bluuebunny/crossref_metadata_2025_split huggingface dataset:
Electrocardiogram (ECG) Diagnosis of Left Ventricular Hypertrophy and its Associations in Patients Living with Diabetes
Authors: Chetty Rushern R. , Pillay Somasundram 
Published: August 2024

Background:
Macrovascular complications of diabetes mellitus (DM) include cardiac manifestations such as left ventricular hypertrophy (LVH), which can increase the risk of heart failure and death.

Objectives:
To determine associations between LVH and other variables in patients living with DM (PLWD).

Methods:
A retrospective study over 1 year was conducted on patients who attended the DM clinic at Edendale Hospital in South Africa. Electrocardiographs (ECGs) and standardised data sheets were analysed. The Sokolov–Lyon, Cornell and Romhilt–Estes methods were utilised for diagnosing LVH on ECGs.

Results:
There were 609 PLWD included in the study, with 80 PLWD (13.1%) having LVH (LVH+), whereas 529 PLWD (86.9%) had no LVH (LVH−). The Sokolov–Lyon method proved to be the best method of diagnosing LVH based on ECG (100% of patients diagnosed), with an ‘R wave in Augmented Vector Left (AVL) ≥11 mm’ being the best approach for determining LVH. LVH + patients were significantly younger than LVH − patients (27.22 years vs. 58.98 years, P < 0.001) and had lower systolic blood pressure (SBP) (118.62 mmHg vs. 139.77 mmHg, P < 0.001). Type 1 DM (DM1+) comprised the majority (77.5%) of LVH + patients. LVH + patients had significantly better high-density lipoproteins (1.36 mmol/L vs. 1.25 mmol/L, P = 0.024) and triglycerides (1.40 mmol/L vs. 1.85 mmol/L, P = 0.010) than LVH − patients.

Conclusion:
LVH was seen more frequently in younger patients who often had DM1+, lower SBP, higher HDL, and lower triglycerides. Most cases of LVH were diagnosed using the Sokolov–Lyon method. LVH should be screened for frequently in PLWD, irrespective of whether patients are hypertensive or not, and this should be done at all ages.
C-Reactive Protein Level can be a Better Indicator than Erythrocyte Sedimentation Rate in Assessing the Severity of Inflammation and Guiding Glucocorticoid Therapy in Subacute Thyroiditis
Authors: Baruah Manash P. , Bhattacharya Bhaskar , Baruah Upasana M. 
Published: August 2024

Background:
Despite the widespread use of several diagnostic tests in subacute thyroiditis (SAT), their usage remains largely subjective. C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) are useful indicators of inflammation in patients with SAT. The purpose of this study was to compare the scope for utilising CRP and ESR objectively in deciding the requirement of glucocorticoid therapy.

Methods:
A total of 28 patients with SAT were included in this study. Serum CRP and ESR were measured in all the patients. The characteristics of these tests were assessed firstly by using previously accepted positivity criterion for the particular diagnostic test. The area under the receiver operating characteristics (ROC) curve was obtained to provide an index of the overall discriminative ability of both tests.

Results:
Fifteen out of 28 patients were found to have features of significant thyroid inflammation eventually requiring glucocorticoid based on the current recommendations. The mean CRP value was significantly higher in patients requiring glucocorticoids. The ROC curves indicated that the optimal positivity criterion was 19.3 mg/L for the CRP level and 46 mm at the 1st hour for ESR. CRP with a sensitivity of 0.67, a specificity of 0.92, a positive likelihood ratio of 8.67, and an accuracy of 0.64 appeared better than ESR, which showed a sensitivity of 0.93, a specificity of 0.53, a positive likelihood ratio of 2.02, and an accuracy of 0.60.

Conclusions:
The serum CRP level provided a clear advantage over ESR in the assessment of the severity of inflammation before initiation of glucocorticoid therapy in SAT. However, a well-powered study is needed to examine the clinical relevance of such a role for CRP in thyroidology.
The Glucocorticoid Taper: A Primer for the Clinicians
Authors: Priya Gagan , Laway Bashir A. , Ayyagari Mythili , Gupta Milinda , Bhat Ganesh H. K. , Dutta Deep 
Published: August 2024

Abstract
Glucocorticoid (GC) therapy can ameliorate debilitating and life-threatening symptoms in several inflammatory/immunological disorders. However, it can also cause significant side effects, especially with higher doses and longer duration of use. Therefore, GCs should be used at the lowest effective dose for the shortest possible time to minimise adverse effects. GC therapy may cause suppression of the endogenous hypothalamic-pituitary-adrenal (HPA) axis and abrupt discontinuation predisposes patients to features of GC-induced adrenal insufficiency. The practice of tapering GC therapy allows for recovery of the HPA axis while minimising the risk of a disease flare-up or symptoms of AI. Moderate-to-high dose GC therapy may be tapered rapidly to near-physiological doses while watching for features of disease reactivation. Once close to the physiological dose, tapering is slower and at longer intervals to allow for recovery of the HPA axis. It is important to use short- or intermediate-acting GC preparations such as hydrocortisone or prednisolone in physiological doses, administered in the morning to mimic the endogenous cortisol rhythm. A general principle to follow is that HPA axis recovery takes longer if the period of suppression has been long. In such cases, tapering should be slower over a few months to even a year. In select cases at high risk of AI or if symptoms appear during tapering, the decision to further taper and discontinue steroids may be based on testing of HPA axis function using basal and/or stimulated serum cortisol. All patients on exogenous steroids should be advised about the need for an appropriate increase in GC doses during acute medical or surgical illness and should carry a steroid alert card to avoid adrenal crisis.
A Comparative Study of Bone-Health and Associated Factors in Healthy Indian Adolescents and Young Women
Authors: Kajale Neha A. , Oza Chirantap , Ladkat Dipali , Gondhalekar Ketan , Katapally Tarun R. , Bhawra Jasmin , Mansukhani Nina , Bapat Anita , Khadilkar Vaman , Khadilkar Anuradha 
Published: August 2024

Abstract

Introduction:
Adolescence is a critical period for the accrual of bone mass. However, few studies have assessed the bone geometry in slum-dwelling girls/young women. We thus conducted this study: (1) to assess bone health in Indian adolescent girls and young women residing in slum vs nonslum (NS) areas and (2) to identify factors associated with poor bone health.

Methods:
This cross-sectional case–control study was performed on 110 apparently healthy unmarried, nonpregnant, nonlactating, postmenarchal adolescent girls and young women aged 11 to 24 years residing in urban slums with the same number of age-matched controls from NS areas. Anthropometric, dietary, physical-activity and bone-health parameters (using dual-energy X-ray absorptiometry and peripheral quantitative computed tomography—DXA and pQCT—respectively) were evaluated using standard protocols. A P value of < 0.05 was considered statistically significant.

Results:
Slum girls were significantly shorter and lighter and had lower dietary intakes of calcium and protein after adjusting for total daily calorie intake than NS girls (P < 0.05). Areal bone-mineral density (BMD) at lumber spine (0.940 ± 0.13 vs1.042 ± 0.15 g/cm2), femur and total body (less-head), bone-mineral apparent density adjusted for volume at the lumbar spine (0.295 ± 0.04 vs 0.319 ± 0.04 g/cm3) and height-adjusted bone density at femur (0.862 ± 0.011 vs 0.905 ± 0.011 g/cm2) were significantly lower in slum dwelling participants as compared to their NS counterparts (P < 0.05). After adjusting for confounders like sunlight exposure, anthropometric parameters and dietary calcium intake, area of dwelling was still a significant factor for the difference in BMD.

Conclusions:
The potential determinants of poor bone density and geometry in girls and young women residing in slums include residential location, dietary habits, and physical activity levels. Despite adjustments for confounding factors, differences in bone health between those in slum and nonslum areas suggest adaptations developed over generations of deprivation in these individuals, necessitating urgent intervention.
Evaluation of Prevalence of PCOS and Associated Depression, Nutrition, and Family History
Authors: Vishnubhotla Deepa Switha , Tenali Shouni Niveditha , Fernandez Mini , Madireddi Sujatha 
Published: August 2024

Context:
Polycystic ovarian syndrome (PCOS) is a common condition affecting women in the prime of reproductive age. The symptoms include infertility, amenorrhea, hirsutism, obesity, and androgenic alopecia. It is a socially stigmatizing condition and is often associated with depression, poor mental health, and quality of life.

Settings and Design:
We carried out a questionnaire based cross sectional study that assessed the prevalence of PCOS, collected information on the nutritional and life style related factors. A questionnaire was used to collect information with an intention to assess the prevalence of PCOS and to understand the contribution of life style/nutrition to the risk of PCOS. Student’s t test and Z proportion test were used to assess significance and a ‘p’ value of ≤ 0.05 was considered significant.

Results:
A total of 972 females completed the questionnaire (mean age:24.37±8.37 years). Majority were from Telangana (n=823;84.67%) and students (690;70.98%). The mean weight was 60.58±13.03 kg and height was 1.78±2.56 m. Sizeable proportion reported irregular menstrual cycle (n=289;29.73%), that they get easily depressed: 283/972 (29.11%), low self-esteem:242/972 (24.90%), insomnia:223/972 (22.94%). A higher proportion of females were diabetic (8/243;3.29%Vs.10/706;1.42%;p=0.02) and non-vegetarian (69/243;28.40%Vs.119/706;16.86%;p=0.0002). No difference in the consumption of processed/fast food, carbonated drinks and lifestyle were noted. A significantly (p=0.0001) higher proportion of females had a positive family history (32/243;13.17%Vs.26/706;3.68%).

Conclusion:
Higher prevalence of PCOS was noted in young female population. Identifying at-risk individuals and imparting life style, nutrition-based modifications would be beneficial. Furthermore, regular counseling sessions might help tackle depression leading to a better overall physical and mental health.
Role of Growth Hormone Therapy in Metabolic-Dysfunction-Associated Steatotic Liver Disease: A Systematic Review and Meta-Analysis
Authors: Dutta Deep , Nagendra Lakshmi , Mohindra Ritin , Bhattacharya Saptarshi , Joshi Ameya , Kamrul-Hasan ABM 
Published: August 2024

Abstract
Multiple observation studies and meta-analysis have linked growth hormone (GH) deficiency with metabolic-dysfunction-associated steatotic liver disease (MASLD). No meta-analysis has analysed the efficacy and safety of GH therapy on different aspects of MASLD. We undertook this meta-analysis to address this gap in knowledge. Electronic databases were searched for RCTs involving patients with MASLD receiving GH therapy. Primary outcome was to evaluate changes in radiologic measures of MASLD (magnetic resonance spectroscopy (MRS) and ultrasonography) and liver enzymes. Secondary outcomes were to evaluate alterations in body composition parameters [dual-energy X-ray absorptiometry (DXA)], lipids, glycaemia and side effects. From initially searched 1047 articles, data from three RCTs (120 patients) which fulfilled all criteria were analysed. After 6 months of GH therapy in MASLD, the per cent reduction in intrahepatic lipid (MRS) was significantly higher with GH as compared to placebo [MD -5.85% (95%CI:-11.41– -0.30); P = 0.04; I2 = 63%]. Visceral adipose tissue (VAT) area reduction (DXA) was significantly higher with GH [MD-9.94 cm2 (95%CI:-19.04– -0.84); P = 0.03; I2 = 0%]. Serum insulin-like growth factor-1 (IGF-1) was significantly raised in MASLD patients receiving GH as compared to placebo [MD +166.86 ng/ml (95%CI: 79.19–254.53); P < 0.0.001; I2 = 90%]. High-sensitivity C-reactive protein (hsCRP) was significantly lower in patients receiving GH [MD -0.89 mg/L (95%CI:-1.40–-0.38); P = 0.0.0006; I2 = 0%]. Patients receiving GH had similar changes in triglycerides [MD-1.06 mg/L (95%CI:-20.45–18.34); P = 0.91; I2 = 15%] and fasting glucose [MD -0.56 mg/L (95%CI:-4.67–3.55); P = 0.79; I2 = 39%]. Gamma-glutamyl transpeptidase was significantly lower in patients receiving GH [MD -7.86 U/L (95%CI:-12.46–-3.27); P = 0.0008; I2 = 0%]. No increase in new-onset hypothyroidism was noted [OR 5.49 (95%CI: 0.25–121.18); P = 0.28]. Short-term 6-month GH therapy in MASLD is associated with a significant reduction in intrahepatic lipid content, visceral adiposity, GGT and hsCRP without any increased occurrence of dysglycaemia or hypothyroidism.
Circulating C-Terminal Agrin Fragment
Authors: Racha Pranathi , Selvam Sumithra , Bose Beena , Bantwal Ganapathi , Sambashivaiah Sucharita 
Published: August 2024

Background:
Undetected onset of sarcopenia among individuals with chronic diseases especially Type 2 Diabetes Mellitus (T2D) makes it important to be evaluated. The feasibility of diagnosing sarcopenia in a clinical setup might be a difficult task. Circulating markers including C-terminal agrin fragment (CAF) are emerging as an alternative. Hence, the objectives of the study were to compare circulating CAF levels between T2D, prediabetes (PD) and healthy controls and to study its association with sarcopenic index, muscle mass, strength and quality.

Methods:
Ninety-nine participants (n = 42, T2D; n = 33, PD; n = 24, healthy controls) aged 18 to 60 yrs were recruited. HOMA (homeostatic model assessment) indices were derived using plasma glucose and insulin. All participants underwent lipid profiling, muscle strength including quality (isokinetic dynamometer), body composition (Dual energy X-ray Absorptiometry (DXA)) and sarcopenic index (appendicular skeletal muscle mass/body weight) assessment. Serum samples were used to estimate CAF levelsusing enzyme-linked immunosorbent assay (ELISA).

Results:
Median CAF level was significantly higher among T2D group compared to PD and control groups (P < 0.0001). Circulating CAF levels correlated positively with age and glycated haemoglobin (HbA1c) (both, P < 0.001) and negatively with HOMA-B and muscle quality (both, P < 0.001), and sarcopenic index (P = 0.07). Multivariable analysis demonstrated that the odds of being in the highest tertile category was 7.67, 95% C.I. (2.10, 29.3) among T2D.

Conclusion:
Circulating CAF levels were significantly higher among T2D compared to PD and control study groups along with reduced skeletal muscle quality. This suggests that the circulating CAF level has the potential to be considered as a clinical marker to evaluate sarcopenia among T2D.
Prevalence and Clinical Course of Water and Electrolyte Disturbances Following Transsphenoidal Pituitary Adenoma Surgery in Immediate and Early Postoperative Period: A Prospective Observational Study
Authors: Bhardwaj Shivendu , Jaiswal Awadhesh K. , Yadav Subhash C. , Gupta Devendra , Yadav Rajanikant , Singh Alok P. , Bhatia Eesh 
Published: August 2024

Abstract

Introduction:
Transsphenoidal pituitary adenoma surgery (TSS) was commonly associated with water and electrolyte disturbances (WEDs) in the postoperative period, which could lead to prolonged hospital stay, readmission and is rarely life threatening. The present study aimed to investigate the prevalence and predictive factors of WEDs following TSS.

Methods:
Fifty-eight patients with pituitary adenoma were prospectively studied for the occurrence of WEDs. Patients were checked at 6 weeks postoperatively for persistence of diabetes insipidus and new-onset hormone deficiencies or recovery. Multivariate regression was applied to determine predictive factors for the occurrence of WEDs.

Results:
A total of 58 patients underwent TSS (median age: 43 years, 66% male). In the immediate postoperative period, 16 (27.6%) had transient diabetes insipidus (DI), two (3%) had transient DI followed by syndrome of inappropriate antidiuretic hormone (SIADH), five (8.6%) had isolated SIADH, five (8.6%) had persistent DI and only one patient had a triple-phase response. At 6 weeks, five (11%) patients continued to have persistent DI. In multivariate analysis, apoplexy and duration of surgery were predictive of DI occurrence. Recovery rate at 6 weeks was 11.1%, 13% and 9.3% for cortisol, thyroid and gonad axis, respectively. New-onset hormone deficiencies at 6 weeks were 5.6%, 5.6% and 7.4% for cortisol, thyroid and gonad axis, respectively.

Conclusions:
WEDs remain an important concern post-TSS. Timely follow-up should always be integral part of postoperative care for early diagnosis of new hormone deficiencies and avoiding unnecessary treatment in those with recovered axis.
Trends in Presentation and Management of Endogenous Hyperinsulinaemic Hypoglycaemia Over the Last Three Decades at a Tertiary Care Centre (1992–2022)
Authors: Gupta Setu , Goyal Alpesh , Kandasamy Devasenathipathy , Agarwal Shipra , Damle Nishikant , Pal Sujoy , Tandon Nikhil , Jyotsna Viveka P. 
Published: August 2024

Abstract

Introduction:
Endogenous hyperinsulinaemic hypoglycaemia (EHH) is characterized by inappropriate insulin secretion from pancreatic beta cells despite low blood glucose concentrations. We aimed to evaluate the secular changes in presentation and management of EHH due to insulinoma/non-insulinoma pancreatogenous hypoglycaemia syndrome (NIPHS) at our centre.

Methods:
This was a single-centre ambispective study (2014–2022). The clinical, biochemical, hormonal and radiological parameters (n = 63) collected as part of this study were compared with our earlier studies (1992–2005, n = 31; and 2006–2013, n = 35) and with other centres across the world.

Results:
A total of 63 patients (39 males) with a preoperative diagnosis of EHH (insulinoma, n = 58; and NIPHS, n = 5) and a mean age of 40.7 years were studied. The mean lag time from the onset of symptoms to diagnosis decreased from 4.6 years during the first study period to 1.9 years during this study period. However, the majority presented with fasting hypoglycaemia of 98.4%, and both fasting and postprandial hypoglycaemia of 32%. Exclusive postprandial hypoglycaemia was present in 1.7% of insulinoma. A histopathological diagnosis of insulinoma was made in 52 patients and nesidioblastosis in two patients. Intraoperative ultrasonography (IOUS) and intraoperative palpation (IOP) yielded 100% sensitivity, while endoscopic ultrasonography (EUS) and 68Ga-DOTA-Exendin-4 positron emission tomography/computed tomography (PET/CT) yielded sensitivity of 86% and 85%, respectively, for localizing insulinoma. Resolution of hypoglycaemia was noted in 53 of 57 (93%) patients who underwent surgery with a preoperative diagnosis of insulinoma.

Conclusion:
We observed a trend towards earlier diagnosis of EHH, increased patient numbers and availability of nuclear imaging techniques for preoperative localization in the last decade compared to earlier.
Comprehensive insights into heart failure with mildly reduced ejection fraction: A critical review
Authors: Ezhumalai Babu 
Published: August 2024

Abstract
This review explores the enigmatic heart failure (HF) subtype known as HF with mildly reduced ejection fraction (HFmrEF), which constitutes a significant percentage of HF cases yet remains inadequately understood. Characterized by an ejection fraction (EF) between 41% and 49%, HFmrEF poses unique challenges in diagnosis and treatment due to its intermediary nature between HF with reduced EF (HFrEF) and HF with preserved EF (HFpEF). Epidemiological data reveal variable prevalence rates influenced by demographic and regional factors, with a higher incidence associated with aging and cardiovascular comorbidities such as hypertension and diabetes. Pathophysiological insights suggest a blend of systolic and diastolic dysfunction, myocardial fibrosis, and inflammatory processes that differentiate HFmrEF from other HF categories. Diagnostic approaches currently rely on echocardiography and biomarkers such as N-terminal pro-brain natriuretic peptide, but there is a need for more precise tools. Treatment largely extrapolates from HFrEF and HFpEF protocols, yet specific evidence for HFmrEF is sparse, underscoring the necessity for targeted clinical trials. Patient outcomes, falling between those of HFrEF and HFpEF, further highlight the need for individualized management strategies. This review underscores the urgency of dedicated research to refine diagnostic criteria, optimize therapeutic regimens, and ultimately improve patient care for those with HFmrEF. Future research must focus on tailored treatments, pathophysiological clarity, and identifying specific biomarkers to advance our understanding and management of this complex condition.
Management of high thrombus burden during primary percutaneous coronary intervention
Authors: Kumar Akhilesh , Bhandari Suman 
Published: August 2024

Abstract
Managing high thrombus burden during primary percutaneous coronary intervention (PCI) poses significant challenges and is associated with increased procedural complications and adverse clinical outcomes. This abstract reviews current strategies and controversies surrounding the treatment of high thrombus burden in patients undergoing PCI. It discusses pharmacological approaches such as potent antiplatelet agents, glycoprotein IIb/IIIa inhibitors, and novel antithrombotic therapies, alongside mechanical strategies including thrombus aspiration and balloon angioplasty. The importance of individualized treatment based on clinical presentation, thrombus characteristics, and procedural factors is emphasized. Clinical trials and guidelines are reviewed to provide evidence-based recommendations for optimizing outcomes in this complex patient population. Future directions in research and technology aimed at further refining management strategies are also explored.
Simultaneous alcohol septal ablation and intravascular imaging-guided percutaneous transluminal coronary angioplasty – An effective approach in patients with hypertrophic obstructive cardiomyopathy and critical coronary artery disease
Authors: Mastebhakti Bhavana , Mustaqueem Arif , Bhandari Suman 
Published: August 2024

Abstract
We report a case of symptomatic hypertrophic obstructive cardiomyopathy refractory to medical management with a left ventricular outflow tract pressure gradient (LVOTPG) of 160 mmHg associated with a significant calcific coronary artery disease treated using simultaneous percutaneous transluminal septal myocardial ablation (PTSMA) and an intravascular imaging-guided percutaneous transluminal coronary angioplasty. The left anterior descending artery stenosis distal to the third septal perforator was stented using a drug-eluting stent under optical coherence tomography guidance. Subsequently, the LVOTPG was addressed using PTMSA. Following the procedure, the patient had an uncomplicated recovery. A follow-up echo revealed an LVOTPG of 15 mmHg 4 weeks later.