Biochemical Profile Of Patients Research Articles

Matrix Calculi in the Urinary Tract- A Prospective Cohort Study

Introduction: Matrix calculi are infrequently encountered in the urinary tract. Their biochemical composition and unusual radiological appearance make it difficult to differentiate them from fungal balls or tumours of the urinary tract. Aim: To study radiological, biochemical and microbiological characteristics of matrix calculi in the urinary tract and their management. Materials and Methods: This prospective observational cohort study was conducted at a tertiary care hospital, from July 2016 to August 2019. Analysis of the clinical, radiological and biochemical profiles of patients who were found to have matrix renal or ureteric calculi was done. These patients underwent Percutaneous Nephrolithotomy (PCNL) or Ureteroscopic Lithotripsy (URSL) and the stone material evacuated was sent for analysis. Data was analysed using Microsoft Excel, version 2016. Results: Matrix urinary stones were found in a total of 21 patients, out of which 15 were renal matrix calculi and six were ureteric matrix calculi. Mean age of the patient population was 44.5 years. Male to female ratio was 1.33:1. Total 7 (33.3%) patients were found to have Chronic Kidney Disease (CKD). The mean radiodensity of all the stones was 403 Hounsfield Unit (HU). Six patients also had a concomitant crystalline calculus. Histopathological analysis of these matrix calculi revealed an amorphous lamellated appearance. The postoperative course of all the patients was uneventful. One patient presented with a non matrix stone in the opposite kidney after one year of follow-up. Conclusion: Matrix calculi of the urinary tract are usually radiolucent on plane radiographs and have a low radiodensity on Computerised Tomography (CT) scan. Biochemical analysis of these calculi shows protein to be the predominant component. These calculi are more often seen in patients with Diabetes Mellitus (DM) or CKD and are frequently associated with a positive urine culture. They can be managed successfully with a combination of PCNL and URSL. Complete clearance is necessary to minimise recurrence.

Effect of Metformin on Anthropometric Measurements and Hormonal and Biochemical Profile in Patients with Prediabetes.

Objectives Metformin is the most widely preferred first-line oral antidiabetic agent that results in clear benefits in blood sugar regulation and diabetes-related complications. This study is aimed at assessing the effect of metformin on anthropometric, hormonal, and biochemical parameters in patients with prediabetes or insulin resistance. Methods A prepoststudy was conducted among 52 patients with prediabetes or insulin resistance who met the inclusion criteria. Weight, body mass index (BMI), and waist circumference were measured before and 12 months after metformin treatment. Serum concentrations of sex steroids, gonadotropins, and lipids were also assessed. Homeostasis model assessment (HOMA) index and quantitative sensitivity check (QUICKI) index scores were calculated before metformin treatment and after 12 months of use. Results After 12 months of metformin treatment, female patients had significant reduction in weight, BMI, and waist circumference after adjusting for age. Metformin use for 12 months resulted in significant reduction in mean fasting blood glucose and HbA1c in females only. Total cholesterol decreased significantly among men only and serum HDL-C showed a significant rise among females only. Serum LDL-C and triglycerides did not change significantly in females and males. Our study did now significant changes in ACTH and cortisol levels in both females and males after metformin treatment. Metformin use resulted in significant increase in luteinizing hormone (LH) and progesterone levels in males, while it was associated with significant increase in prolactin, follicular stimulating hormone (FSH), and dehydroepiandrostenedione-sulphate (DHEA-S) levels and significant decrease in total testosterone level in females. Conclusion Metformin treatment in females with prediabetes reduces BMI, waist circumference, fasting blood glucose, and HbA1c. The changes in the studied parameters differed significantly according to sex.

Platelet Phenotype Analysis of COVID-19 Patients Reveals Progressive Changes in the Activation of Integrin αIIbβ3, F13A1, the SARS-CoV-2 Target EIF4A1 and Annexin A5.

Background: The fatal consequences of an infection with severe acute respiratory syndrome coronavirus 2 are not only caused by severe pneumonia, but also by thrombosis. Platelets are important regulators of thrombosis, but their involvement in the pathogenesis of COVID-19 is largely unknown. The aim of this study was to determine their functional and biochemical profile in patients with COVID-19 in dependence of mortality within 5-days after hospitalization.Methods: The COVID-19-related platelet phenotype was examined by analyzing their basal activation state via integrin αIIbβ3 activation using flow cytometry and the proteome by unbiased two-dimensional differential in-gel fluorescence electrophoresis. In total we monitored 98 surviving and 12 non-surviving COVID-19 patients over 5 days of hospital stay and compared them to healthy controls (n = 12).Results: Over the observation period the level of basal αIIbβ3 activation on platelets from non-surviving COVID-19 patients decreased compared to survivors. In line with this finding, proteomic analysis revealed a decrease in the total amount of integrin αIIb (ITGA2B), a subunit of αIIbβ3, in COVID-19 patients compared to healthy controls; the decline was even more pronounced for the non-survivors. Consumption of the fibrin-stabilizing factor coagulation factor XIIIA (F13A1) was higher in platelets from COVID-19 patients and tended to be higher in non-survivors; plasma concentrations of the latter also differed significantly. Depending on COVID-19 disease status and mortality, increased amounts of annexin A5 (ANXA5), eukaryotic initiation factor 4A-I (EIF4A1), and transaldolase (TALDO1) were found in the platelet proteome and also correlated with the nasopharyngeal viral load. Dysregulation of these proteins may play a role for virus replication. ANXA5 has also been identified as an autoantigen of the antiphospholipid syndrome, which is common in COVID-19 patients. Finally, the levels of two different protein disulfide isomerases, P4HB and PDIA6, which support thrombosis, were increased in the platelets of COVID-19 patients.Conclusion: Platelets from COVID-19 patients showed significant changes in the activation phenotype, in the processing of the final coagulation factor F13A1 and the phospholipid-binding protein ANXA5 compared to healthy subjects. Additionally, these results demonstrate specific alterations in platelets during COVID-19, which are significantly linked to fatal outcome.

Early metabolic support for critically ill trauma patients: A prospective randomized controlled trial.

There is a lack of consensus regarding the optimal nutritional support for trauma patients. We hypothesize that early postinjury metabolic support focusing on adequate protein would modify the metabolic signature and alter the inflammatory environment for critically ill trauma patients. We conducted a prospective randomized controlled pilot trial for adult patients admitted to the surgical intensive care unit following traumatic injury. Patients were randomized to receive early metabolic support (EMS) (peripheral amino acid infusions) or standard of care (enteral nutrition as soon as feasible). Routine laboratory assessments, nitrogen balance, cytokines, and metabolomic analyses were assessed at baseline and day 5 after intervention. A total of 42 trauma patients were randomized into well-balanced groups with similar age (32 years), Injury Severity Score (25), and body mass index (27.4 kg/m2). Early metabolic support provided significantly more protein (1.43 g/kg vs. 0.35 g/kg; p < 0.0001) and more calories (12.6 kcal/kg vs. 7.5 g/kg; p = 0.0012) over the first 5 days as compared with the standard of care. Early metabolic support modified protein catabolism and synthesis as demonstrated by a larger median negative nitrogen balance (-16.3 g vs. -5.3 g; p = 0.03) and a unique metabolomic profile at day 5. The biochemical profile of patients who received EMS was defined by greater declines in circulating levels of stress hormone precursors and increased levels of amino acids. The inflammatory response following EMS resulted in a greater decrease in interleukin-1B (p = 0.02) and increase in soluble interleukin-6 receptor (p = 0.01) between baseline and day 5 as compared with the standard of care. The EMS group had a decreased length of stay (15 vs. 22 days) and decreased surgical intensive care unit length of stay (8 vs. 9 days); however, this disappeared after adjustment for Injury Severity Score in this small population. Early metabolic support with amino acid is safe, modifies metabolism, and may downregulate the inflammatory state associated with significant trauma, warranting a larger trial to assess for improved outcomes. Therapeutic/Care Management; Level II.

Diagnostic comparison of biochemical profile in patients with Covid-19, dengue and Acute Febrile illness: Implications for patient management

PurposeAlthough there are specific laboratory tests available for the diagnosis of Covid-19 and dengue, during the present pandemic era of prioritized focus on Covid-19 assessment, there are possibilities that persons with dengue may remain undiagnosed. The present study explores the role of biochemical markers in the differential diagnosis of Covid-19 and dengue. MethodsA total of 212 participants with Acute Febrile Illness were tested for Covid-19 and dengue at the secondary care hospital, Civil Hospital Narwana, Haryana, India. The Covid-19 and dengue diagnosis were performed using standard tests followed by hematological profiling which included neutrophil lymphocyte ratio (NLR), platelet count, Vitamin D3 assessment, SGOT, SGPT, and SPO2 concentration levels. ResultsOut of 212 participants, 118 were diagnosed with Covid-19 positive only, 18 dengue positive only, 5 co-infected with Covid-19 and dengue, and 71 persons with Acute Febrile Illness (control group). ANOVA revealed that mean SPO2 was significantly lower in Covid-19 and dengue than control, while SGPT and SGOT levels of Covid-19 and dengue patients were significantly higher than the control group. The mean NLR was significantly higher in Covid-19 and dengue than control and Vitamin D3 levels were significantly reduced for Covid-19 patients. Besides, thrombocytopenia was observed only in dengue patients. ConclusionThe results advocate the potential use of combinations of these makers in differential diagnosis of these two fatal viral conditions and can help by enabling the adaptation of the therapeutic conduct to the needs of individual patients.

Do Patients With Atypical Parathyroid Adenoma Need Close Follow-up?

Atypical parathyroid adenomas (APAs) are neoplasms with uncertain malignant potential but lack unequivocal histological signs of malignancy. This work aims to retrospectively evaluate the clinical and biochemical profiles of patients with APA, the outcome after parathyroidectomy (PTX), and the presence of CDC73 germline and somatic mutations. This monocentric study was conducted on consecutive patients undergoing PTX for primary hyperparathyroidism (PHPT) between June 2000 and December 2020. Fifty-eight patients with a confirmed histopathological diagnosis of APA, and age- and sex-matched controls with parathyroid adenoma (PA) were also included. Fifty-four patients had sporadic PHPT and 4 had familial isolated hyperparathyroidism (FIHP). Thirty-four patients (59%) had symptomatic disease. Serum calcium and parathyroid hormone (PTH) levels were significantly higher in symptomatic compared to asymptomatic patients (P = .048 and .008, respectively). FIHP patients were younger than their sporadic counterparts (30 ± 17 years vs 55 ± 13 years). APA patients had significantly higher serum calcium and PTH levels and lower 25-hydroxyvitamin D concentration, bone mineral density, and T score at one-third distal radius compared to those with PA. Four of 56 APA patients displayed a CDC73 germline mutation. No somatic CDC73 mutation was identified in 24 tumor specimens. The mean follow-up after surgery was 60 ± 56.4 months. All but 6 patients (90%), 5 with apparently sporadic PHPT and 1 with FIHP, were cured after surgery. The large majority of patients with APA, despite a moderate/severe phenotype, have a good prognosis. Germline CDC73 mutation-positive patients had a higher rate of persistent/recurrent disease. CDC73 gene alterations do not seem to have a relevant role in the tumorigenesis of sporadic APA.

A Prospective Observational Study of Clinicopathological and Biochemical Profile of Patients with Cholecystitis Visiting a Teaching Tertiary Care Centre of Haryana

Abstract Introduction Gallstone diseases constitute a major part of patients visiting hospitals, and more than 50% of operation theaters are occupied by it or diseases related to it. It also imposes significant financial burden on health resources. The 21st century has opened with an improved foundation to our understanding of the basis of bile formation by defining the key transporters of the lipids in bile and the responsible genes. The specter of obesity as an epidemic in developed countries, and the recent recognition of the metabolic syndromes and their links to gallstone formation, emphasize the expectation of a rise in the frequency of cholesterol cholelithiasis. Materials and Methods Data pertaining to patients who were admitted/received surgery for a diagnosis of gallstone diseases at the Department of General Surgery of BPS GMC Khanpur Kalan was collected.The collected data was entered in a Microsoft Excel spreadsheet. Mean ± standard deviation (SD) was calculated for quantitative data, using Student’s “t” test/Kruskal test. Chi-square test was used to find out the association for categorical data. Results and Discussion Most of the patients were experiencing right hypochondriac pain (79.23%) as presenting complaints, with the most common age range being 31 to 40 years, followed by 41 to 50 years, that is, 31.85% and 20.74%, respectively. Females were most commonly affected, approximately 90%, and only 10% of patients with gallstones visiting our hospital were males. Maximum patients had chronic cholecystitis (80%) on histopathological examination, followed by cholesterosis (6.15%). As much as 82.6% of patients presented with mixed gallstones, followed by cholesterol stones, that is, 10.43%. All types of stones are more common in patients with abdominal adiposities, that is, having waist-to-hip ratio more than 0.85, and these findings are statistically significant. Conclusion Our study concluded that gallstones were more common in females of younger population (31–40 years) with right hypochondriac pain as presenting complaints. The most common histopathology was chronic cholecystitis with mixed types of stones, which is associated with increased waist-to-hip ratio. All biochemical markers were within normal range.

Retraction: Nutritional and Biochemical Parameters Among Multiple Sclerosis Patients: A Case-Control Study.

[This retracts the article DOI: 10.7759/cureus.15108.].

Nutritional and Biochemical Parameters Among Multiple Sclerosis Patients: A Case-Control Study.

BackgroundThe pathogenesis and prognosis of multiple sclerosis (MS) is an area of active medical research. Dietary and biochemical parameters such as serum 25-dihydroxycholecalciferol, magnesium, and potassium play a role in disease progression. This study aimed to compare the nutritional status and biochemical profile of patients with and without MS.MethodologyThis case-control study included a total of 112 participants (56 in the control group and 56 in the MS group). The participants’ socioeconomic and demographic profiles, nutritional status, and biochemical details were all gathered using history, patient files, and records. The effect of these parameters on the presence of MS was evaluated using a decision tree model. Student’s t-test and Mann-Whitney U test were performed to compare these parameters.ResultsA decision tree model was developed with an accuracy rate of 86.52%. The vitamin and mineral intake of the groups showed significant statistical differences (p = 0.001). The differences were important in terms of biochemical parameters, especially serum levels of 25-dihydroxycholecalciferol and potassium.ConclusionsThe key parameters that varied between MS patients and the control group, according to the constructed decision tree, were serum levels of 25-dihydroxycholecalciferol, magnesium, calcium, potassium, and carbohydrate intake. Nutritional measures against MS can be taken based on the decision tree.

Genetics and biochemical profile of patients with homozygous familial hypercholesterolemia

Genetics and biochemical profile of patients with homozygous familial hypercholesterolemia

The Clinical and Biochemical Profile of Patients with Urolithiasis coming to the Nephrology Department of this Tertiary Care Centre in South India

The Clinical and Biochemical Profile of Patients with Urolithiasis coming to the Nephrology Department of this Tertiary Care Centre in South India

Phosphaturic Mesenchymal Tumors from Head to Toe: Imaging Findings and Role of the Radiologist in Diagnosing Tumor-Induced Osteomalacia.

This study aimed at evaluating the imaging findings of phosphaturic mesenchymal tumors and tumor-induced osteomalacia and assess the clinical and biochemical profiles of patients with tumor-induced osteomalacia. Imaging findings in six patients with tumor-induced osteomalacia and histopathologically proven phosphaturic mesenchymal tumors were evaluated. Clinical and biochemical profiles of these patients were also assessed. Along with having a characteristic biochemical profile, patients with phosphaturic mesenchymal tumors also have certain imaging findings which can aid in the diagnosis such as increased uptake on DOTA PET-CT and homogeneous post-contrast enhancement on CT and MRI. Patients with tumor-induced osteomalacia have characteristic symptoms, imaging and biochemical profiles. For radiologists, raising the suspicion of a phosphaturic mesenchymal tumor in patients with refractory hypophosphatemic osteomalacia as well as localizing the tumor on imaging is crucial, as complete excision of the tumor leads to resolution of the osteomalacia and the patient's clinical symptoms.

Clinical and biochemical profile of patients with Iron deficiency anemia at a tertiary care hospital

Introduction: Iron deficiency anemia (IDA) is the most common cause of anemia worldwide, especially in adolescent girls, women of reproductive age group, and young children. The clinical presentation and the other biochemical parameters differ in a different age, sex, and geographical group. A study to evaluate the clinical and biochemical profile of patients with IDA at a tertiary care hospital. Materials and Methods: One hundred and two Cases of IDA were taken from the outpatient department (OPD) and ward. After taking consent, the workup was done. Complete history and physical examination were done, and patients were evaluated for signs and symptoms of IDA. Laboratory investigations such as complete blood count with differential count, reticulocyte count, peripheral blood smears, serum iron, total iron binding capacity, serum ferritin, lactic dehydrogenase, stool for occult blood and ova, cysts, liver and renal function were done in all the patients. Results: One hundred and two patients of IDA were enrolled from OPD and ward. The majority of the patients were from the 21 to 30 years age group (25.5%). 37.3% were male and 62.7% were female patients. The main presenting complaint was weakness and easy fatigability (91%). Among the associated comorbidities, the most common were hypertension (13.7%). The majority of the patients had severe pallor (54.9%). Icterus was found in 1.9%. Splenomegaly was found in 4.9%. General blood pictures showed 97.1% had microcytes, 96.1% had hypochromasia and 97.1% had Anisocytosis, which is characteristic of IDA. Conclusion: The majority of patients came to the hospital after developing clinical features due to severe anemia. Therefore, a population based study to evaluate the mild form of IDA or to evaluate a preanemic iron deficiency state can help in the early diagnosis of these patients before they develop severe form.

"Spectrum of 46 XY Disorders of Sex Development": A Hospital-based Cross-sectional Study.

Background:Disorders of sex development (DSD) are a wide range of relatively rare conditions having diverse pathophysiology. Identification of an underlying cause can help in treating any coexisting hormone deficiencies and can help with anticipating any other immediate or long-term health concerns.Objective:To study the clinical and biochemical profile of patients with 46 XY DSD along with androgen receptor (AR) gene mutation status in selected group of patients.Methods:A cross-sectional study was conducted after enrolling the eligible DSD patients. Thorough elicitation of history and detailed clinical examination was done. Assays for luteinizing hormone, follicle-stimulating hormone, testosterone, dihydrotestosterone, androstenedione, AMH & Inhibin B (where indicated), and human chorionic gonadotropin stimulation were done as per protocol.Results:In total, 48 patients were included in the study. Ambiguous genitalia (58.3%) followed by hypospadias (33.3%) were common presentation. Androgen biosynthetic defect were the most commonly encountered diagnosis followed by androgen insensitivity syndrome (AIS). Swyer syndrome was diagnosed in 4.2% of cases; partial gonadal dysgenesis, ovotesticular DSD, and vanishing testis syndrome contributed to 2% of cases each. Eight cases (16.7%) who presented with isolated proximal and midshaft hypospadias for whom no diagnosis was found were categorized in the “etiology unclear” group. AR gene mutation analysis designed against specific exons did not yield any results.Conclusion:46 XY DSD is a heterogeneous group of patients with a varying age of presentation and a diverse clinical profile. Most patients are reared as males and maintained the same gender identity except in isolated cases. Diagnosis of AIS remains a clinical challenge as a definite hormonal criterion does not exist and genetic mutations in AR gene may be negative. Flanking region sequencing, whole genome sequencing, and promoter region sequencing may reveal pathogenic variants. Variations in other genes regulating AR pathway may also be candidates to be studied.

THE EFFECTS OF ALLOFERON (ALLOKIN) IN THE THERAPY OF METABOLIC SYNDROME (A PILOT STUDY)

The aim of this work was to study the influence of treatment with alloferon (allocin) in combination with pyrogenal and cytokine therapy on the parameters of immunity, systemic inflammation, levels of herpesvirus replication and biochemical profile of patients with metabolic syndrome to search for new approaches to the treatment of the early stages of the disease. Markers of systemic inflammation and immunity, including key cytokines and lymphocyte subpopulations, were investigated. It was found that 1 month after the start of the study in patients receiving only allokin, there were signs of activation of humoral immunity. In patients receiving complex therapy, there were signs of activation of the cell-mediated mechanisms of adaptive immunity. These changes persisted after 6 months and were not accompanied by signs of systemic inflammation when evaluated at 1 and 6 months. The results of further observation showed that in patients receiving complex therapy, there were positive changes in lipid profile, which were the most prominent at the end of the study. Thus, in this study it was shown that in patients with metabolic syndrome complex immunomodulatory therapy, including allokin, pirogenal, ingaron and Roncoleukin, led to the activation of the cellular link of adaptive immunity, without causing a long-term increase in the level of markers of systemic inflammatory response. During long term observation the patients had positive dynamics of the main markers of the lipid profile, and a reduce in the level of serum markers of systemic inflammation. These delayed effects can apparently be associated with immunomodulatory effects of therapy, including the possible activation of regulatory CD4+CD25+Foxp+ cells, which, according to the literature, have a protective effect in obesity, reducing insulin resistance.

A515 Loss of Weight, Glucose and Hemoglobin Glyced in Patients with Diabetes Mellitus II - 6 Months after Gastroplasty

Obesity is a public health problem that has been increasing the number of bariatric surgeries (BS). Glycemic indicators such as glycated hemoglobin (HbA1c) and glucose may be affected by BS and are associated with the incidence of Diabetes Mellitus II. This study aims to analyze the repercussions of BS on weight and biochemical profile of patients in two periods: preoperative and 6 months after BS.

Clinical Profile of Patients with Incidentally Detected Non-alcoholoic Fatty Liver Disease

Introduction: Non-alcoholic fatty liver disease (NAFLD) is the commonest liver problem worldwide with disease spectrum ranging from steatosis to steatohepatitis, advanced fibrosis and cirrhosis.&#x0D; Objective: To delineate the clinical and biochemical profile of patients with incidentally detected NAFLD.&#x0D; Materials and Methods: In this observational study subjects without overt liver disease having sonological evidence of fatty liver underwent thorough physical examinations including anthropometric measurements and investigated for blood glucose level, lipid profile and liver function status. Aspartate aminotransferase (AST) /alanine aminotransferase (ALT) ratio and BMI and diabetes (BARD) score were computed to assess hepatic fibrosis status non-invasively.&#x0D; Results: Out of 407 final participants, 213 were male and 194 were female. Mean age of the patients was 42.05±10.54 (range 21-71 years). Mean body mass index (BMI) of the subjects was 26.92±3.75Kg/m2. Visceral obesity as measured by abdominal circumference and waist-hip-ratio were found increased in 333(81.81%) and 336(82.5%) subjects respectively. Obesity (BMI &gt; 25 mg/m2), diabetes mellitus, hypertension, and metabolic syndrome (MS) were present in 68.8%, 48.2%, 36.4%, and 87.5% patients respectively. Cholesterol, high density lipoprotein, low density lipoprotein and triglyceride were found increased in 47.7% (n=194), 83.05% (n=338), 42.8%(n=174) and 80.59%(n= 328) NAFLD patients respectively. Elevated AST and ALT levels were found in 98 (24.1%) and 233 (57.0%) patients, respectively. AST/ALT ratio &gt;1 and BARD score &gt;2 were found in 27.5% (n=112) and 29.2% (n=119) patients respectively.&#x0D; Conclusion: In Bangladesh incidentally detected NAFLD patients are predominantly middle aged and obese. MS and hypertriglyceridaemia are highly prevalent among them. Around one fourth of them have evidence of advanced fibrosis non-invasively.&#x0D; Journal of Armed Forces Medical College Bangladesh Vol.14(1) 2018: 4-9

How should we select suspected Crohn’s disease patients for capsule enteroscopy?

Background: In suspected Crohn’s disease (CD), non-diagnostic ileocolonoscopies are often followed by small bowel capsule endoscopy (SBCE). Adequate pre-selection of patients for SBCE is a key to optimize allocation of resources. We aimed to establish a rational approach for the CD diagnostic workflow, based on biochemical profile of patients with suspected CD, targeting an optimization of patients’ selection for SBCE.Methods: Multicenter cohort study includes consecutive patients with suspected undergoing SBCE after non-diagnostic ileocolonoscopy. Minimum follow-up period after the capsule enteroscopy was six months. The outcome was confirmation of CD diagnosis. Univariate analysis and logistic regression were performed.Results: In included 220 patients, 62.3% of women were with a mean age of 41 years [26–54]. A confirmed diagnosis of CD was established in 98 patients (44.5%). The initial univariate analysis identified variables above the threshold of marginal statistical association toward CD diagnosis (p < .15). The regression model identified high CRP levels (OR 1.028 p = .128) and low serum Iron (OR 0.990 p = .025) as the independent variables with consistent correlation with CD diagnosis. Those two variables present a suitable discriminative power (AUC = 0.669, p < .001) for the diagnosis of CD.Conclusion: In suspected CD, low serum iron and elevated CRP had a statistically significant association with CD diagnosis, being helpful to identify patients with higher CD probability before SBCE. However, the lack of a proper validation of the model leads us to currently recommend SBCE to all patients with suspected CD and negative ileocolonoscopy, as no specific biochemical profile can be used to confidently exclude small bowel CD.

Thyroid Symptomatology across the Spectrum of Hypothyroidism and Impact of Levothyroxine Supplementation in Patients with Severe Primary Hypothyroidism.

Objective:This study aimed to determine the clinical and biochemical profile of patients with severe primary hypothyroidism (SPH) (TSH ≥40 μIU/ml) as compared to milder forms of hypothyroidism and document improvement in hypothyroidism symptoms in SPH.Methods:Thyroid symptomatology and biochemistry were evaluated in SPH, non-severe overt primary hypothyroidism (NSOPH; TSH <40 μIU/ml), subclinical hypothyroidism (ScH) and healthy controls. A total of 598 consecutive patients of hypothyroidism were screened of which 461 patients' data were analyzed (91 SPH, 130 NSOPH and 240 ScH). Thyroid symptomatology was re-evaluated at 12 weeks follow-up in SPH following restoration of euthyroidism with levothyroxine.Results:The median (interquartile range) age of patients was 35 (28-42) years with 91.6% female. The commonly noted symptomatology were shortness of breath (93.4%) and fatigueability (91.2%) in SPH, fatigueability (68.46%) and limbs swelling (43.07%) in NSOPH, and fatigueability (56.67%) and shortness of breath (32.92%) in ScH. All symptomatology were significantly higher in SPH. Delayed tendon reflex, carpel tunnel syndrome and meno-metrorrhagia were exclusive in SPH. Occurrence of menstrual irregularities was 73.62%, 28.46% and 16.25% in SPH, NSOPH and ScH, respectively. SPH patients had significantly higher cholesterol and triglycerides. There was significant improvement in symptomatology, reduction in body weight (−2.11 kg), improvement in hemoglobin (+0.64 g/L) with fall in total cholesterol (−18.96%), LDL-cholesterol (−23.46%) and triglycerides (−13.53%) following euthyroidism restoration in subjects with SPH. Common residual symptoms were fatigue (10%), poor memory (8%) and menstrual irregularities (6%).Conclusion:Thyroid symptomatology differs significantly across spectrum of hypothyroidism, being significantly worse in SPH. Euthyroidism restoration is associated with reversal of majority of thyroid symptomatology.

A Hospital-based Study for Clinico-investigative Profile of Newly Diagnosed Patients of Hypothyroidism

Introduction: Hypothyroidism in adults has an insidious onset with a range of non-specific symptoms resulting in delayed diagnosis. Hypothyroidism is characterized by a broad clinical spectrum ranging from an overt state of myxedema, end-organ effects and multisystem failure to an asymptomatic or subclinical condition with normal levels of thyroxine and triiodothyronine and mildly elevated levels of serum thyrotropin. Thyroid dysfunction leads to altered glucose and lipid metabolism leading to insulin resistance, which is an important risk factor for cardio vascular diseases. This study attempts to study clinical and biochemical profile of patients with subclinical hypothyroidism or overt hypothyroidism. Aim of study: To study clinical and investigative profile of hypothyroidism in the newly diagnosed patients of hypothyroidism. Methods: All newly diagnosed hypothyroidism patients fulfilling inclusion and exclusion criteria were taken in to study. Demographic profile of all enrolled patients was recorded. They were subjected to detailed history and examination and the findings were recorded as a predesigned Performa. The clinical diagnosis of hypothyroidism was made as per Indian thyroid society guidelines. The following laboratory investigations were performed: serum lipid profile and serum uric acid using enzymatic assay, fasting insulin, creatinine, direct bilirubin, and the following liver function parameters: aspartate aminotransferase (AST), alanine aminotransferase (ALT). Thyroid-hormone profile, including thyroid-stimulating hormone (TSH), free triiodothyronine (FT3), and free thyroxine (FT4), including anti-thyroid peroxidase (TPO). Observation and results: Between October 1, 2015 and September 30, 2016, 226 patients with newly diagnosed hypothyroidism were studied. Out of 226 patients, 48 patients excluded from the study. Central hypothyroidism was present in 4 patients and 44 were pregnant and lactating women. 178 patients with newly diagnosed hypothyroidism were enrolled in study. Out of 178 patients’ subclinical hypothyroidism was present in 29(16.9%) patients. Out of 178 patients, 131 (73.6%) were females and 47 (26.4%) were males and various parameters were studied. Conclusion: Our study confirms that dyslipidemia, insulin resistance and metabolic syndrome correlate positively with newly diagnosed hypothyroid patients.