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Purpose: To study the prevalence, subtypes, and risk markers for the development of gonadal germ cell tumors (GCT's) among disorders of sexual differentiation (DSD) patients with the Y chromosome. Materials and Method: Design: A retrospective review of the patient's case records from 2010 to 2020 in Government Medical College, Thiruvananthapuram, India was studied. The study participants included 54 subjects with DSD containing the Y chromosome. Demographic data, external masculinization scoring, associated congenital anomalies, karyotyping, intraoperative findings such as gonadal location and internal genital ducts, histopathology of the resected gonads, and its immunohistochemistry were collected. The prevalence of gonadal GCT's was estimated from paraffin-embedded gonadectomy samples (S = 82). Results: The median age of occurrence of gonadal GCT's was 18 years. The prevalence of malignant gonadal GCT's was highest among the PAIS group (19.2%) followed by gonadal dysgenesis (15.8% each in MGD and CGD) and least among CAIS (7.7%) (p < 0.01). The most common type of malignant gonadal GCT's in the descending order of frequency was dysgerminoma, seminoma, mixed GCT, and yolk sac tumor. Multivariance logistic analysis showed post-puberty and the presence of congenital anomalies were associated with the occurrence of gonadal GCT's (P < 0.01). Conclusion: The overall prevalence of gonadal GCT's (malignant and premalignant) among DSD with Y chromosomes is nearly 25%. Dysgerminoma is the most common malignant gonadal GCT's. Age at or above 18 years and the presence of congenital anomalies like renal agenesis, retroperitoneal vascular defects, and congenital diaphragmatic hernia were independent risk markers for the development of gonadal GCT's. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Clinical biochemistry reference intervals (RIs) play a crucial role in interpreting patient test results and making informed clinical decisions. Using data from an ongoing Indian Council of Medical Research-National task force study on healthy women, normative ranges for commonly analyzed biochemical analytes were established. MATERIALS AND METHODS: A total of 13,181 women of reproductive age (18-40 years) were recruited from different urban and rural regions of the country, of which 9898 women signed an informed consent were included. Among these, women having features of hyperandrogenism, menstrual cycle irregularities, and comorbidities were excluded. RIs of 22 analytes were computed in the remaining 938 women controls. To estimate the 95% range of the reference distribution, the limits of the 2.5th percentile and the 97.5th percentile were used in the study. RESULTS: Mean ± standard deviation of age and body mass index of participants was 30.12 ± 6.32 years and 22.8 ± 3.36 kg/m2 respectively. Centiles (2.5th-97.5th) of liver function parameters, lipid parameters, glycaemic parameters, and renal parameters are presented. No significant difference in analytes was observed in relation to the area of residence, and age groups except in albumin (P = 0.03). The distribution of most of the parameters was consistent with the various RI studies conducted in India as well as other countries. CONCLUSION: This is the first study generating biochemical RIs data among a large representative sample of healthy reproductive-age women recruited using a robust design across the country. The resource may serve as a reference range for common biochemical analytes for future in this age group. [ABSTRACT FROM AUTHOR]

The objective of the study was to present a case report on a phenotypic male mixed gonadal dysgenesis (MGD) who presented with hemoptysis due to secondary lung metastasis from dysgerminoma. Phenotypic male MGD (45, X/46, XY) with primary infertility and hemoptysis participated in the study. This study was conducted at a tertiary care center. Laparoscopic visualization of gonads and presence of Müllerian/ Wolffian structures were ascertained. Gonadectomy of intra abdominal dysgenetic gonad were done. Fluorescence in situ hybridization analysis was done in gonadal tissue to find the presence of Y chromosome. Intra-abdominal gonad showed dysgerminoma changes. Müllerian structures in the form of rudimentary uterus and fallopian tubes were seen. Left inguinal gonad showed normal testicular structures. Chemotherapy for secondary lung metastasis contemplated. [ABSTRACT FROM AUTHOR]

Type 1 diabetes mellitus (T1DM) has a wide presence in children and has a high mortality rates. The disease, if left unmanaged, poses various challenges to the patient and healthcare providers, including development of diabetic complications and thus decreasing the life expectancy of the affected child. The challenges of T1DM include awareness of the disease that is very poor among the general public and also in parents of T1DM children along with the health care professionals. The challenge of lack of awareness of T1DM can be met by increasing public awareness programs, conducting workshops for diabetes educators regarding T1DM in children, newsletters, CMEs, online courses, and by structured teaching modules for diabetes educators. Diagnosis of T1DM was a challenge a few decades ago but the situation has improved today with diagnostic tests and facilities, made available even in villages. Investigation facilities and infrastructure, however, are very poor at the primary care level, especially in rural areas. Insulin availability, acceptability, and affordability are also major problems, compounded by the various types of insulin that are available in the market with a varied price range. But effective use of insulin remains a matter of utmost importance. [ABSTRACT FROM AUTHOR]

Background: Endogenous sex hormones and sex hormone-binding globulins (SHBG) determine the risk of occurrence of Type 2 diabetes mellitus (T2DM) in postmenopausal (PM) women., Aims: To investigate the association between sex hormones (estradiol and testosterone) and SHBG with plasma glucose, fasting insulin levels, HbA1c, and homeostasis model assessment insulin resistance (HOMA-IR) and also to investigate independent role of sex hormones in the occurrence of T2DM among PM., Settings and Design: Cross-sectional case-control study., Subjects and Methods: The present study was conducted in Endocrinology department Guwahati, Medical College, Assam, India. The participants included cases - PM women with T2DM ( n = 100) and controls - Healthy PM women ( n = 86). The medical history, clinical examination, and investigations including total testosterone, serum estradiol, SHBG, free testosterone index, high sensitivity C-reactive protein (hs-CRP), lipid profile, fasting insulin, fasting plasma glucose (FPG), and postprandial plasma glucose (PPPG) were done and analyzed. HOMA-IR was calculated., Statistical Analysis: Pearson correlation between sex hormone level and SHBG with plasma glucose, HbA1c, fasting insulin, hs-CRP, and HOMA-IR was seen. Multivariance logistic analysis was done to find the independent association between sex hormones/SHBG and the occurrence of T2 DM. P < 0.05 was considered statistically significant., Results: Among the cases, a significant positive correlation was found between total testosterone/free testosterone index with waist circumference, FPG PPPG, HbA1c, fasting insulin, and HOMA-IR, and a significant negative correlation was found between SHBG and FPG, PPPG, HbA1c, fasting insulin, and HOMA-IR ( P < 0.01). The logistic analysis showed total testosterone levels and SHBG are independently associated with the occurrence of T2 DM among PM ( P < 0.01)., Conclusion: SHBG and testosterone levels in PM can be a risk marker for the development of T2DM., Competing Interests: There are no conflicts of interest., (Copyright: © 2021 Journal of Mid-life Health.)

The current coronavirus disease (COVID-19) pandemic is showing no signs of abatement and result in significant morbidity and mortality in the infected patients. Many therapeutic agents ranging widely between antivirals and anti-inflammatory drugs have been used to mitigate the disease burden. In the deluge of the drugs being used for COVID-19 infection, glucocorticoids (GCs) stand out by reducing mortality amongst in-hospital severe-to-critically ill patients. Health-care practitioners have seen this as a glimmer of hope and started using these drugs more frequently than ever in clinical practice. The fear of mortality in the short term has overridden the concern of adverse long-term consequences with steroid use. The ease of availability, low cost, and apparent clinical improvement in the short term have led to the unscrupulous use of the steroids even in mild COVID-19 patients including self-medication with steroids. The use of GCs has led to the increasing incidence of hyperglycemia and consequent acute complications of diabetic ketoacidosis and mucormycosis in COVID-19 patients. There is an urgent need to dissipate information about optimum management of hyperglycemia during steroid use. In view of this, the Endocrine Society of India has formulated this position statement about the diagnosis and management of hyperglycemia due to the use of GCs in patients with COVID-19 infection., Competing Interests: There are no conflicts of interest., (Copyright: © 2021 Indian Journal of Endocrinology and Metabolism.)

Type 1 diabetes mellitus (T1DM) has a wide presence in children and has a high mortality rates. The disease, if left unmanaged, poses various challenges to the patient and healthcare providers, including development of diabetic complications and thus decreasing the life expectancy of the affected child. The challenges of T1DM include awareness of the disease that is very poor among the general public and also in parents of T1DM children along with the health care professionals. The challenge of lack of awareness of T1DM can be met by increasing public awareness programs, conducting workshops for diabetes educators regarding T1DM in children, newsletters, CMEs, online courses, and by structured teaching modules for diabetes educators. Diagnosis of T1DM was a challenge a few decades ago but the situation has improved today with diagnostic tests and facilities, made available even in villages. Investigation facilities and infrastructure, however, are very poor at the primary care level, especially in rural areas. Insulin availability, acceptability, and affordability are also major problems, compounded by the various types of insulin that are available in the market with a varied price range. But effective use of insulin remains a matter of utmost importance.

Objectives: To define acute optic neuritis following infection with chikungunya virus (CHIKV) and to determine the efficacy of treatment with corticosteroids of acute optic neuritis., Methods: This was an observational study involving 10 patients, who were confirmed cases of infection with CHIKV with acute optic neuritis in one or both eyes. A complete ophthalmic examination was performed in all cases. All 10 patients were treated with intravenous methylprednisolone for 3 days, followed by oral prednisolone for 2 weeks, thereafter reducing the dose of prednisolone over 1 month., Results: Of the 10 patients in the study, seven were male and three female. Seven patients had unilateral optic neuritis and three patients had bilateral optic neuritis. Initial visual acuity in the affected eyes ranged from perception of light to visual acuity of 6/6. After treatment, nine out of 10 patients improved to visual acuity of 6/12 or better. Color vision became normal in eight patients in our study. After treatment, a relative afferent pupillary defect persisted in four patients and six patients had normal pupils. A statistically significant improvement in vision was found after treatment (p ≤ 0.001). Visual field (HFA FF 120) examination showed various types of defect. Visual fields returned to normal in four patients, while the remaining six patients had persistent diffuse visual field defects., Conclusions: CHIKV infection may cause acute-onset of visual loss due to acute optic neuritis. Prompt recovery of vision may follow steroid therapy. Physicians should be aware of the possibility of acute optic neuritis following CHIKV infection so that a preventable cause of vision loss can be treated effectively., (Copyright © 2010 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.)

Metastatic malignancies of the hand are rare and usually develop from lung, breast, or kidney tumors. Metastases from tumors and sarcomas of the gastrointestinal system are even more uncommon. The authors report a case of differentiated adenocarcinoma of the colon in a 76-year-old man who presented with distal phalangeal metastasis and osteolysis in the form of a painful swelling at the tip of the right little finger of 6 months duration. Computed tomography of the abdomen and colonoscopy revealed a mass in the transverse colon. Diagnosis was confirmed by biopsy. Treatment was given with palliative local radiation and systemic chemotherapy. After 4 weeks of chemotherapy, the patient discontinued treatment and eventually succumbed to the disease., (Copyright © 2010 Elsevier Inc. All rights reserved.)

Primary tuberculous osteomyelitis of the sternum is a rare clinical entity. Sternal tuberculosis can result from direct extension of the disease from hilar lymph nodes, hematogenous or lymphatic dissemination from other sites, and following BCG vaccination in children. An unusual case of primary tuberculous osteomyelitis of the sternum that presented with a swelling and pain over the manubrium sterni is reported. Diagnosis was confirmed by demonstration of epithelioid granulomas and acid-fast bacilli and a positive M. tuberculosis culture from the aspirate taken from the sternal swelling. Extensive diagnostic work-up did not reveal any other focus of tuberculosis in this case. The patient was successfully managed with anti-tubercular treatment., (Copyright 2009 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.)

Hypohydrotic ectodermal Dysplasia (Christ-Siemens Touraine syndrome) is a rare genetic disorder that affect several ectodermal structures. The condition is usually inherited as X-linked recessive trait, in which gene is carried by females and manifested in males. The manifestations may vary in individuals and usually involves skin, hair, nail, sweat and sebaceous glands. Hypohydrotic Ectodermal Dysplasia with classical features in two siblings is reported here.