Clinical and pathogenetic aspects of acute pancreatic encephalopathy

Pancreatic encephalopathy is a formidable complication of acute pancreatitis, significantly aggravating the course and increasing the mortality rate in this disease. For pancreatic encephalopathy, an acute onset and fluctuating course with subsequent cyclic progression are typical, and the severity of neurological symptoms may be directly dependent on the activity of the pancreatic process. The risk of having residual symptoms, primarily in the form of cognitive impairment, increases with repeated episodes of acute pancreatic encephalopathy. In the pathogenesis of pancreatic encephalopathy, an important role is played by a combination of enzymatic and hormonal dysfunction of the pancreas, systemic microcirculation disorders due to hypovolemia, typical for acute pancreatitis, and changes in glucose metabolism associated with the effects of secondary hepatocellular insufficiency and pancreonecrosis. Microscopically, gross changes in the vascular link are revealed in the form of plasmorrhages and diapedesic hemorrhages in the Virchow-Robin spaces and the white matter of the brain, desquamation and dystrophy of endothelial cells, swelling of the adventitia membrane, sludge of blood corpuscles, plasma impregnation and segmental necrosis of the vascular wall with predominant involvement and small caliber. The presence of pancreatic encephalopathy should be suspected if neurological symptoms are detected in patients with symptoms of acute pancreatitis, such as psychomotor agitation, visual and auditory hallucinations, delirium, followed by episodes of deafness, adynamia, drowsiness, up to a state of catatonia and coma. In most cases, psychomotor agitation is combined with manifestations of the syndrome of irritation of the meninges. Focal neurological symptoms, myoclonia, hyperkinesis may be associated with mental and general cerebral symptoms. Mortality in acute pancreatic encephalopathy is due to shock, hemorrhagic complications, ketoacidosis, fatty embolism of cerebral vessels or renal failure (bibliography: 35 refs)

Fully Ossified Thyroid Cartilage Found among the Skeletal Remains of A 21-Year-Old Slavic Soldier: Interpretation of a Case

The degree of ossification of the thyroid cartilage in anthropological studies is related to other methods of determining the age of a skeleton. The endochondral ossification process begins at the age of approximately 15–20 years and is generally completed in the fifth or sixth decade of life. In the present case, early and complete mineralization of the thyroid cartilage of a skeleton belonging to a 21-year-old young soldier who died in 1946 was observed. Ossified thyroid cartilage at a very young age is rare and may be associated with specific symptoms, such as compression due to trauma, or may also be related to hormonal dysfunction and various diseases that may cause early mineralization. A macroscopic morphological evaluation and radiographic examination of the thyroid cartilage were performed and a decalcification test was applied to a sample taken from the thyroid cartilage to confirm that the structure was indeed mineralized. There is nothing to exclude that this is simply a physiological anatomical variation. Knowledge of this rare anatomical abnormality at a young age would be useful for the diagnosis of various pathological conditions.

The Rational Use of Hormone Replacement Therapy in Older Adults

Multiple hormone levels are lower in older compared to younger adults, but the clinical implications are controversial. Lower thyroid hormone, testosterone, estrogen and vitamin D are variously associated with metabolic syndrome, sarcopenia, low bone density and cognitive decline, for which treatment has been recommended in the past. However, evidence from the T Trials of testosterone therapy failed to show benefit for endpoints other than sexual function. In the Women’s Health Initiative, a large RCT of estrogen replacement in older women, found evidence of an interaction between estrogen therapy and metabolic risk factors such as diabetes that actually exacerbates risk of cognitive decline. Longitudinal observation of thyroid hormone and thyrotropin patterns in the Baltimore Longitudinal Study of Aging demonstrate heterogeneity that might account for a lack of benefit in studies of treatment for subclinical hypothyroidism in older adults. At the same time, new data suggest the need for a more aggressive threshold for vitamin D in older adults, with a lower threshold associated with a drop in physical function compared to younger adults. Complexity in the regulation of hormonal pathways and the downstream effects on target tissues means multiple individuals with similar hormone levels may have different underlying physiology, with divergent clinical needs. Changes in activity and diet common during aging, and exacerbated by the pandemic, lead to physical and mood changes associated with hormonal dysfunction in popular culture and patient requests for evaluation. The ultimate goal should be personalized treatment decisions based on comprehensive evaluation and pathophysiology.

Problems in managing a co-morbid patient with no previous medical records undergoing alternative therapy

Individuals with intellectual disability are often uncooperative for complete dental evaluation and treatment. Many of these patients fall within autistic spectrum disease. These patients are also said to be associated with other medically relevant disorders such as seizures, and metabolic and hormonal dysfunction. Undertaking treatment of such patients under general anaesthesia will require complete medical evaluation. As many of the antiepileptic drugs interact with anaesthetic agents, a sound knowledge of drugs taken by the patient is necessary. However, when the patient is under alternative therapy, this problem becomes multi-fold. This paper will discuss the basic, but real problems with the gap of understanding between allopathic and alternative therapy, the importance of reviewing the patients’, previous medical records, and its medico-legal consequences. It will also raise the issue of delays in management with increased cost and time of hospitalisation in such patients.

Polycystic ovary syndrome metabolic and hormonal dysfunction in relation to osteoarthritis onset and development: innocent bystander or major risk factor?

The close link between osteoarthritis (OA) and metabolic disorders on the one hand and hormonal disorders on the other suggests a possible association between OA and endocrine-metabolic disorders, such as PCOS. The aim of this review is to analyze the relationship between PCOS and OA, to consider the common pathogenetic mechanisms between the two conditions, and to summarize the data accumulated so far in the literature. For the purposes of our narrative review, a comprehensive search was conducted within credible databases. Our literature search found that epidemiological studies have shown a higher incidence of knee and hip OA in women with PCOS. This can be partly explained by obesity, which is a common intersection between the two conditions. Potential mechanisms among OA, PCOS, and obesity were considered. Another common point between OA and PCOS is that both conditions can be considered as highly heterogeneous syndromes with various etiologies, the result of a combination of systemic (genetic, hormonal, and metabolic) and local factors. To date, hyperandrogenism and greater cartilage thickness in young women with PCOS remain unclear in terms of determining the risk of developing OA. Prospective longitudinal studies are needed to assess the “fate” of the weight-bearing joints in women with PCOS, who are more likely to suffer from knee joint complaints.

P–100 Metabolic, hormonal, and inflammatory status in sub-fertile men with obesity and diabetes

Study question To evaluate the association between sperm functionality parameters and biochemical, hormonal, and inflammatory indices in obese and diabetic men. Summary answer Metabolic changes,hormonal dysfunction,and the presence of inflammatory mediators might be considered possible mechanisms in the development of sub-fertility in obese and diabetic sub-fertile men What is known already Although the higher prevalence of subfertility in obese and diabetic men during the reproductive age is evident, the mechanisms by which obesity and diabetes mellitus (DM) cause male infertility are not entirely understood. Several pathways might be involved in the role of obesity in semen quality, thereby inducing alterations in hormonal profiles, abnormal lipid metabolism, and possibly the formation of inflammatory cytokines, ultimately leading to impaired sperm function Study design, size, duration We enrolled normal weight (BMI<25 kg/m2) and non-type–2 diabetic (control=40), obese and non- type–2 diabetic (obese=40), non-obese and type–2 diabetic (Lean-DM=35), and obese and type–2 diabetic (Obese-DM=35) sub-fertile men, aged 20–50 years, referring to Royan infertility clinic (Tehran, Iran) from March to September 2014 Participants/materials, setting, methods After enrollment and receiving informed consent, all men underwent face-to-face private interviews. The obesity-associated markers, insulin resistance, beta-cell function, hormonal and lipid profile, inflammatory indices, and semen analysis were assessed in four experimental groups. Semen analysis was examined after 2–5 days of sexual analysis).abstinence based on WHO-recommended methods by CASA system (computer-assisted sperm Main results and the role of chance Main results and the role of chance: Our finding showed that diabetic markers were significantly increased in two diabetic groups, while obesity indices were markedly increased in two obese groups. Conventional sperm parameters were significantly lower in obese DM, lean DM, and obese groups compared with the control (p < 0.05). Serum levels of total testosterone (TT) and sex hormone-binding globulin (SHBG) were significantly lower in men with obesity and DM compared with the control (p < 0.05).There was a significant difference in the concentration of high-sensitivity C-reactive protein (hs-CRP) among four experimental groups. Moreover, serum leptin was significantly increased in obese DM, lean DM, and obese groups. Serum insulin levels had a positive correlation with metabolic-associated indices (WC, BMI, FBS,HbA1c,and HOMA-IR), as well as hs-CRP levels, whereas it had a negative correlation with count, motility, and morphology. There is also a negative association between metabolic-associated indices (WC, BMI, FBS, HbA1c, and HOMA-IR) and semen parameters. Limitations, reasons for caution It was better to evaluate inflammatory biomarkers be examined in other tissues Wider implications of the findings: The results of this study demonstrated the association of metabolic changes, hormonal dysfunction, and inflammatory responses with the semen parameters of sub-fertile men with obesity and diabete. Trial registration number Not applicable

Prevalence of thyroid malignancy and hormonal dysfunction following radiation exposure in childhood

ABSTRACT Introduction: Childhood radiation exposure is a known risk factor for thyroid malignancy and dysfunction. However, local data are limited and there is no consensus on the modality and frequency of screening in this high-risk group. Methods: Retrospective analysis study evaluating patients with childhood radiation exposure in 2006–2016 and minimum of 1-year follow-up. Results: Of the 132 childhood cancer survivors in the study, thyroid malignancy was detected in 2 cases (1.5%) and thyroid nodules in 13 (9.8%). The earliest thyroid malignancy was detected 5 years post-radiotherapy via ultrasound. Of the 84 patients who had screening thyroid function test, 26 (31.0%) were detected with abnormal test results post-radiation, majority being subclinical hypothyroidism. Conclusion: Regular screening via clinical examination for thyroid nodules should be performed at least annually. Where feasible and if resources permit, consideration should be given to using ultrasound for thyroid nodule(s) and malignancy screening at 5 years post-radiation therapy. Screening for thyroid dysfunction can be considered from 6–12 months post-radiotherapy. Keywords: Childhood post-radiotherapy complications, post-radiotherapy secondary malignancies, thyroid cancer, thyroid dysfunction, thyroid nodules

Effect of COVID-19 lockdown on noise pollution levels in an Indian city-A case study of Kanpur

Noise pollution is an emerging environmental threat, prolonged exposure of which can cause annoyance, sleep disturbance, hypertension, psychiatric disorders and also hormonal dysfunction. Among all the sources of noise pollution, the noise generated by road vehicle traffic significantly affects the quality of urban environments. Concerning the recent imposition of COVID-19 societal lockdown, this study attempts to investigate the impacts of COVID-19 lockdown on the changes in noise pollution levels before, during and after lockdown phase in different residential, commercial, industrial and silence zones of the city of Kanpur, India. Although a significant reduction in the noise levels was observed during lockdown, except for commercial zone all other monitoring stations had reported sound levels quite higher than the recommended noise limits set by the Central Pollution Control Board (CPCB) of India. Results further indicated that prominent improvements in health benefits could be observed in the lockdown period, much better than the pre-lockdown and unlock phase. Several noise mitigation strategies are also proposed, which may indeed pave the way for devising noise control measures in the local and regional level.

Association of Testosterone Level among Lepromatous and Borderline Leprosy Male Patients: Experience of 30 Cases in Bangladesh

Background: Hormonal dysfunction is reported among the leprosy patients. Objective: The purpose of the present study was to see the association of testosterone level among male patients presented with lepromatous and borderline leprosy. Methodology: This cross-sectional study was conducted in the Leprosy Hospital, Dhaka, Bangladesh from January to December 2016 for a period of one year. All patients with a known diagnosis of leprosy under follow up at the hospital were included in the study. The serum concentration of testosterone was measured using an enzyme immunoassay technique (ELISA) (DiaMetra, Spello, Italy). Result: A total number of 30 cases of leprosy were recruited for this study. The mean with SD of the study population was 39.20±9.065 years. Among 30 cases of study population 26 cases were lepromatous leprosy patents and the rest 4 cases were Borderline Leprosy patients. The mean with the standard deviation of testosterone level in serum was 6.41±4.756 mg/dL and 4.71±2.396 mg/L in lepromatous leprosy and borderline leprosy respectively (p=0.497). Conclusion: In conclusion there is no statistically significant relationship between leprosy and testosterone; however, lower level of testosterone is found among the study population Bangladesh Journal of Infectious Diseases 2020;7(2):36-39

Is the penile golden ratio an indicator of normal sperm count and normal hormonal status? A prospective-observational study

Background and Objective: The constant phi number (1.618…) is accepted as the indicator of esthetic beauty and harmony in numerous fields of natural sciences and is also known to be effective in various biological systems in the human body such as skeletal system and facial anatomy, respiratory system, and cardiovascular system. In this study, we aimed to compare the anthropometric proportions obtained from penile measurements and the phi-value and to investigate whether this number could be an indicator of fertility. Material and Methods: This study included 200 infertile male patients. Penile ratio (PR) was calculated by dividing the corpus penis length by the glans penis length. Patients were divided into two equal groups: Group-I included patients with a PR that was closest to the constant phi-value (n = 100) and Group-II included patients with a PR that was the most distant to the phi-value (n = 100). Spermiogram findings, and serum hormone levels were compared between the two groups. Results: Mean age was 27.37 ± 3.45 years, median penile length was 9.1 (7.1-10.2) cm, and median PR was 2.06 (1.65-2.64). In group I and II, an abnormal spermiogram was detected in 41% and 48% (P = 0.319) and hormonal dysfunction was present in 28% and 26% of the patients (P = 0.750), respectively. Overall sperm counts and sperm concentrations were significantly higher in group I compared to group II. Conclusion: Although PR may not be an indicator of normal spermiogram or hormone status, patients with a closer PR to the phi value are likely to have more favorable spermiogram values.