BACKGROUND Peripheral cytopenia is defined as reduction in either of the cellular elements of blood, i.e. red cells, white cells, or platelets. The aetiology varies widely ranging from transient marrow suppression by viral infections to marrow infiltration by lifethreatening malignancy. Megaloblastic anaemia is not uncommon in India. Diagnosing this disease assumes great clinical importance since it responds exceedingly well to treatment. OBJECTIVES To study the aetiology and clinical profile of patients with cytopenias with special reference being made for cytopenias in megaloblastic anaemia. MATERIALS AND METHODS An observational study was conducted on 149 patients who presented with cytopenias to the Dept. of General Medicine and Dept. of Haematology, GMCH, Guwahati, during the period of June 2014 to May 2015. Their clinical profile, complete haemogram, and bone marrow examination were studied. RESULTS A total of 149 patients with cytopenia were studied. The patients were predominantly males with mean age of 37 years. Bicytopenia (59.7%) was more commonly seen than pancytopenia (40.3%). The most common cause of cytopenia was Megaloblastic Anaemia (28.2%) followed by Acute Myeloid Leukaemia (22.1%). Majority of the patients presented with Generalised Weakness (94.6%) and Fatigue (74.5%). Most common physical finding was Pallor (94.6%) followed by Splenomegaly (40.3%) and Hepatomegaly (36.2%). Of the 42 patients with Megaloblastic Anaemia, majority of the patients had a macrocytic (71.5%) peripheral blood smear followed by dimorphic picture (21.3%) of which all but 7 patients had hypersegmented neutrophils. Bone marrow examination was done in 31 patients of megaloblastic anaemia, which showed mainly a hypercellular marrow (83.8%). CONCLUSION A detailed clinical history and meticulous physical examination along with a complete haemogram and bone marrow examination in patients presenting with cytopenias is useful in diagnosing the aetiology and initiating quick management.
BACKGROUND Obesity is a global pandemic in adolescent and adult population. Although changes in hypothalamic-pituitary-gonadal (HPG) axis with obesity is well known, there is dearth of literature from Eastern India especially with its relationship to obesity parameters, insulin resistance (IR) & inflammatory markers. We wanted to study the changes in total testosterone (TT), sex hormone binding globulin (SHBG) and calculated free testosterone (cFT) with parameters of obesity [body mass index (BMI), waist, hip, neck, wrist circumference and waist-hip ratio], insulin resistance [homeostatic model assessment (HOMA) – insulin resistance (HOMA-IR) and (HOMA2-IR) and inflammation (adiponectin and high sensitivity C-reactive protein, hs-CRP)] in overweight and obese (OWOB) adolescent and adult males. METHODS An institution based cross-sectional study was done from January 2018 to January 2020 consisting of 323 male participants including adolescent and adults presenting to or being referred for overweight or obesity to the Department of Endocrinology and non-obese volunteers. RESULTS TT was lower in OWOB groups (adolescents - 216.6 ± 82.2 vs. 259.0 ± 111.1 ng / dl; P = < 0.0001, adults - 392.3 ± 131.4 vs. 500.24 ± 137.8 ng / dl; P = < 0.0001) compared to nonobese. Luteinizing hormone (LH), SHBG and cFT was also significantly lower in OWOB groups. Obesity parameters (except waist-hip ratio), HOMA-IR, HOMA2-IR and adiponectin correlated with TT, SHBG and cFT in OWOB adults and only TT in OWOB adolescents. Hs-CRP correlated with TT, SHBG and cFT in OWOB adults. CONCLUSIONS Testosterone was found to have a significant correlation with parameters of obesity, insulin resistance, and inflammation in overweight and obese adolescent and adult males. KEYWORDS Overweight, Obesity, Insulin Resistance, Testosterone, Hypogonadism
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