Effect of Steroid Therapy on Thyroid Function Status in Typically and Atypically Presented Nephrotic Syndrome

Background: Mild or subclinical hypothyroidism may coexist with NephroticSyndrome (NS). But persistence of this hypothyroidism is related with remission ofproteinuria. Objectives of the study is to compare thyroid function status (FT4 andTSH) in the atypical and typical NS before and 4 weeks after steroid therapy. Materials and methods: This was a hospital based comparative observational studywith prospective follow up of study subjects. It was carried out in the Department ofPediatrics and in the Department of Nephrology, Chattogram Medical CollegeHospital (CMCH) Chattogram, Bangladesh from January to December’ 2017. A total83 diagnosed admitted cases of initial attack idiopathic NS, aged 1-18 years ofeither sex divided into 2 groups were included. Typically presented NS were in groupA and atypically presented NS were in group B. FT4 and TSH were estimated in allpatients on 2 occasions before and 4 weeks after initiation of steroid therapy andcomparison was done between 2 groups. Results: FT4 level was normal before and after steroid therapy in both typically andatypically presented nephrotic syndrome. Before steroid therapy, mean TSH valuewas found significantly raised in both groups (9.28±5.17 vs 7.26±3.67 μIU/ml).Proportion of subclinical hypothyroidism was statistically similar. After treatmentwith steroid, number of subclinical hypothyroid cases reduced in both groups withreduction of TSH value (3.13±1.14 vs 5.38±2.52 μIU/ml). But significant difference inTSH value was observed in between two groups. There was persistence of subclinicalhypothyroidism after treatment with steroid among 16.6 % (14.2% grade II and2.3% grade I) children with atypically presented NS and which is statisticallysignificant (p=0.006). Conclusion: Subclinical hypothyroidism persists in atypically presented nephroticsyndrome even after treatment with steroid. Chatt Maa Shi Hosp Med Coll J; Vol.19 (1); January 2020; Page 28-32

Download Full-text

Variation in thyroid function in subclinical hypothyroidism: importance of clinical follow-up and therapy

Acta Endocrinologica ◽

10.1530/eje-10-1021 ◽

2011 ◽

Vol 164 (3) ◽

pp. 317-323 ◽

Cited By ~ 44

Author(s):

Jesper Karmisholt ◽

Stig Andersen ◽

Peter Laurberg

Keyword(s):

Thyroid Function ◽

Subclinical Hypothyroidism ◽

Repeated Measurements ◽

Thyroid Peroxidase ◽

Biochemical Tests ◽

Free Triiodothyronine ◽

Significant Difference ◽

Hypothyroid Patients ◽

Symptoms And Signs

Subclinical hypothyroidism (SCH) is a common condition that is often observed without therapy. However, no evidence-based recommendation exists with regards to how patients with untreated SCH should be monitored.Monitoring involves regular assessment of symptoms and signs of hypothyroidism (HYPO) and biochemical tests of thyroid function. An important question when repeated tests of thyroid function are performed is how large a difference in test results is needed to be confident that the change is real and not just due to chance variation.Recent data show that the least significant difference between two tests in SCH is 40% for TSH and 15% for free thyroxine and free triiodothyronine, with 90% confidence. Furthermore, monitoring has to be based on biochemical function testing because serial evaluation of symptoms and signs related to HYPO is rather insensitive in detecting worsening of thyroid insufficiency.When the presence of thyroid peroxidase auto-antibodies (TPO-Ab) in serum has been demonstrated, repeated measurements do not add much useful information in the monitoring of individual subclinical hypothyroid patients, as levels of TPO-Ab vary in parallel with TSH in these patients.Lastly, we discuss how differences in the monitoring procedure influence the diagnostic outcome, and we suggest a follow-up approach for untreated subclinical hypothyroid patients.

Download Full-text

Thyroid Dysfunction States and Incident Cardiovascular Events: The Tehran Thyroid Study

Hormone and Metabolic Research ◽

10.1055/s-0043-121031 ◽

2017 ◽

Vol 50 (01) ◽

pp. 37-43 ◽

Cited By ~ 6

Author(s):

Maryam Tohidi ◽

Arash Derakhshan ◽

Samaneh Akbarpour ◽

Atieh Amouzegar ◽

Ladan Mehran ◽

...

Keyword(s):

Thyroid Function ◽

Subclinical Hypothyroidism ◽

Thyroid Dysfunction ◽

Middle Eastern ◽

Thyroid Stimulating Hormone ◽

Overt Hypothyroidism ◽

Subclinical Hyperthyroidism ◽

Significant Difference ◽

Middle Eastern Population

AbstractThe objective of the study was to investigate the relation of different thyroid function states with the incidence of cardiovascular disease (CVD)/coronary heart disease (CHD) among a Middle-Eastern population with a high incidence of CVD/CHD. A total of 3975 participants entered the study (43.6% men). According to their thyroid stimulating hormone (TSH) and free thyroxin (FT4) levels, the participants were categorized into 5 groups: euthyroid, subclinical hypothyroidism, overt hypothyroidism, subclinical hyperthyroidism, and overt hyperthyroidism. Multivariable Cox proportional hazard models were used to assess the relation of different thyroid function states with incident CVD/CHD, with euthyroid state as reference. The mean age (SD) of the participants was 46.5 (12.0) years. At baseline, no significant difference was observed in the frequency of prevalent CVD cases (n=201) between all groups. No significant interaction was found between prevalent CVD and different thyroid function states with outcomes, hence, we did not exclude participants with prevalent CVD from data analysis. A total of 400 CVD events (358 CHD cases) during a median follow-up of 11.2 years (inter-quartile range: 1.96) occurred. During the follow-up, even in the age and sex adjusted model, no association was observed between different states of thyroid dysfunction and incidence of CVD/CHD. The multivariable hazard ratios (95% CI) of subclinical hypothyroidism, hypothyroidism, subclinical hyperthyroidism, and hyperthyroidism for CVD events were 1.21 (0.77–1.88), 0.76 (0.33–1.69), 0.81 (0.46–1.41) and 1.48 (0.70–3.16), respectively. Both at baseline and during follow-up, no relation was observed between different states of thyroid function with prevalence and incidence of CVD/CHD.

Download Full-text

Whether Evacuation surgery should be the first step for Postoperative Delayed Lumbar Epidural Hematomas?A Retrospective Comparative Study

10.21203/rs.2.14569/v1 ◽

2019 ◽

Author(s):

Liangliang Cao ◽

Yumei Liu ◽

Rundong Guo ◽

Jianguang Xu ◽

Wei Mei ◽

...

Keyword(s):

Neurological Status ◽

Invasive Treatment ◽

Neurological Outcomes ◽

Significant Difference ◽

Surgical Evacuation ◽

Before And After ◽

Group A ◽

Group B ◽

Neurological State

Abstract Background To analyze the efficacy and necessity of multiple lumbar punctures for postoperative delayed lumbar epidural hematoma(PDLEH).Methods Patients who underwent lumbar spinal surgeries between 2012 and 2016 at our institution, were reviewed through their medical records. For patients with PDLEH, the therapies, duration to onset(DO), duration from onset to intervention (DOI), symptoms (ASIA grade), neurological outcomes, VAS before and after treatment were examined. Only patients that received evacuation surgery(Group A) or mutiple lumbar punctures(MLP)(Group B) were included. We compared ASIA grade and VAS before and after treatment, DOI between the two therapies, and analyzed the correlation among the parameters.Results 15 cases(Group A) were performed with emergent surgical evacuation of the hematoma, and 16 cases(Group B) were treated with lumbar MLP at surgical site. The DOIs were 10.87±6.14h in group A and 2.05±5.33 in group B(P=0,P<0.05.). Preoperative neurological status in Group A were slighter than that in Group B.(P=0,P<0.05.). There was significant difference on VAS after treatment (P=0,P<0.05). Correlation analysis revealed that DOI were significantly positively correlated with neurological state before interventions (r=0.672, p=0,). In Group A, neurological outcomes at 2 years follow-up were correlated significantly with DOI (r=0.594, p=002) and neurological state before reoperation (r=0.665,p=0.007,). And in Group B, the correlation coefficient of neurological state and neurological outcomes at 2 years follow-up was r=o.584 (p=0.02),while there was no correlation between neurological outcomes and DOI(r=0.158,p=0.558).Conclusions In addition to serving as a timely, minimally invasive treatment, MLP could also serve as a preliminary measure during preoperative preparation before surgical evacuation.

Download Full-text

A Retrospective Analysis of Toxicity and Efficacy for 2 Hypofractionated Irradiation Schedules Versus a Conventional One for Post-Mastectomy Adjuvant Radiotherapy in Breast Cancer

Breast Care ◽

10.1159/000449433 ◽

2016 ◽

Vol 11 (5) ◽

pp. 328-332 ◽

Cited By ~ 6

Author(s):

Vassilis Kouloulias ◽

Eftychia Mosa ◽

Anna Zygogianni ◽

Efrosini Kypraiou ◽

John Georgakopoulos ◽

...

Keyword(s):

Randomized Study ◽

Skin Toxicity ◽

Retrospective Evaluation ◽

Acute Skin Toxicity ◽

Significant Difference ◽

Group A ◽

Grade Ii ◽

Group B ◽

Hypofractionated Irradiation

Introduction: The aim of this analysis was a retrospective evaluation of the efficacy and toxicity of 2 hypofractionated irradiation schedules compared to conventional therapy in post-mastectomy patients. Methods: 3 irradiation schedules were analyzed: 48.30 Gy in 21 fractions (group A, n = 60), 42.56 Gy in 16 fractions (group B, n = 27) and 50 Gy in 25 fractions (group C, n = 30) of the front chest wall. All groups were also treated with a supraclavicular field, with 39.10 Gy in 17 fractions (group A), 37.24 Gy in 14 fractions (group B) or 45 Gy in 25 fractions (group C). Results: No local recurrences were noted in any group during 36 months of follow-up. Acute skin toxicity presented in all groups, with 58.3%, 70.4% and 60% of grade I; 35%, 25.9% and 40% of grade II; 6.7%, 3.7% and 0% of grade III being seen in groups A, B and C, respectively. Late skin toxicity was noted only as grade I in 16.7%, 25.9% and 26.7% of groups A, B and C, respectively. No significant difference was noted among all groups for either acute or late skin toxicity, or for radio-pneumonitis (chi2 test, p > 0.05). Conclusion: All schedules were equally effective with equivalent toxicity. A prospective randomized study is needed to confirm our results.

Download Full-text

Melatih Kepemimpinan Perangkat Desa Kebonharjo Kulonprogo: Membangun Sikap Anti Korupsi

Proceeding of Community Development ◽

10.30874/comdev.2017.16 ◽

2018 ◽

Vol 1 ◽

pp. 107

Author(s):

Adi Heryadi ◽

Evianawati Evianawati

Keyword(s):

Transformational Leadership ◽

Data Collection ◽

Paired Samples ◽

Significant Difference ◽

Before And After ◽

Post Test ◽

Sample Test ◽

Corruption Perception ◽

Measuring Tool

This study aims to prove whether transformational leadership training is effective for building anti-corruption attitudes of villages in Kebonharjo village, subdistrict Samigaluh Kulonprogo. This research is an experimental research with one group pre and posttest design.Subject design is 17 people from village of 21 candidates registered. Measuring tool used in this research is the scale of anti-corruption perception made by the researcher referring to the 9 anti-corruption values with the value of reliability coefficient of 0.871. The module used as an intervention made by the researcher refers to the transformational leadership dimension (Bass, 1990). The data collected is analyzed by statistical analysis of different test Paired Sample Test. Initial data collection results obtained sign value of 0.770 which means> 0.05 or no significant difference between anti-corruption perception score between before and after training. After a period of less than 1 (one) month then conducted again the measurement of follow-up of the study subjects in the measurement again using the scale of anti-corruption perception. The results of the second data collection were analysed with Paired Samples Test and obtained the value of 0.623 sign meaning p> 0.05 or no significant difference between post test data with follow-up data so that the hypothesis of this study was rejected.

Download Full-text

SUBLINGUAL VITAMIN D3 DRUG THERAPY IN VITAMIN D DEFICIENCY PATIENTS AT PRAVARA RURAL HOSPITAL

International Journal of Clinical and Biomedical Research ◽

10.31878/ijcbr.2019.54.05 ◽

2019 ◽

pp. 18-20

Author(s):

Sanjeeva Kumar Goud T ◽

Rahul Kunkulol

Keyword(s):

Vitamin D ◽

Vitamin D Deficiency ◽

Vitamin D3 ◽

Serum Vitamin ◽

Cross Sectional ◽

Serum Vitamin D ◽

Significant Difference ◽

Before And After

The present study was aimed to study the effect of Sublingual Vitamin D3 on Serum Vitamin D level in Vitamin D deficiency patients. This was a cross-sectional and interventional study. All the Vitamin D deficiency patients of age 18-60years and either gender, willing to participate in the study were included. Patients who had greater than 20 ng/ml were excluded from the study. The total number of participants in our study was 200, out of these 111 males and 89 females, the mean age in our study was 51.07 ± 7.39Yrs. All volunteers were given sublingual vitamin D3 (60,000IU) in six doses every fifteen days of follow up for 3 months. The subject’s serum 25(OH)D levels were estimated before and after the treatment of sublingual vitamin D3. There was a statistically significant difference in serum vitamin D3 level before 16.61±6.71 ng/ml and after 35.80±7.80 ng/ml after treatment with Sublingual Vitamin D3. Six doses of 60,000IU of Vitamin D3 sublingual route having improved the role of serum 25(OH)D levels in the treatment of Vitamin D3 deficiency patients.Keywords: Vitamin D3; Sublingual route

Download Full-text

A Comparative Study of Amalaki Choorna along with Madhu and Vata Twak Kashaya Yoni Pichu Dharana in the Management of Shweta Pradara

Journal of Ayurveda and Integrated Medical Sciences (JAIMS) ◽

10.21760/jaims.v2i4.9322 ◽

2017 ◽

Vol 2 (4) ◽

Author(s):

Renuka M. Tenahalli

Keyword(s):

Vitamin C ◽

Early Stage ◽

Pathological Condition ◽

Before And After ◽

Group A ◽

Phosphorus Iron ◽

Group B ◽

Busy Schedule ◽

Iron And Calcium

Shweta Pradara (Leucorrhoea) is the disease which is characterized by vaginal white discharge. Vaginal white discharge this symptom is present in both physiological and pathological condition, when it becomes pathological it disturbs routine life style of the woman. Most of the women in the early stage will not express the symptoms because of hesitation and their busy schedule. If it is not treated it may leads to chronic diseases like PID (Garbhashaya Shotha etc.) Charaka mentioned Amalaki Choorna along with Madhu and Vata Twak Kashaya Yoni Pichu Dharana. This treatment is used in Shweta Pradara shown positive results, hence a study was under taken to assess its clinical efficacy. 30 diagnosed patients of Shweta Pradara were randomly selected, allocated in three groups. Group A and Group B received Amalaki Choorna with Madhu and Vata Twak Kashaya Yoni Pichu Dharana respectively and Group C received Amalaki Choorna with Madhu followed by Vata Twak Kashaya Yoni Pichu Dharana for 15 days. The patients were assessed for the severity of the symptoms subjectively and objectively before and after the treatment and at the end of the follow up. Data from each group were statistically analyzed and were compared. No side effects were noted and it may be considered as an effective alternative medicine in Shweta Pradara (leucorrhea). Amalaki is rich in natural source of vitamin C and contains phosphorus, iron and calcium. Honey contains carbohydrate, vitamin C, phosphorus iron and calcium. All together these help to increase Hb% and immunity. Vata Twak Kashaya contains tannin which helps to maintain normal pH of the vagina.

Download Full-text

Importance of a Follow-Up Ultrasound Protocol in Monitoring Posttraumatic Spleen Complications in Children Treated with a Non-Operative Management

Medicina ◽

10.3390/medicina57080734 ◽

2021 ◽

Vol 57 (8) ◽

pp. 734

Author(s):

Ivona Djordjevic ◽

Dragoljub Zivanovic ◽

Ivana Budic ◽

Ana Kostic ◽

Danijela Djeric

Keyword(s):

Splenic Abscess ◽

Operative Management ◽

High Energy ◽

Significant Difference ◽

Injury Grade ◽

Grade Ii ◽

The Mean ◽

Non Operative Management ◽

Grade Iii

Background and objectives: For the last three decades, non-operative management (NOM) has been the standard in the treatment of clinically stable patients with blunt spleen injury, with a success rate of up to 95%. However, there are no prospective issues in the literature dealing with the incidence and type of splenic complications after NOM. Materials and methods: This study analyzed 76 pediatric patients, up to the age of 18, with blunt splenic injury who were treated non-operatively. All patients were included in a posttraumatic follow-up protocol with ultrasound examinations 4 and 12 weeks after injury. Results: The mean age of the children was 9.58 ± 3.97 years (range 1.98 to 17.75 years), with no statistically significant difference between the genders. The severity of the injury was determined according to the American Association for Surgery of Trauma (AAST) classification: 7 patients had grade I injuries (89.21%), 21 patients had grade II injuries (27.63%), 33 patients had grade III injuries (43.42%), and 15 patients had grade IV injuries (19.73%). The majority of the injuries were so-called high-energy ones, which were recorded in 45 patients (59.21%). According to a previously created posttraumatic follow-up protocol, complications were detected in 16 patients (21.05%). Hematomas had the highest incidence and were detected in 11 patients (14.47%), while pseudocysts were detected in 3 (3.94%), and a splenic abscess and pseudoaneurysm were detected in 1 patient (1.31%), respectively. The complications were in a direct correlation with injury grade: seven occurred in patients with grade IV injuries (9.21%), five occurred in children with grade III injuries (6.57%), three occurred in patients with grade II injuries (3.94%), and one occurred in a patient with a grade I injury (1.31%). Conclusion: Based on the severity of the spleen injury, it is difficult to predict the further course of developing complications, but complications are more common in high-grade injuries. The implementation of a follow-up ultrasound protocol is mandatory in all patients with NOM of spleen injuries for the early detection of potentially dangerous and fatal complications.

Download Full-text

Comparison of montelukast and mometasone furoate in the prevention of recurrent nasal polyps

Therapeutic Advances in Respiratory Disease ◽

10.1177/1753465811427577 ◽

2011 ◽

Vol 6 (1) ◽

pp. 5-10 ◽

Cited By ~ 21

Author(s):

Erkan Vuralkan ◽

Cem Saka ◽

Istemihan Akin ◽

Sema Hucumenoglu ◽

Binnur Uzmez Unal ◽

...

Keyword(s):

Recurrence Rate ◽

Nasal Spray ◽

Peripheral Blood ◽

Nasal Polyposis ◽

Mometasone Furoate ◽

Significant Difference ◽

Before And After ◽

Group A ◽

Group B ◽

Snot 22

Background: The aim of our study was to compare the effects of montelukast and mometasone furoate nasal spray on the postoperative course of patients with nasal polyposis. Patients and methods: Fifty patients diagnosed with nasal polyposis between March 2006 and August 2007 were included in the study. All patients underwent bilateral endoscopic sphenoethmoidectomy and were randomized postoperatively into two groups. Group A ( n = 25) received 10 mg montelukast per day and group B ( n = 25) received 400 µg mometasone furoate nasal spray twice daily. All patients were followed up for 6 months. Sino-Nasal Outcome Test (SNOT)-22 scores, polyp grades, computerized tomography (CT) scores (Lund–Mackay), eosinophils in peripheral blood and polyp tissue were evaluated before and after surgery. Results: There was a significant reduction in SNOT-22 scores in both groups throughout the study period. There was a significant difference in the recurrence rate between both groups with a marginal advantage of mometasone furoate nasal spray. Eosinophils in peripheral blood were found to be effective on the recurrence rate ( p < 0.05). Conclusions: In conclusion, both drugs seem to have a complementary action and further studies are needed to determine which patients should receive which treatment.

Download Full-text

The effect of levothyroxine in comparison with placebo on serum osteocalcin levels in patients with subclinical hypothyroidism

Current Drug Safety ◽

10.2174/1574886316666210525102230 ◽

2021 ◽

Vol 16 ◽

Author(s):

Reihaneh Rezaee ◽

Masoud Mohebbi ◽

Mozhgan Afkhamizadeh ◽

Mohammad Ali Yaghoubi ◽

Mona Najaf Najafi ◽

...

Keyword(s):

Thyroid Hormones ◽

Subclinical Hypothyroidism ◽

Intervention Group ◽

Serum Levels ◽

Overt Hypothyroidism ◽

Serum Osteocalcin ◽

Significant Difference ◽

Before And After ◽

Metabolic Conditions ◽

And Control

Background and Objective: Subclinical hypothyroidism can potentially develop to overt hypothyroidism. Thyroid hormones have substantial roles in metabolism and glucose homeostasis and thus are closely related to determinant factors of metabolic syndromes, such as obesity and insulin resistance. Osteocalcin is considered a predictor of metabolic conditions in thyroid diseases. This study aimed to investigate the effect of levothyroxine vs. placebo on serum osteocalcin levels in patients with subclinical hypothyroidism. Methods: This randomized clinical trial was performed on 30 patients with subclinical hypothyroidism who were referred to the endocrine clinics of Ghaem and Imam Reza hospitals in Mashhad, Iran. After giving informed consent, patients were randomly divided into intervention (50 µg/day levothyroxine for 2 months) and control (placebo) groups. Serum levels of osteocalcin, thyroid hormones, lipid profile, insulin, and fasting glucose, as well as other clinical and anthropometric data, were measured at baseline and at the end of the study. SPSS was used to analyze the data and P<0.05 was considered significant. Results: Mean age in the intervention and control groups was 35.07 ± 9.94 and 31.30 ± 4.30, respectively (P=0.20). There was no significant difference between osteocalcin levels before and after the intervention in either of the groups (P=0.54). TSH level was significantly decreased in the levothyroxine group after the intervention (P<0.01). T4 level was significantly increased in the intervention group (P=0.02). Conclusion: Levothyroxine had no significant effect on increasing the levels of serum osteocalcin in patients with subclinical hypothyroidism. We have registered the trial in the Iranian registry of clinical trials (IRCT) with the registration code IRCT20171129037677N1.

Download Full-text