference and pain perception, which also significantly improved overall quality of life in these patients. [ABSTRACT FROM AUTHOR]

Background: Non-alcoholic fatty liver disease (NAFLD) is an influential cause of liver disease burden. However, there is no evidence-based standard of care. Considering that oxidative stress and diet deficiency of choline plays a role in the pathophysiology of hepatic damage, natural compounds such as silymarin, choline, and ursodeoxycholic acid (UDCA) represent popular therapeutic options. Aims and Objectives: The present study aimed to compare the efficacy, safety, and adherence of the silymarin-choline combination and UDCA in patients with NAFLD. Materials and Methods: A double-blind parallel arm study where 88 NAFLDdiagnosed patients were randomized to receive either silymarin-choline bitartrate or UDCA for 6 months, along with lifestyle modification recommendations. Weight, body mass index, liver enzyme levels, lipid profile parameters, homeostatic model assessment of insulin resistance, liver stiffness measurement, and liver biopsy were monitored at baseline and 6 months. Adverse events and adherence were monitored. Results: A total of 39 patients received a tablet of silymarin-choline bitartrate, while 40 received UDCA. A significant improvement was observed in aspartate aminotransferase (U/L) levels from 54.18 (17.02) to 37.23 (9.94) (P=0.000), NAFLD activity score from 6.5 (0.37) to 2.7 (1.26) (P=0.000), and transient elastography (kilopascal) scores, more in patients receiving the silymarincholine combination, whereas for those receiving UDCA, a significant improvement was observed in total cholesterol (mg/dL) from 187.88 (27.49) to 171.45 (28.47) (P=0.000) and low-density lipoprotein levels. No major safety issues were observed in both groups. Conclusion: NAFLD is currently treated by treating associated comorbidities, which cannot always stop its progression. Silymarin-choline bitartrate can be used as a better alternative to UDCA for the treatment of NAFLD. [ABSTRACT FROM AUTHOR]

This article discusses a case of disseminated tuberculosis in a patient with beta-thalassaemia major and uncontrolled type 1 diabetes mellitus. Beta-thalassaemia is a genetic blood disorder that can lead to iron overload in various organs, including the pancreas, which can result in abnormal glucose metabolism and diabetes. The patient in this case was a 31-year-old woman with beta-thalassaemia major and type 1 diabetes who presented with fever, cough, and sputum production. Laboratory tests confirmed the diagnosis of tuberculosis, and the patient was treated with anti-TB medication. The article highlights the rare association between beta-thalassaemia major, type 1 diabetes, and disseminated TB. [Extracted from the article]

Background: The isometric handgrip (IHG) test is commonly used to detect sympathetic autonomic dysfunction. Tamsulosin, approved for the management of symptomatic benign prostatic hyperplasia (BPH), acts as an antagonist for α1-adrenergic receptors (α1-AR), whereas prazosin, an α 1 receptor blocker, being less selective than tamsulosin, is used as an antihypertensive agent clinically. Our objective was to investigate if there is a distinction in blood pressure (BP) increase during IHG exercise between individuals with essential hypertension taking tamsulosin compared to those taking prazosin., Materials and Methods: A cross-sectional observational study was performed on 50 subjects receiving tablet prazosin and 47 subjects receiving tamsulosin, who were asked to undergo an IHG test. Pre- and posttest BP was recorded for both the groups, and the difference in diastolic BP (DBP) (delta DBP) was compared between the groups and to their respective baseline values., Results: Post-IHG test, mean DBP was found to be 93.98 ± 9.13 mm Hg in the prazosin group and 101.00 ± 12.05 mm Hg in the tamsulosin group, respectively. The change of delta DBP in the tamsulosin group was significant, but the prazosin group showed an insignificant rise in DBP., Conclusion: Prazosin, being less selective than tamsulosin in terms of α1 receptor antagonism, showed suppression of BP during IHG. Tamsulosin demonstrates high selectivity for prostatic receptors while showing minimal affinity for vascular receptors. As a result, its impact on BP is expected to be minimal., (© Journal of the Association of Physicians of India 2024.)

Background: Gestational hypertension carries a high-risk for adverse maternal and fetal outcomes, and it can also develop into preeclampsia. A relative decrease in parasympathetic and increase in sympathetic activity has been seen in normal pregnancy which returns to baseline after delivery. The present study aimed to detect any abnormality in sympathetic neurofunction in gestational hypertension and to identify its possible association with the development of preeclampsia/eclampsia., Methods: A prospective, observational study was carried out among gestational hypertensive patients between 24 and 26 weeks of gestation, who were sent to clinical pharmacology clinics for autonomic neurofunction testing, along with their 24-hour urinary protein testing reports. Preisometric handgrip (IHG) and post-IHG differences in diastolic blood pressure (DBP) were noted. The association between Δ DBP and the development of eclampsia/preeclampsia was probed., Results: A total of 52 pregnancy-induced hypertension (PIH) participants, both multigravida ( n = 15) and primigravida ( n = 37) were included in one arm (PIH arm), and 52 matched (age and gravida) pregnant women, those do not have PIH included in another arm for comparative analysis. On comparing the PIH arm and normal arm, prehand grip DBP ( p ≤ 0.0001), posthand grip DBP, and Δ DBP were significantly higher in the PIH arm. Correlation between Δ DBP and 24 hours' proteinuria was observed in the PIH arm, with a significant positive correlation., Conclusion: A high-rise in DBP post-IHG exercise is associated with gestational hypertensive mothers and this rise is strongly correlated with the development of preeclampsia and eclampsia, which suggests that addressing sympathetic hyperactivity could be a potential area to target therapeutics while managing gestational hypertension., (© Journal of the Association of Physicians of India 2024.)