Impact of Lifestyle Intervention for Management of the Modern Life Scourge of Polycystic Ovarian Syndrome among Girls – A Case Series

Polycystic ovarian syndrome (PCOS) is a complex endocrine, metabolic and reproductive disorder. It affects various body organs. Oligomenorrhea, hirsutism, insulin resistance, obesity and polycystic ovaries are its hallmark features. Usual medicines for PCOS focus on blood glucose and hormonal regulation. Diet, exercise and lifestyle changes for losing weight provide relief from symptoms. We describe here eight PCOS cases enrolled in an RCT. The study aimed to ascertain the impact of the lifestyle intervention for management of polycystic ovarian syndrome among girls. Anthropometric assessments and biochemical parameters, including reproductive hormones and insulin resistance, were performed at baseline and after 6 months of intervention, change in their health profile was noted. After intervention, menstrual regularity was achieved in all cases. The average weight loss was 4.07 kg (range 2.5–14 kg). The average BMI reduced from 26.6 to 25.0 and waist circumference from 94.1 to 86.6. At the end of the intervention, five cases had normal ovarian size, LH:FSH was normal in three cases. Out of six with insulin resistance, only one tested positive after intervention. One of the subjects said “I am very satisfied with the treatment. Almost all of my problems have been resolved – periods are regular, lab reports are normal, mood has improved, weight has reduced; other people ask me how I have lost weight.” Simple changes in lifestyle can easily provide relief in PCOS cases without any medical intervention

Fall in Vitamin D Levels during Hospitalization in Children

Plasma levels of 25-hydroxyvitamin D [25(OH)D] were measured by competitive Electrochemiluminescence Immunoassay (ECLIA) in 92 children (67 boys, 25 girls) aged 3 months to 12 years at admission to hospital (timepoint 1, T1) and at discharge (timepoint 2, T2). There was a significant fall in the mean 25(OH)D from T1 (71.87 ± 27.25 nmol/L) to T2 (49.03 ± 22.25 nmol/L) (mean change = 22.84 nmol/L, P value = 0.0004). Proportion of patients having VDD (levels <50 nmol/L) at admission (25%, 23/92) increased significantly at the time of discharge (51.09%, 47/92) (P=0.0004). There was a trend towards longer duration of hospital stay, requirement of ventilation and inotropes, development of healthcare-associated infection, and mortality in vitamin D deficient as compared to nondeficient patients though the difference was statistically insignificant. In conclusion, vitamin D levels fall significantly and should be monitored during hospital stay in children. Large clinical studies are needed to prospectively evaluate the effect of vitamin D supplementation in vitamin D deficient hospitalized children on various disease outcome parameters

Evaluation of preoperative carbohydrate loading compared to preoperative fasting for enhanced recovery after elective gynecological surgeries

Background: This study aimed to evaluate the impact of preoperative carbohydrate loading on insulin resistance and clinical outcomes in patients undergoing elective gynecological surgeries. Methods: A single-center, parallel-group, randomized controlled study was conducted at the Post Graduate Institute of Medical Education and Research, Chandigarh, India. Thirty-nine patients were randomized into two groups: the carbohydrate loading group (CHO, n=20) received 600 ml of a carbohydrate-rich drink the day before surgery and 200 ml two hours before surgery; the control group (CO, n=19) fasted overnight. Results: Baseline serum insulin, blood glucose, and insulin resistance levels were similar between the groups. Two hours before surgery, the CO group had significantly higher serum insulin levels (7.5±5.6 IU/ml) compared to the CHO group (4.5±2.9 IU/ml) (t=2.08, p=0.04). Insulin resistance was also higher in the CO group (1.9±1.6) compared to the CHO group (0.9±0.6) (t=2.40, p=0.02). Seventy-five percent of the CHO group regained bowel sounds within 24 hours post-surgery, compared to seventy-three percent of the CO group, who achieved bowel sounds after 24 hours (χ²=9.24, p=0.02). No significant differences were observed in postoperative mobilization, urinary catheter removal, fever, nausea, vomiting, length of hospital stay, or surgical site infections. Conclusions: Preoperative carbohydrate loading reduces insulin resistance and facilitates faster bowel recovery without increasing postoperative complications in elective gynecological surgery

Fracture of neck of femur with fracture of posterior column of acetabulum: a rare case of floating hip

Injuries around the hip joint are one of the most common orthopedic injuries and these types of injuries are grossly debilitating until treated properly. Simultaneous occurrence of fracture of proximal femur with fracture of ipsilateral acetabulum or pelvis is termed as floating hip injury. These injuries are very rare, only to be found 1 in 10,000 as well as there is lack of literature support regarding proper treatment protocol. Here we are going to present a case of fracture of neck of left femur along with fracture of left acetabulum in a 45 years old male undergone road traffic accident.

GCM2 Silencing in Parathyroid Adenoma is associated with Promoter Hypermethylation and Gain of Methylation on Histone 3

PURPOSE: Glial cells missing 2 (GCM2), a zinc finger-transcription factor, is essentially required for the development of parathyroid glands. We sought to identify if the epigenetic alterations in the GCM2 transcription are involved in the pathogenesis of sporadic parathyroid adenoma. In addition, we examined the association between promoter methylation and histone modifications with disease indices. EXPERIMENTAL DESIGN: mRNA and protein expression of GCM2 were analyzed by RT-qPCR and immunohistochemistry in 33 adenomatous and 10 control parathyroid tissues. DNA methylation and histone methylation/acetylation of GCM2 promoter were measured by bisulfite sequencing and ChIP-qPCR. Additionally, we investigated the role of epigenetic modifications on GCM2 and DNA methyltransferase 1 (DNMT1) expression in PTH-C1 cells by treating with 5-aza 2\u27deoxycytidine (DAC) and BRD4770 and assessed for GCM2 mRNA and DNMT1 protein levels. RESULTS: mRNA and protein expression of GCM2 were lower in sporadic adenomatous than in control parathyroid tissues. This reduction correlated with hypermethylation (P\u3c0.001) and higher H3K9me3 levels in GCM2 promoter (P\u3c0.04) in adenomas. In PTH-C1 cells, DAC treatment resulted in increased GCM2 transcription and decreased DNMT1 protein expression, while cells treated with the BRD4770 showed reduced H3K9me3 levels but a non-significant change in GCM2 transcription. CONCLUSION: These findings suggest the concurrent association of promoter hypermethylation and higher H3K9me3 with the repression of GCM2 expression in parathyroid adenomas. Treatment with DAC restored GCM2 expression in PTH-C1 cells. Our results showed a possible epigenetic landscape in the tumorigenesis of parathyroid adenoma and also that DAC may be promising avenues of research for parathyroid adenoma therapeutics

Imatinib Inhibits GH Secretion From Somatotropinomas

Background: Imatinib, a tyrosine kinase inhibitor, causes growth failure in children with chronic myeloid leukemia probably by targeting the growth hormone (GH)/insulin like growth factor-1 (IGF-1) axis. We aim to explore the imatinib targets expression in pituitary adenomas and study the effect of imatinib on GH secretion in somatotropinoma cells and GH3 cell line.Materials and Methods: The expression pattern of imatinib's targets (c-kit, VEGF, and PDGFR-α/β) was studied using immunohistochemistry and immunoblotting 157 giant (≥4 cm) pituitary adenomas (121 non-functioning pituitary adenomas, 32 somatotropinomas, and four prolactinomas) and compared to normal pituitary (n = 4) obtained at autopsy. The effect imatinib on GH secretion, cell viability, immunohistochemistry, electron microscopy, and apoptosis was studied in primary culture of human somatotropinomas (n = 20) and in rat somato-mammotroph GH3 cell-line. A receptor tyrosine kinase array was applied to human samples to identify altered pathways.Results: Somatotropinomas showed significantly higher immunopositivity for c-kit and platelet-derived growth factor receptor-β (PDGFR-β; P &lt; 0.009 and P &lt; 0.001, respectively), while staining for platelet-derived growth factor receptor-α (PDGFR-α) and vascular endothelial growth factor (VEGF) revealed a weaker expression (P &lt; 0.001) compared to normal pituitary. Imatinib inhibited GH secretion from both primary culture (P &lt; 0.01) and GH3 cells (P &lt; 0.001), while it did not affect cell viability and apoptosis. The receptor tyrosine kinase array showed that imatinib inhibits GH signaling via PDGFR-β pathway.Conclusion: Imatinib inhibits GH secretion in somatotropinoma cells without affecting cell viability and may be used as an adjunct therapy for treating GH secreting pituitary adenomas