BACKGROUND: The study was done to evaluate the feasibility, safety and outcomes of a one-stop thyroid clinic (OSTC) in a low- and middle-income country (LMIC) setting METHODS: This was a prospective non-randomised case control study consisting of patients with thyroid nodules evaluated and managed at a tertiary referral centre in an LMIC between February 2019 and January 2020. Patients were divided into two groups based on the kind of preoperative evaluation protocol: OSTC group (n =118) - OSTC protocol, and control group (CG, n = 108) - routine protocol RESULTS: Baseline clinical characteristics of the two groups including median age (p = 0.13) and gender distribution (p = 0.76) were comparable. The majority of patients in both groups belonged to a low-income group (46.6% vs 47.3%; p = 0.91), followed by a middle-income group (35.6% vs 30.5%; p = 0.41). The median number of outpatient department visits (1 vs 3 days; p = < 0.001), waiting time for neck ultrasonography (1 vs 3 days; p = < 0.0001), fine needle aspiration cytology (1 vs 2 days; p = < 0.0001), and out of pocket expenditure (INR 3 965 vs 6 624; p = < 0.001) was significantly less in the OSTC group compared to the CG. Patients in the OSTC group reported better satisfaction levels (p = < 0.0001). Accuracy of diagnosis did not differ between the two groups (p = 0.14 CONCLUSION: OSTC practice is feasible, provides comparative clinical outcomes and seems cost effective in an LMIC. This protocol can be adopted as a routine practice in any health system

Abstract Objective: To determine the frequency and characteristics of mesiodens in Indian school children. Material and Methods: 1232 radiographs of patients attending the Department of Oral Medicine and Radiology of the age group of 4-15 years studied for the present retrospective study. The intraoral periapical radiographs and occlusal radiographs of the premaxilla were examined to determine the presence of mesiodens. The data regarding the presence of mesiodens, number, position, location on the arch, shape and associated complications were recorded. Results: Eleven patients had 14 mesiodens, with a frequency of 0.8%. The ratio of boys to girls was 1.2:1. Maximum mesiodens observed in the age group of 7-9 years. Most of the mesiodens were conical in shape and found on the palatal side. Fifty percent of the mesiodens were unerupted. The majority of patients (57.1%) had vertically positioned mesiodens. Midline diastema was the most common complication due to mesiodens (66.7%). Conclusion: Routine check-up during the primary dentition and mixed dentition stages helps for early detection of mesiodens and thus preventing complications. Early identification is useful for planning comprehensive management, initiating proper consultation and referral for evaluation and treatment.

O presente estudo descreve as mudanças sazonais na delta5 3beta hidroxiesteróide desidrogenase (3beta-HSD), glicose-6 fosfato desidrogenase (G-6-PD), e lipídios no ovário de um morcego vespertilionidae, Scotophilus heathi. As atividades totais dos lipídios e do 3beta-HSD estão restritas às células tecais e intersticiais do ovário. Os lipídios, 3beta-HSD e G-6-PD totais, aumentaram significantemente durante a recrudescência, e permaneceram elevados durante a dormência de inverno e o período de acasalamento, quando comparados a outras fases reprodutivas. A alta incidência de atividade de lipídios e enzimas nas células intersticiais durante o período de acasalamento e durante o período de ovulação sugere claramente que estas células estão ativamente envolvidas na esteroidogênese. O declínio da atividade dos lipídios e enzimas durante a dormência de inverno, o qual se correlaciona com os níveis decrescentes da esteroidogênese, podem ser o fator responsável pela longa sobrevivência do folículo de De Graaf no ovário do S. heathi.

The present study describes seasonal changes in delta5 3beta hydroxysteroid dehydrogenase (3beta-HSD), glusose-6 phosphates dehydrogenase (G-6-PD), and lipids in the ovary of a vespertilionid bat, Scotophilus heathi. Total lipids and 3beta-HSD activity are restricted to thecal and interstitial cells of the ovary. The total lipids, 3beta-HSD, and G-6-PD significantly increase during recrudescence, and remain high during winter dormancy and breeding as compared to the other reproductive phases. High incidence of lipids and enzyme activity in interstitial cells during the breeding period and at the time of ovulation clearly suggests that these cells are actively involved in steroidogenesis. A decline in enzymes and lipid activity during winter dormancy, which correlates with the declining levels of steroidogenesis, might be the factors responsible for prolonged survival of the Graafian follicle in the ovary of S. heathi.

The causes of luteal phase progesterone deficiency in polycystic ovary syndrome (PCOS) are not known. To determine the possible involvement of hyperinsulinemia in luteal phase progesterone deficiency in women with PCOS, we examined the relationship between progesterone, luteinizing hormone (LH) and insulin during the luteal phase and studied the effect of metformin on luteal progesterone levels in PCOS. Patients with PCOS (19 women aged 18-35 years) were treated with metformin (500 mg three times daily) for 4 weeks prior to the test cycle and throughout the study period, and submitted to ovulation induction with clomiphene citrate. Blood samples were collected from control (N = 5, same age range as PCOS women) and PCOS women during the late follicular (one sample) and luteal (3 samples) phases and LH, insulin and progesterone concentrations were determined. Results were analyzed by one-way analysis of variance (ANOVA), Duncan's test and Karl Pearson's coefficient of correlation (r). The endocrine study showed low progesterone level (4.9 ng/ml) during luteal phase in the PCOS women as compared with control (21.6 ng/ml). A significant negative correlation was observed between insulin and progesterone (r = -0.60; P < 0.01) and between progesterone and LH (r = -0.56; P < 0.05) concentrations, and a positive correlation (r = 0.83; P < 0.001) was observed between LH and insulin. The study further demonstrated a significant enhancement in luteal progesterone concentration (16.97 ng/ml) in PCOS women treated with metformin. The results suggest that hyperinsulinemia/insulin resistance may be responsible for low progesterone levels during the luteal phase in PCOS. The luteal progesterone level may be enhanced in PCOS by decreasing insulin secretion with metformin.

O objetivo do presente estudo foi comparar as mudanças na glândula tireóide com o ciclo reprodutivo de S. heathi. A tireóide mostrou variação sazonal marcada em peso, quantidade de colóide e altura do epitélio folicular, sugerindo que esta glândula está inativa durante a quiescência e o torpor de inverno e ativa durante o tempo de recrudescência e acasalamento, similarmente ao ciclo testicular. A concentração de tiroxina (T4) do plasma mostrou significantes mudanças sazonais com alta concentração durante o acasalamento e pós-acasalamento e baixa concentração durante a quiescência. Entretanto, a concentração plasmática de T4 aumentou da fase reprodutiva à pós-reprodutiva, quando o peso dos testículos estava se reduzindo. Sugere-se que, em S. heathi, a estreita correlação entre os ciclos testicular e tireóideo durante algumas fases do ciclo reprodutivo esteja relacionada à sensibilidade aumentada no período reprodutivo e à atividade metabólica.

The aim of present study was to compare the changes in thyroid gland with the reproductive cycle of S. heathi. Thyroid showed marked seasonal variation in weight, quantity of colloid and follicular epithelial height, suggesting the thyroid gland to be inactive during quiescence and winter dormancy and active during the time of recrudescence and breeding similarly to the testicular cycle. Plasma thyroxin (T4) concentration showed a significant seasonal change with high concentration during breeding and post-breeding and low concentration during quiescence. However, the T4 concentration increased from breeding to post-breeding phase, when the testes weight was declining. It is suggested that in S. heathi the positive correlation between thyroid and testicular cycles occurs only during the phases of the reproductive cycle when the body weight and testicular activity are also closely correlated.