No abstract

Leiomyoma arising from adrenals are extremely rare with less than 20 cases reported in medical literature. Leiomyomas, though benign lesions, may frequently be confused with a malignancy, both clinically and on imaging studies, especially when they occur at atypical sites like the adrenals. We present a 42-year-old lady with cachetic symptoms, abdominal swelling and dragging sensation for 6 months, having a 10 cm diameter non-tender firm palpable abdominal mass, which on computed tomography was diagnosed to be a 12.2 × 10.3 × 8.0 cm heterogeneously enhancing adrenal mass having absolute and relative contrast washout values suggestive of malignancy. The tumor was hormonally inactive. Left adrenalectomy was done. Resected specimen weighed 91 g measuring 12 × 10 × 8.0 cm. Histopathology revealed a well-circumscribed and encapsulated benign spindle cell arranged in fascicles and whorls confirming leiomyoma. In the last evaluation 6 months after surgery, there was no evidence of tumor recurrence. This is the largest adrenal leiomyoma ever reported. Leiomyomas have a varied age of presentation (2 -72 years, median: 38) with female preponderance. They are usually unilateral and hormonally inactive. Human immunodeficiency virus and Epstein-Barr virus infections have been observed in 44.44% and 16.67% of cases respectively. However, direct link between immunodeficiency and adrenal leiomyoma has not been established. Adrenal leiomyoma can present as huge abdominal masses clinically mimicking malignancy, and radiologic investigations can also be misleading. Adrenal leiomyoma should always be considered in the differential diagnosis of huge unilateral non-functional incidentally detected adrenal lesions.

IN BRIEF Diabetic myonecrosis is an uncommon muscular complication of diabetes with significant morbidity. Clinical features and radiological findings are helpful in the diagnosis of myonecrosis. Management is conservative and focused on symptomatic relief and control of diabetes.

Odisha has 4.2 million diabetic patients against the country’s 70 million with an urban prevalence of nearly 15.4%. Diabetes is affecting younger age groups, thus having a crucial impact on quality of life of the affected. A qualitative endeavour was attempted at the diabetic clinic of a tertiary care set up in the capital city of Bhubaneswar to create a diabetic surveillance data assembly, wherein subjects above 18 years of age and newly diagnosed or on follow-up, after obtaining informed consent, were made to respond to a quality of life (QOLID) validated tool. The pretested tool has 8-domain role limitation due to physical health, physical endurance, general health, treatment satisfaction, symptom botherness, financial worries, emotional/mental health, and diet advice tolerance. The validated tool had 34 items (questions) that were selected to represent these domains on the basis of extraction communality, factor loading, and interitem and item-total correlations. The final questionnaire had an overall Cronbach’s alpha value of 0.894 (subscale: 0.55 to 0.85), showing high internal consistency in the current study population. A score for each domain was calculated by simple addition of items scores. Each individual domain score was then standardized by dividing by maximum possible domain score and multiplying by 100. All individual standardized domain scores were then added and divided by 8 (number of domain) to obtain an overall score. The data collection was done for 400 patients as an interim analysis. Univariate and subsequently multivariate analysis was performed to decide the predictors that affected quality of life. Age over 50 years (OR = 1.81, CI 1.12–2.93; p = 0.014 ), female gender (OR = 2.05, CI 1.26–3.35; p = 0.004 ), having foot complications (OR = 2.81, CI 1.73–4.55; p < 0.001 ), and having depression (OR = 1.88, CI 1.15–3.06, p = 0.011 ) emerged as predictors of poor QOLID scores. The tool can be made a subtle part of chronic case management of diabetes to ensure patient’s participation in the treatment of the disease and to create a database that can redefine diabetic care in India to suit the diverse regional settings in the country.

Background: Quality of life in Diabetics (QOLID) questionnaire is a validated tool to assess the quality of life affected by diagnosed diabetic patients and has 8 sub domains, which are essential factors that have proven effect on the management. In a state of art Diabetic clinic in Bhubaneswar city, the tool was used to add more quality to diabetic management. Methods: The ongoing assessment through the months of 2020 (study period being from December 2019 to August 2020), offered an opportunity to assess the effect of the pandemic on QOLID scores and review some nascent or strong factors which may be affecting chronic disease management. Results: Complete data could be collected from 599 subjects, 343 from pre pandemic and 256 from pandemic period. The overall scores which were on 100, did not show any significant difference for pre covid and the Covid period, interestingly nearly 1.93 points better in Covid period (69.69±11.10 vs71.62±8.49; p=0.396). Mild difference in overall scores of 4.82 points is seen in females in Covid period; and as seen in age group data maximum gain in sub domains, more for females is seen in the emotional and mental health. Though women reporting to the clinic in both periods are usually in 1:2 ratios, as against men; but QOLID scores in both men and women in Covid period was 71 to 80 points. After the univariate analysis for significant factors, it was that Covid (1.50; 1.08 - 2.07) ; compliance to medications (2.27; 1.48 - 3.50) and reporting of all diabetic complications especially that of eye and depression are coming out to be strong associative factors to affect QOLID scores. Interestingly, rising education has a protective effect on QOLID scores that was significant as higher awareness and better job or earning opportunities may be a contributor for higher QOLID scores for the well educated. Conclusion: This brings out a strong emphasis on QOL assessments to be made an inbuilt part of Diabetic management at all centers to maximize treatment outcomes

No abstract

No abstract

No abstract