Etiological Spectrum with Diagnosis and Prognosis of Central Diabetes Insipidus needs Long Term Followup: A Single Centre Experience

Introduction: Central Diabetes insipidus (CDI) is a rare disorder caused vasopressin deficiency characterized by the excretion of copious volumes of unconcentrated urine. Objective: To assess the etiological,clinical, biochemical and radiological spectrum of Central DI in our institute and long term follow up of these cases. Material and Methods:32 patients with Central DI admitted in Department of Endocrinology,Guwahati Medical College, Assam in the last 2.5 years were included.Detailed clinical assessment, biochemical evaluation and MRI (Magnetic Resonance imaging) brain were done in all the patients. Central DI without any identifiable cause was considered Idiopathic and those with structural lesion in hypothalamic pituitary region were considered organic. Result: Idiopathic CDI was present in 12(37.5%) patients and 20(62.5%) patients had organic CDI with acute onset of presentation.12(60%) patients with organic CDI present with neurological symptoms but 8(40%) patients had no neurological symptoms even with organic cause. Pituitary dysfunction was common in organic CDI as compared to idiopathic CDI. Paediatric patients commonly present with organic cause for CDI with low cortisol most common hormonal deficit. One patient of idiopathic CDI with normal stalk thickness at baseline presented with clinical and radiological features of  (Langerhans cell histiocytosis) on follow up. Conclusion: Organic CDI more likely to have acute onset of presentation than idiopathic CDI and even in absence of neurological features. Paediatric patients commonly have organic cause for CDI. We propose the paramount importance of long-term clinical follow-up and reassessment of endocrine function in patients with CDI for definitive diagnosis of autoimmune and inflammatory causes of idiopathic CDI and timely treatment of pituitary ypofunction

Post-surgery Quality of Life in Patients with Acromegaly Using SF36 Quality of Life Questionnaire-prospective Study

Introduction: Acromegaly is chronic progressive disease with multisystem involvement characterised by an excess secretion of growth hormone and increased circulating insulin like growth factor 1 concentration.Aims and Objectives: To assess surgical outcome of acromegaly patients at tertiary care institute using SF 36 quality of life questionnaire. SF-36 scores comprise 3 components: the physical component summary (PCS), the mental component summary (MCS) and role-social component summary (RCS).30 acromegaly patients admitted in Guwahati medical college were enrolled in study and followed up post operatively for surgical remission. All participants completed the SF-36 preoperatively, 1 year and 2 years postoperatively.Material and Method: Out of 30 patients 6 patients had surgical remission post operatively on the basis of postoperative glucose suppressed GH Level done after 12 weeks. Preoperatively subscale scores (physical functioning, role physical, general health) which were below the set standards for the normal population show significant postoperative improvements along with mental health (MH) scores. Similarly, PCS, MCS and RCS scores changed significantly after surgery. We also compared the QOL of 6 patients whose peak GH level was < 0.4 µg/L during postoperative oral glucose tolerance testing with those patients whose nadir GH level was ≥ 0.4 µg/L. There was significant difference between partial and complete remission group in subscale score role physical, social function and mental health. Similarly, PCS and RCS score significantly different in partial and complete remission group than MCS score.Conclusions: QOL is considerably reduced in patients with acromegaly compared to general population which improves significantly after surgical treatment. Patients achieving the new remission criteria had significant improvement in physical and social components than those who did not

Urinary C-peptide Creatinine Ratio and Its Correlation with Parameters of Metabolic Syndrome

To assess the correlation between urinary C peptide creatinine ratio with serum C peptide, serum insulin and its correlation with clinical and biochemical parameters of metabolic syndrome. A total of 100 subjects more than 18 years of age with metabolic syndrome according to ATP III criteria with 100 controls were included in a prospective observational study for a period of 1.5 years. Individual parameters of metabolic syndrome was higher in females with hypertriglyceridemia was most common and hyperglycaemia least common parameter of metabolic syndrome. Fasting urinary C peptide creatinine ratio and Stimulated urinary C peptide correlate significantly with fasting serum C peptide (p2.7 can be used as a parameter to distinguish individual with and without metabolic syndrome. Urinary C peptide creatinine ratio correlate with serum C peptide and parameters of metabolic syndrome and can be used as a non-invasive simple tool to assess insulin resistance and also to distinguish patients with and without metabolic syndrome

Clinical profile of primary hyperparathyroidism in Northeast India: a single centre experience

Background: A retrospective study of the presentation of primary hyperparathyroidism was done at a tertiary care centre in northeast India and was compared with variable features in other parts in India and worldwide.Methods: The clinical presentation, biochemical parameters, radiological and histopathology findings of 27 subjects of primary hyperparathyroidism who presented to us over a period of 5 years were retrospectively analysed. Chi-square test, student t test and 'one way ANOVA' were used to compare different variables. Statistical significance was set at p&lt;0.05.Results: The age distribution ranged from as young as 13 years to 72 years (39±16.7). The male:female ratio was 1:1.25. The duration of symptoms at presentation ranged from 2 to 72 months (21.7±20.3). The most common presentation was bone pain in 59.2% of cases, followed by proximal myopathy (48.1%), fatigue (44.4%), abdominal pain (44.4%), constipation (11.1%), hypertension (18.5%), palpable neck swelling (22.2%), limb deformity (22.2%) and fracture (14.8%). The mean serum calcium was 12.2±0.87mg/dl. Parathyroid adenoma was localized radiologically in all patients and single adenoma was the most common cause in 96.3%. Left inferior parathyroid adenoma was the most common site of involvement in 51.8%.Conclusions: Hyperparathyroidism at our centre in northeast India has a classic symptomatic presentation with severe bone and renal involvement and younger age at diagnosis, and equal gender distribution

AN AYURVEDIC PERSPECTIVE TO COGNITIVE BEHAVIOURAL THERAPY VIS A VIS SATWAVAJAYA CHIKITSA

Ayurveda, the science of life is regarded as the complete health care system for prevention as well as treatment of different diseases. It emphasizes on sustaining the equilibrium of body, mind and soul for the maintenance of proper health. Based on these three aspects Ayurveda suggested three treatment modalities i.e. Daivavyapashraya, Yuktivyapashraya and Satwavajaya Chikitsa. Satwavajaya is the comprehensive psychosomatic-spiritual approach to the preservation and treatment of both physical and mental health and is described as the major non-pharmacological approach to the treatment of different diseases. Though Psychotherapy is only a century old in western medicine, it is nothing new in Ayurveda, as the ancient system was well aware of psychic means of curing diseases. In fact, in the history of Ayurvedic medicine, Psychotherapy is as old as drug therapy. When the contemporary art of psychotherapy and the knowledge of ancient science of Ayurveda is integrated, it becomes a powerful combination. Cognitive behavioral therapy which is a part of psychotherapy is widely in practice in the present era. This paper is an attempt to highlight the practice of age old concept of mental and health termed as Satwavajaya chikitsa and its current practice in the contemporary science as Cognitive Behavioral Therapy for the management of psychic disorders

A CRITICAL ANALYSIS OF NASAPRATINAHA IN RELATION TO CONTEMPORARY CONCEPT OF NASAL OBSTRUCTION

Nasal obstruction or blocked nose or stuffy nose is a common problem seen in E.N.T. as well as general practice. Patients visit the doctors with varying conditions of nasal obstruction- unilateral or bilateral, incomplete or complete, temporary or persistent etc. along with various others associated complaints. Depending on the causes of nasal obstruction, management also varies; which ranges from behavioural changes (i.e. avoiding exposure to inciting factors) and use of oral as well as topical drugs to invasive surgeries. The treatment can thus be medical or surgical. The existing treatment practices have their own merits and demerits, indications and contraindications, recurrences and complications etc. too, and accordingly the outcome differs. While relief is seen in many, many others have to live with a persistent stuffy nose throughout their life. In Ayurveda, detailed description of diseases of nose is found, under the broad heading of ‘Nasa Rogas’. Among these ‘Nasanaha’ or ‘Nasapratinaha’ is an important entity which is characterized by the clinical features of blocked nose. Ayurvedic Acharyas, have described about ‘Nasapratinaha’ along with the management in their texts. A systematic literary review of the Ayurvedic literature regarding ‘Nasapratinaha’ along with the various disease entities of contemporary science having similar presentations have been conducted in this study.

A CLINICAL STUDY ON KSHARAKARMA IN THE MANAGEMENT OF NASAPRATINAHA WITH SPECIAL REFERENCE TO HYPERTROPHIED INFERIOR TURBINATES

Nasal obstruction or stuffy nose, is one of the commonest presenting complaints in otorhinolaryngology clinics. If defects of the nasal septum are excluded, most commonly the problem can be attributed to the dysfunction of the nasal turbinates, mostly the inferior turbinates. Although every person experiences some degree of turbinate dysfunction at some point in life, persistent dysfunction is also not uncommon, involving approximately 50% of the population. In the short-term, the cases respond well to medical line of management which mainly constitute the use of decongestants, but their prolong use is not indicated because of health reasons. Similarly, the other medicines used, have only short-term benefits; once the inferior turbinates undergo submucosal fibrosis, then they become incapable of decongestion with medical line of management and those chronic cases of nasal obstruction need to be managed by surgical therapies only. Over the years, many surgical procedures have been employed for turbinate reduction, but incidences of complications, recurrence etc. along with the cost-factor mean that still there is much to be achieved in the management of hypertrophied turbinates of nose. Ksharakarma is a popular procedure of chemical cautery in Ayurveda, which has been used for centuries as a minimal invasive procedure for reduction of enlarged tissues. This study has been conducted to manage nasal obstruction, termed as Nasapratinaha in Ayurveda, due to hypertrophied turbinates, by application of Ksharakarma with significant results.

Bistable soliton switching dynamics in a PT\mathcal{PT}-symmetric coupler with saturable nonlinearity

We investigate the switching dynamics in a $\mathcal{PT}$-symmetric fiber coupler composed of a saturable nonlinear material as the core. In such a saturable nonlinear medium, bistable solitons may evolve due to the balance between dispersion and saturable nonlinearity, which we extend in the context of $\mathcal{PT}$-symmetric coupler. Our investigations of power-controlled and phase-sensitive switching show richer soliton switching dynamics than the currently existing conventional counterparts, which may lead to ultrafast and efficient all-optical switching dynamics at very low power owing to the combined effects of $\mathcal{PT}$ symmetry and saturable nonlinearity. In addition to the input power, the relative phase of the input solitons and saturable coefficient are additional controlling parameters that efficiently tailor the switching dynamics. Also, we provide a suitable range of system and pulse parameters that would be helpful for the practical realization of the coupler to use in all-optical switching devices and photonic circuits.Comment: 7 pages, 9 figure

Empty sella syndrome - beyond being an incidental finding

Introduction: Empty sella is characterized by the herniation of the subarachnoid space within the sella, which is often associated with some degree of flattening of the pituitary gland. This study was undertaken to evaluate the clinical and hormonal profile in patients with empty sella. Aims and Objectives: To evaluate the clinical and hormonal profile of the patients with an empty sella. Materials and Methods: Patients undergoing a CT/MRI at our center, for various reasons but with the finding of the empty sella were included in this study. A detailed history and clinical examination was done. Apart from routine tests, hormonal evaluation included serum thyroid stimulating hormone, T4, cortisol (8 am), prolactin, total testosterone, follicle stimulating hormone, leutinizing hormone, and fasting Insulin like Growth factor 1 (IGF 1) were done. Results: A total of 34 patients, diagnosed radiologically to have empty sella, were evaluated and of them 24 had primary empty sella (PES) and 10 had secondary empty sella (SES). In subjects with PES, 12 out of 24 (50%) had endocrine dysfunction. The most common endocrine dysfunction noted was hyperprolactinemia, which was seen in 5 (20.8%) patients and the most common hormonal deficiency was isolated GH deficiency seen in four patients (12.5%). Conclusion: The high incidence of endocrine abnormalities in patients with PES mandates that these patients should routinely be subjected to endocrine evaluation to detect these deficiencies early, and appropriate replacement instituted where necessary, thus ensuring them of a better quality of life