Category Archives: Endocrinology

Endocrinology

expert reaction to study looking at disturbed sleep and … – Science Media Centre

April 15, 2023

A study published in the Lancet Respiratory Medicine and presented at the European Congress of Clinical Microbiology & Infectious Diseases (ECCMID) looks at sleep disturbance, dyspnoea and impaired lung function following hospital admission due to COVID-19 in the UK.

Dr Ivana Rosenzweig, Clinical Reader in the Neuroscience of Sleep, Kings College London, said:

Does the press release accurately reflect the science?

The study is a well-designed prospective multicentre cohort substudy that investigated the effects of sleep disturbance on recovery after COVID-19 in a cohort of adult participants, who were recruited from the Post-hospitalisation COVID-19 study (PHOSP-COVID). Based on their findings, the authors of the study (justifiably) speculate, that sleep disruption may be a major drive of breathlessness in these patients. However, it remains unclear to which extent this is further affected/moderated by the associated reduced muscle function and increased anxiety, both also recognised causes of breathlessness.

Is this good quality research? Are the conclusions backed up by solid data?

I agree that major strengths of the study include its size, multicentre nature, and the use of different complementary assessment measures to evaluate sleep disturbance. The findings and the authors conclusions are also further supported by the replicated and consistent clinical associations across each evaluation method.

Have the authors accounted for confounders? Are there important limitations to be aware of?

This is a substudy of a larger study, and thus, it is impossible to exclude that there are other potentially unaccounted for confounders. However, the authors were frank that only associations and learned conclusions can be done in clinical research, this is sometimes as good, and as close as we can get in uncovering the underlying mechanisms, and the authors have done their best to declare all possible limitations and to exclude or account for all known confounders.

What are the implications in the real world? Is there any overspeculation?

It will be now really interesting to see if interventions targeting sleep disturbance can improve daytime breathlessness too.

Dr Richard Russell, Clinical Reader in Respiratory Medicine at King College London, said:

This is an important study in that it sheds light into the nature of Long-Covid, its impact on those living with it and also a new focus for treatment. This nation-wide study was performed by an expert group who have looked at Long-Covid in a robust manner. This study has generated new evidence on this condition and also confirmed the importance of sleep to human well-being.

Sleep quality is not just about quantity; too little is not good for health as is too much. Quality is important. The finding that sleep disturbance occurs in people living with Long-Covid and that this is linked to symptoms is important as there are effective strategies to improve sleep quality that will hopefully impact the burden of this disease and improve the lives of those living with it.

Prof David Ray, Professor of Endocrinology, Oxford Centre for Diabetes, Endocrinology and Diabetes; and Sir Jules Thorn Sleep and Circadian Neuroscience Institute, University of Oxford, said:

This is an observational cohort study. People hospitalised with Covid, after discharge were invited to take part, and about 50% of those approached did so. Observational data can identify associations, and here breathlessness was associated with poor sleep. It could be that breathlessness leads to poor sleep, the other way around, or something else e.g. anxiety could lead to both. The authors acknowledge the limitations of the study design, and attempt to control for them. However, it is clear that poor sleep and poor quality of life are closely linked, and so attention to improving sleep may be a low risk, and high gain approach to help people suffering with long covid. That would require a proper interventional trial, and that may be hard to do as the covid waves are now subsiding.

Prof Nicholas Hart, Professor of Respiratory and Critical Care Medicine, Kings College London, said:

This important study provides further insights into physical and mental health impact following hospitalisation as a consequence of COVID-19 infection. This study has shown that sleep disturbance, anxiety and dyspnoea (breathlessness) were more prevalent in hospitalised COVID-19 survivors following discharge. Of particular interest, these patients showed greater rest time and less efficient sleep during recovery. The next step is to confirm or exclude sleep disordered breathing or other sleep disorders, such as periodic limb movement disorder, so that we can apply interventions to improve sleep quality and assess the impact on breathlessness and anxiety.

Dr Julie Darbyshire, Senior Researcher, University of Oxford, said:

Patients rarely sleep well in hospital and poor sleep following hospital admission is common. Feeling breathless, especially overnight, is distressing and this study demonstrates how this is associated with disturbed sleep.

This study assessed sleep using validated methods which ensures quality of recording and comparison with other similar sleep assessment studies.

It is important to note that this study asked people to recall their sleep before they were hospitalised which is an unreliable measure. Comparisons between sleep before and after hospitalisation are therefore less reliable than comparisons between measures reported in real-time. This should not detract from the wider message that sleep quality after hospitalisation with COVID-19 is poor and is also associated with lower measures of health.

The statistical analysis in the article provides compelling evidence for the association between sleep and breathlessness, muscle weakness, and anxiety after hospitalisation for COVID-19. The press release suggests that sleep disruption might cause breathlessness (dyspnoea) whereas the article itself reports an association between the two without attributing a causal pathway. The press release does not mention the other primary associations with greatest sleep irregularity which include a lower deprivation index, smoking, existing depression or anxiety, diabetes, high blood pressure, and kidney disease.

Although we cant be sure from this study, it is plausible that targeting sleep disruption following admission to hospital for Covid may improve general health and recovery in some people, including muscle strength, anxiety, and breathlessness. In general I would say that for any patient struggling to sleep, regardless of why they were admitted to hospital, addressing this is likely to have an effect on their recovery.

Prof Amitava Banerjee, Professor of Clinical Data Science and Honorary Consultant Cardiologist, Institute of Health Informatics, UCL, said:

This is a detailed and very interesting analysis using novel methods, showing that sleep disturbance is common in patients hospitalised with COVID, even 5-8 months following hospital admission, and the sleep quality seems to be worse, even when compared with control groups in UK Biobank, both hospitalised and non-hospitalised. The authors found associations with multiple symptoms, especially shortness of breath, anxiety and muscle weakness.

However, there are some limitations. First, as the accompanying editorial notes, there may be biases in the patients who had sleep monitoring, compared to the overall population of people hospitalised with Covid. Second, this study only concerns hospitalised post- Covid individuals. The majority of people with Long Covid were not hospitalised for Covid so the results may not be generalisable to this larger group. Third, this study only shows correlation and does not show that sleep disturbance causes the symptoms of long Covid. For example, the sleep disturbances could well be an effect rather than a cause of symptoms like breathlessness and anxiety.

Good quality sleep is important for health and reduces risk of chronic diseases, such that it is included in the American Heart Associations Lifes Essential 8 health behaviour recommendations (https://www.heart.org/en/healthy-living/healthy-lifestyle/lifes-essential-8). Quality of sleep is therefore likely to be important for those with Long Covid in reducing their risk of chronic disease, but the role of sleep in the mechanism of Long Covid needs further research.

Effects of sleep disturbance on dyspnoea and impaired lung function following hospital admission due to COVID-19 in the UK: a prospective multicentre cohort study by Callum Jackson et al. was published in the Lancet Respiratory Medicine at 23:30 UK time on Saturday 15 April 2023.

DOI: 10.1016/S2213-2600(23)00124-8

Declared interests

Dr Ivana Rosenzweig: No COIs.

Prof David Ray: No conflicts.

Prof Nicholas Hart: I am part of PHOSP but not part of this study. No other conflicts relating to this work.

Dr Julie Darbyshire: I have no conflicts of interest to declare. I was the Chief Investigator for the NIHR funded SILENCE study which investigated the relationship between sound levels, sleep, and delirium in the intensive care unit, and Im currently working alongside patients with long covid to understand how long covid clinics can best support their recovery.

Prof Amitava Banerjeeis the chief investigator of STIMULATE-ICP, an NIHR-funded study in non-hospitalised individuals with Long Covid. He has also received research funding from Astra Zeneca unrelated to Covid or Long Covid.

For all other experts, no reply to our request for DOIs was received.

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expert reaction to study looking at disturbed sleep and ... - Science Media Centre

Endocrinology

Systemic Immune Inflammation Index Predictor for Thyroiditis | IJGM – Dove Medical Press

Introduction

Subacute thyroiditis (SAT) is a self-limiting inflammatory thyroid gland disease and is characterized by a sudden onset of neck pain, fever, and thyrotoxicosis caused by follicular epithelial destruction.1,2 Females between the ages of 30 and 50 are particularly vulnerable. In recent years, significant progress has been demonstrated in SAT pathogenesis, epidemiology, and clinical courses. It is a known fact that, inflammation plays a significant role in the development of SAT. Pathogenesis of SAT depends on genetic background and triggering factors, such as several viral infections, vaccines, and some drugs.3 The disease severity may reach its peak within three to four days and continues with fluctuating intensity for three to six weeks. Pain lasts for a week to a few months. The American Thyroid Association guidelines recommend corticosteroids in moderate/severe SAT. In our clinical practice, either non-steroidal anti-inflammatory agents (NSAIDs) or 1632 mg methylprednisolone (MPS) treatment has been administered depending on the clinicians preference. Clinical diagnosis can be made based on history, physical examination, biochemical evidence of transient thyrotoxicosis, and reduced radio-iodine uptake on radioactive iodine uptake scan.4 A very high (>50 mm/h) erythrocyte sedimentation rate (ESR) is an additional distinctive diagnostic feature in subacute thyroiditis. C-reactive protein (CRP) may also be elevated in many cases. Thyroid ultrasonography demonstrates heterogeneously hypoechoic and suppressed vascular patterns.5

A complete blood cell count provides information on the number and morphology of various cells. Neutrophils, a part of the innate immune system, have been shown to increase and release inflammation mediators in inflammatory conditions such as SAT. However, the mechanism of lymphocytopenia in patients with SAT remains unclear. Virus infection of T cells6 and elevated cortisol levels7 may be potential factors leading to lymphopenia. Platelets are known to have regulatory effects on both the innate and adaptive immune systems and that the various cytokines they secrete in collaboration with neutrophils cause tissue destruction as a result of the activation of more and more neutrophils and platelets. It is involved in the pathogenesis of numerous acute and chronic inflammatory and autoimmune diseases.8,9

There is a growing interest in the discovery of new biomarkers as indicators of inflammation. Several new leukocyte-based inflammatory indicators, including the Systemic Immune Inflammation Index (SII), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), and neutrophil-to-lymphocyte ratio (NLR), have recently been used as diagnostic and prognostic predictors of certain diseases. These indicators have also been investigated as biomarkers for inflammatory and rheumatic diseases. SII, which was first developed in 2014, is considered to be more predictive compared to NLR and PLR.10 Besides, it has been shown to be associated with oncological outcomes in several types of cancer.11,12 It is also believed that SII may reflect the balance between host immune and inflammatory conditions.

Considering the research on this matter, our study may be the first one demonstrating the role of SII in the diagnosis and estimating the recovery time of SAT considering treatment.

The primary purpose of the present study is to evaluate the clinical significance of SII regarding recovery time, hypothyroidism, and recurrence rate in patients with SAT and to compare it to other inflammatory markers. Therefore, clinicians may have an idea about the most effective therapeutic choice and its duration by estimating recovery time.

Sixty-nine SAT patients (52 females and 17 males) with no comorbidities and 59 healthy volunteers (43 females and 16 males) admitted to the Outpatient Department of Endocrinology and Metabolism Diseases, Erzurum Training and Research Hospital between November 2021 and June 2022 were involved in this study. SAT was confirmed by typical symptoms, physical examination, increased ESR, elevated free T4 (fT4), decreased TSH, decreased radioactive iodine uptake and presence of hypoechoic areas with blurred margins and decreased vascularization on thyroid ultrasound in all the patients. Considering age and gender factors, there was almost no difference between the patient and control groups. The patients were followed up on 612 months. Anti-inflammatory medication (indomethacin or 1632 mg MPS, depending on their clinical condition) was started for all patients. The dose titration and duration of treatment could be changed according to the patients clinical symptoms. The number of the patients administered indomethacin and MPS was 31 and 38, respectively. Patients below 18 years, pregnant women, patients with chronic diseases such as heart disease, renal failure, hematological diseases, cancer, or rheumatic diseases, and patients receiving medical treatment that may influence the blood system during the preceding three months were excluded from the study.

Biochemical and hematologic tests were studied. Complete blood count parameters white blood cells, platelet count, neutrophil, lymphocyte, and monocyte count were performed with a Sysmex XN 9000 brand autoanalyzer. Other biochemistry parameters were studied with a Cobas C 701 brand biochemistry autoanalyzer (Roche, Germany). TSH and fT4 were measured by the chemiluminescent immunoassay method (Beckman Coulter, DXI 800, Brea, CA, USA). Reference ranges were defined as fT4: 0.891.76 ng/dl, TSH: 0.554.78 mIU/L, ESR: 020 mm/h, and CRP: 05 mg/L.

Novel inflammation parameters were calculated using the formulas NLR = neutrophils / lymphocytes, PLR = platelets / lymphocytes, SII (neuthrophils platelets) / lymphocytes, SLR (ESR lymphocyte rate) = ESR / lymphocytes and CLR (CRP lymphocyte rate) = CRP / lymphocytes.

Theoretically, CRP level increases more rapidly than ESR in early-stage inflammatory diseases and begins to decrease more quickly than ESR. Therefore, we defined the time when the CRP level decreased to normal and the clinical symptoms of patients resolved as the recovery time.

SPSS 22.0 (SPSS Inc., Chicago, IL, USA) statistical software was used for all analyses. The variables were investigated through visual and analytic methods (KolmogorovSmirnov/ShapiroWilk test) to determine whether they were normally distributed or not. Students T-Test and the MannWhitney U-Test were used to compare normally and non-normally distributed variables, respectively. Descriptive analyses were presented using means and standard deviations for normally distributed variables, whereas medians and minimum-maximum were used for non-normally distributed variables. The chi-square test was used to compare categorical variables. On the other hand, the Spearman correlation coefficient was used. P value less than 0.05 was deemed statistically significant.

Table 1 displays the age and gender distributions of the patient and control groups. There was no significant difference in genders or mean ages between the two groups (p>0.05). Neutrophils, monocytes, ESR, CRP, SII, PLR, SLR, CLR, and NLR were found to be significantly higher at the time of diagnosis in the patient group compared to the control group, while LMR was found to be lower. The median recovery period in the study group was thirty-five days (Table 2).

Table 1 The Distribution of Gender and the Means and Standard Deviations of the ParticipantsAge

Table 2 The Medians, Minimum, and Maximum Ranges of Parameters of the SAT Patients at the Time of Diagnosis and Healthy Controls

According to the results of Spearman correlation analysis, a statistically significant positive correlation was detected in SII levels, compared to other inflammation markers like SLR. On the other hand, as expected, there was a statistically significant negative correlation between SII and LMR. Furthermore, our statistical analysis revealed a strong positive correlation between SII and SAT recovery time and a weak-moderate positive correlation between PLR and recovery time (Table 3). According to the correlation analysis between the recovery time and SII based upon the medication administered in the treatment of SAT, a strong positive correlation was detected only in the group given MPS, not in the group given NSAIDs (Table 4). Also, SII levels at the time of diagnosis were already higher in patients receiving MPS (Table 5).

Table 3 Recovery Time Correlations with Other Inflammatory Markers in Patients with Subacute Thyroiditis Using Spearman Correlation Analysis

Table 4 Correlation Analyses Between Systemic Immune Inflammation Index and Recovery Time in Terms of Medical Treatment in Patient Group

Table 5 Comparisons of Some Parameters According to the Type of SAT Treatment

There was no correlation between SII level and ESR, CRP, fT4, or age factor. Hypothyroidism developed in 12 out of 69 patients (17%) during 612 months follow-up period. No significant correlation was detected between the development of hypothyroidism and other parameters such as SII, NLR, LMR, PLR, fT4, CRP/lymphocyte, ESR/lymphocyte, recovery time, and gender factor. Over the course of the follow-up period, only eight (11%) patients in the MPS group had recurrence. No recurrence was observed in the NSAID group (Table 5).

SII levels did not differ between patients developing and not developing recurrence. TSH and ESR levels at the time of diagnosis were higher in patients with recurrence, compared to those without recurrence (Table 6). Considering gender factor, the recurrence rate was 11.8% for males and 11.5% for females.

Table 6 Comparisons of Laboratory Test Results and Recovery Time of the Patients with and Without Recurrence

Subacute thyroiditis is an inflammatory disease with a high inflammatory load that can progress to long-term severe clinical symptoms and significant comorbidity. As can be seen in our study, females between the ages of 30 and 40 are exposed to subacute thyroiditis more frequently, compared to males (a ratio of 3 to 5:1). This inflammatory disease may be diagnosed with medical history and clinical, laboratory, and imaging findings. In the early phase of SAT, almost all patients may have hyperthyroidism and elevated acute-phase reactants. ESR is one of the most widely used laboratory tools for detecting inflammatory syndromes like SAT. However, it is important to take into account all factors that may influence ESR values such as age and gender factors, the lifestyles of patients, and common metabolic abnormalities.13 Occasionally, value discrepancies may be observed between CRP and ESR due to their kinetic differences. To illustrate, CRP level increases faster than ESR level and begins to decrease more quickly. However, whether one over the other or one over two tests combined has a higher predictive value remains debatable.14 Therefore, studies investigating additional parameters to guide diagnosis and prognosis of subacute thyroiditis are ongoing. Although the diagnostic role of ESR and CRP was determined in patients with SAT pursuant to other studies, we found in our study that these parameters were not clinically effective for estimating the healing process.

Some blood cell-derived indexes, including SII, NLR, PLR, and LMR, have been proposed as biomarkers for various inflammatory and non-inflammatory diseases. As a result, we felt compelled to investigate the blood cell-derived indexes, considering the severity of inflammation, duration of the disease, and treatment in patients with SAT. Although there are many studies on various hemogram-related ratios of subacute thyroiditis in the literature, the number of the studies on subacute thyroiditis and SII is limited.15,16 In these studies, as in our study, SII level has elevated significantly in the patient group with SAT when compared to the control group. However, the current study differs from the other studies in question owing to being a prospective observational study. Apart from this, whether blood cell-based inflammatory markers, particularly SII, are associated with recovery time is one of the most significant research subjects, considering the scope of our study. We found that SII may have prognostic value in predicting the healing process as well as its diagnostic role.

ESR, CRP, SII, PLR, and NLR levels in this study were found to be higher in the patient group, whereas the LMR level was found to be lower. SII and other inflammation markers such as CLR and SLR showed a statistically significant positive correlation. All these parameters might be used to assist acute-phase reactants in detecting inflammatory burden at the time of diagnosis. In the study of Takaldiran et al, NLR and PLR levels were found to be higher in patients with SAT than in the control group, similar to our study.17 We also revealed that patients with higher SII levels had a significantly longer recovery period. We know that the types of treatment have a strong confounding effect on the correlation between SII and recovery time. For this reason, we also studied on the correlation between the recovery time and SII based on the treatment modalities performed. We determined that SII levels affected the recovery time with a strong positive correlation in the patients receiving MPS, not NSAID. Not surprisingly, SII levels were found to be higher in patients receiving MPS due to the presence of milder clinical conditions in patients treated with NSAIDs.

In clinical practice, it is important to decide the most effective and appropriate treatment in the acute phase of the disease through the combination of all parameters such as medical history, clinical, laboratory, and imaging findings, and the severity of the disease, which accurately assess the inflammatory burden of the disease in patients with SAT suffering from severe pain and hyperthyroidism symptoms in order not to cause loss of time.

Thyroid inflammation and hyperthyroidism are usually transient, lasting two to eight weeks. Euthyroidism, hypothyroidism, and finally restoration of normal thyroid functions are experienced following hyperthyroidism. Some patients may skip the hyperthyroid phase entirely and proceed directly from the hypothyroid phase to the recovery phase, which is diagnosed clinically in general. However, 5% to 15% of patients progress to persistent thypothyroidism, which requires levothyroxine treatment.18,19 As mentioned above, hypothyroidism is generally transient, but it may nevertheless be permanent. In our study, hypothyroidism developed in 17% of the patients, pursuant to the study results in the literature. However, no correlation was found between the development of hypothyroidism and hematological parameters. The relatively short follow-up period of only 612 months, which is critical for progression to relapse or hypothyroidism in our study, may have affected this correlation.

In our study, patients receiving MPS had a higher SAT recurrence rate (21%), and the total recurrence rate was 11% consistent with the literature.20 In addition, TSH levels at the time of diagnosis were higher in the recurrence group, while TSH levels were lower in the non-recurrence group in accordance with the literature.21,22 Since the recurrence rate of patients with clinically severe hyperthyroidism is lower, the duration of the treatment administered may be shorter, which reduces the possibility of side effects when compared to a longer treatment period.

SII is a widely available, low-cost, universal, non-invasive, and easy-to-reproduce method for detecting inflammation on SAT. As a result, predicting the prognosis and the duration of the disease in the SAT acute phase could provide benefits in the follow-up process, as well as in the selection of aggressive anti-inflammatory treatment. Although SAT is a benign, self-limiting disease, the severe inflammatory burden of the disease in the acute phase may be exhausting for both patients and physicians. According to the results of our study, estimating the duration of the recovery period by considering the level of SII at the time of the diagnosis has importance. As a high SII level indicates a longer recovery period, deciding whether an aggressive treatment with a higher anti-inflammatory effect as the initial treatment would prevent loss of time. On the other hand, a low SII level indicates a shorter recovery period, which means patients may complete the treatment process without suffering any complications and side effects of a more aggressive treatment. Additionally, we found that higher pre-treatment TSH and ESR values may be a risk factor for recurrence. In clinical practice, this result may help the clinician choose an appropriate treatment without increasing recurrence risk, which is already high in the case of high TSH and ESR levels. In addition, shortening the duration of treatment may be considered in patients at low risk of recurrence.

With all these clinical data, multicenter studies involving a large number of patients and years of follow-up are required for SAT.

ESR and CRP levels play a crucial role in the diagnosis of SAT; however, SII level may also be a parameter in order to give clinicians an idea not only on the diagnosis of the disease but also on its prognosis. As a practical biomarker, SII level may be a new diagnostic and prognostic tool for SAT. According to our point of view, more comprehensive studies with a long follow-up period and a large number of patients need to be conducted to contribute to the research on SAT in the literature.

SAT, Subacute thyroiditis; SII, Systemic Immune-Inflammation Index; TSH, thyroid stimulating hormone; NSAIDs, non-steroidal anti-inflammatory agents; MPS, methylprednisolone; CRP, C-reactive protein; ESR, erythrocyte sedimentation rate; PLR, platelet-to-lymphocyte ratio; LMR, lymphocyte-to-monocyte ratio; NLR, neutrophil-to-lymphocyte ratio; SLR, sedimentation-to-lymphocyte ratio; CLR, CRP-to-lymphocyte ratio.

The datasets analysed during the current study are available from the corresponding author on reasonable request.

The study was conducted in accordance with the Declaration of Helsinki (as revised in 2013). The study was approved by the Erzurum Training and Research Hospital Ethics Committee (Decision KAEK 2022/07-72 Date: 06.06.2022). Written informed consent was obtained from all participants.

We would like to thank the Society of Endocrinology and Metabolism of Trkiye for their valuable contributions to the research process by providing data and to the translation process.

There is no specific funding related to this research.

The authors report no conflicts of interest.

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2. Grges J, Ulrich J, Keck C, Mller-Wieland D, Diederich S, Janssen OE. Long-term outcome of subacute thyroiditis. Exp Clin Endocrinol Diabetes. 2020;128:703708. doi:10.1055/a-0998-8035

3. Stasiak M, Lewiski A. New aspects in the pathogenesis and management of subacute thyroiditis. Rev Endocr Metab Disord. 2021;22:10271039. doi:10.1007/s11154-021-09648-y

4. Intenzo CM, Park CH, Kim SM, Capuzzi DM, Cohen SN, Green P. Clinical, laboratory, and scintigraphic manifestations of subacute and chronic thyroiditis. Clin Nucl Med. 1993;18(4):302306. doi:10.1097/00003072-199304000-00007

5. Vural , Paksoy N, Gk ND, Yazal K. Subacute granulomatous (De Quervains) thyroiditis: fine-needle aspiration cytology and ultrasonographic characteristics of 21 cases. Cytojournal. 2015;12:9. doi:10.4103/1742-6413.157479

6. Fois AG, Paliogiannis P, Scano V, et al. The Systemic Inflammation Index on admission predicts in-hospital mortality in COVID-19 patients. Molecules. 2020;25:5725. doi:10.3390/molecules25235725

7. Calapkulu M, Sencar ME, Sakiz D, et al. The prognostic and diagnostic use of hematological parameters in subacute thyroiditis patients. Endocrine. 2020;68:138143. doi:10.1007/s12020-019-02163-w

8. Wang J, Arase H. Regulation of immune responses by neutrophils. Ann N Y Acad Sci. 2014;1319:6681. doi:10.1111/nyas.12445

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10. Fest J, Ruiter R, Ikram MA, Voortman T, Van Eijck CHJ, Stricker BH. Reference values for white blood-cell-based inflammatory markers in the Rotterdam Study: a population-based prospective cohort study. Sci Rep. 2018;8(1):10566. doi:10.1038/s41598-018-28646-w

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15. Keskin , Dileki EN, ZA, Cengiz D, Duran C. Can the systemic immune-inflammation index be used as a novel diagnostic tool in the diagnosis of subacute thyroiditis? Biomark Med. 2022;16(10):791797. doi:10.2217/bmm-2022-0095

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17. Takaldiran I, Omma T, nder E, et al. Neutrophil-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, and platelet-to-lymphocyte ratio in different etiological causes of thyrotoxicosis. Turk J Med Sci. 2019;49(6):16871692. doi:10.3906/sag-1901-116

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Systemic Immune Inflammation Index Predictor for Thyroiditis | IJGM - Dove Medical Press

Endocrinology

INDIA NEEDS A SPORTING CULTURE TO EXCEL IN THE WORLD … – Face2News

TWO DAYS CONFERENCE ON ENDOCRINOLOGY CONCLUDES.

Face2News/Chandigarh:

The two-days medical conference named EPIC (Empower Physicians with International Practices in advanced Diabetes Care), concluded here yesterday with a motivational keynote by the Padma Bhushan Olympian Abhinav Bindra.

Abhinav shared his lifes journey and how the sports changed his outlook towards life with various facets of life and character that helped him develop better self-respect, self-discipline, and self-confidence, and more importantly overcome the fear of failure.

One learns to listen to ones coach and other experts and self-analyse ones strengths and weaknesses, and hone the ability to stay in the moment, focussed and determined, through regular practice, he said, which everyone should try to be the best and get better than yesterday.

The conference concluded with a session on Work-Life balance by ex-IAS, author, and TEDx speaker Vivek Atray, who touched upon physical and mental fitness by advising patients to follow creative pursuits and manage their anger and stress through regular meditation, essential to managing the lifestyle disease like diabetes and obesity.

Abhinav responded to the doctors queries on stress, and anxiousness, he said that all conflicts emerge within and it is only through the practice of staying focussed on the moment to accomplish what one wants to do can make a difference.

When asked about the absence of more sportspeople winning medals for the country, Abhinav said that we need to develop a culture of sports with everyone happily participating in games joyfully, and celebrating it, which would encourage more youth to excel for better performance.

Abhinav Bindra along with EPICs organizing chairman Dr. Sanjay Kalra and secretary Dr. Sachin Mittal conferred Lifetime Achievement Award on two stalwarts in the field of endocrinology, Dr. B. S. Bhatia, Prof. Sarita Bajaj, for their contribution in the field.

Earlier the medical sessions covered various aspects of diabetic patients, wherein the cardiologists Dr. HK Bali, Dr Puneet Verma, Dr Rajneesh Mittal, Dr. Soumik Goswami, Dr. Anil Dhall, Dr. Neeraj Bhalla and Dr. Dilip Bhalla, underlined the need for early detection, prevention and treatment of cardio-renal damage to

Dr. Akshata Desai, Dr. Gurpreet Singh, Dr Mani Kant Singla, Dr Savita Kapila, Dr JK Mokta, Do Soham Mukherjee looked at the practical challenges and solutions in the use of insulin for diabetic patients.

The conference concluded with a session on Work-Life balance by ex-IAS, author, and TEDx speaker Vivek Atray, who touched upon physical and mental fitness by advising patients to follow creative pursuits and manage their anger and stress through regular meditation, essential to managing the lifestyle disease like diabetes and obesity.

Dr. Sachin Mittal, organising secretary, said that sensitization of general practitioners towards newer developments in endocrinology was essential and also how different organs affected by diabetes need to be taken care of at an early stage.

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INDIA NEEDS A SPORTING CULTURE TO EXCEL IN THE WORLD ... - Face2News

Endocrinology

The impact of SARS-CoV-2 infection in pregnancy on infant growth – News-Medical.Net

A recently accepted article manuscript published in the Journal of Clinical Endocrinology and Metabolism discussed recent findings on the impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in pregnancy on infant growth.

Study:Whats past is prologue: growth in infants born from pregnancies complicated by SARS-CoV-2 infection. Image Credit:MIAStudio/Shutterstock.com

SARS-CoV-2 infection in pregnancy raises concerns about the potential risk of transmission to the fetus and the adverse uterine environment for the growing fetus.

The pressing need for research in this domain was recognized, leading to longitudinal studies on the impact of coronavirus disease 2019 (COVID-19) during pregnancy and the development of biorepositories.

COVID-19 can cause excess complications in pregnancy, such as prematurity, preeclampsia, gestational hypertension, and a proinflammatory systemic milieu, that may impact lifelong infant health.

A recent study compared longitudinal trajectories of length, weight, and body mass index (BMI) between infants with and without in-utero exposure to SARS-CoV-2.

The investigators excluded mothers vaccinated during the study period to decrease heterogeneity. The study found that SARS-CoV-2-exposed infants had lower BMI at birth, even when adjusted for gestational age and relevant covariates than those without exposure.

Notably, BMI increased rapidly in exposed infants in the first year of life after accounting for factors influencing BMI.

Also, this postnatal increase in BMI was the steepest in those born to those with severe COVID-19. Statistical analyses revealed that low birth weight mediated most effects of COVID-19 on postnatal BMI increase. Although minor changes in length were noticeable, they were not statistically significant.

Measuring infant length is challenging and could be more error-prone in clinical and research settings. Therefore, research data collection and larger samples may better appreciate the impact of exposure to SARS-CoV-2 on infant growth.

A multinational study on neonates with and without in-utero exposure to COVID-19 found that newborns were small. With weight, head circumference, and length being adversely impacted.

Previously, the authors of the present study observed that infants born with lower BMI had a rapid postnatal increase and noted that exposure to poverty or tobacco was associated with the postnatal BMI catch-up. Further, epidemiologic studies report associations between low birth weight and later catch-up with excess cardiometabolic risk during adulthood.

However, they do not establish a causal relationship between rapid gain in infant weight and adverse outcomes later in life. Socioeconomic disparities contributing to adverse health throughout the lifecycle may contribute to this pattern. Thus understanding the long-term risks associated with the rapid weight gain of infants exposed to COVID-19 in-utero is yet to be determined.

Thus, more research is necessary to understand how long the effects of antenatal COVID-19 persist in life after birth. Additionally, identifying protective factors might result in strategies to enhance preventive care in infants after in-utero SARS-CoV-2 exposure.

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Tarun is a writer based in Hyderabad, India. He has a Masters degree in Biotechnology from the University of Hyderabad and is enthusiastic about scientific research. He enjoys reading research papers and literature reviews and is passionate about writing.

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The impact of SARS-CoV-2 infection in pregnancy on infant growth - News-Medical.Net

Endocrinology

Research suggests brain receptor linked to PCOS symptoms – Mirage News

Polycystic ovarian syndrome, or PCOS, can cause a range of symptoms, including disrupted menstrual cycles, abdominal obesity, cardiovascular disease, and type 2 diabetes. Its also one of the biggest causes of infertility in fact, many people dont discover they have the condition until they try to become pregnant.

One of the hallmarks of PCOS are elevated levels of hormones produced by the ovaries called androgens. Androgens play important roles in puberty and reproduction in people with ovaries and people with testes.

Researchers are trying to understand why PCOS develops and how androgens lead to negative symptoms. A recent study led by Alexandra Cara, Ph.D., a former graduate student in the U-M Medical Schools Department of Molecular and Integrative Physiology, used mouse models to take a closer look at hormonal receptors.

If you expose mice to androgens during two critical windows, before birth or around puberty, they will go on to develop different symptoms of PCOS, said Cara, now a postdoctoral research fellow at the University of California, Los Angeles. Some scientists believe prenatal exposure to androgens or endocrine-disrupting chemicals may lead to PCOS in humans as well.

The study, published in the journal Endocrinology, builds on earlier work in which researchers deleted the androgen receptors (which as their name suggests bind to androgens) in mice. They then exposed the animals to excess androgens before they were born. Without androgen receptors, the mice were protected from developing some symptoms of PCOS.

But, explains Cara, androgen receptors are located throughout the body, including the brain, and deleting them all still left the open question of which receptors were implicated for PCOS development.

Cara hypothesized that another type of receptor called the leptin receptor, studied extensively by her principal investigator Carol Elias, Ph.D., may be involved. Previous work found androgen receptors are highly expressed in certain populations of leptin receptor-expressing neurons in the hypothalamus part of the brain that controls the release of hormones. Leptin, a hormone produced by fat tissue, is involved in the regulation of appetite and metabolism.

We know that a subpopulation of people with PCOS are more likely to have diabetes and visceral obesity. We thought leptin could be a good link between metabolism and reproduction and might be influenced by androgen receptor-mediated androgen signaling, she said.

To test this hypothesis, the team exposed mice that had androgen receptors deleted from leptin receptor neurons to excess androgens prenatally. These mice had improvement in some PCOS symptoms including regulation of their estrous cycles (analogous to a menstrual cycle in humans.)

Cara hopes follow up studies will explore androgen exposure around puberty, as this type of model tends to mimic the weight gain found in some people with PCOS.

I hope these mouse studies can find better therapeutic targets for people with PCOS, Cara said. The first intervention offered is lifestyle modification, like diet and exercise, but as anyone with the condition would tell you, that doesnt help everything.

Even with body weight regulation and restoration of menstrual cycles, people can still struggle with getting pregnant. And while anti-androgen drugs can block the hormones in the body, you cant take them when trying to conceive, she noted.

Its hard to have a perfect model of PCOS, but this is the closest weve gotten so far, said Elias. Once we have a good idea what is causing PCOS and how it develops, things get easier to target.

Paper cited: Deletion of Androgen Receptor in LepRb Cells Improves Estrous Cycles in Prenatally Androgenized Mice, Endocrinology. DOI: 10.1210/endocr/bqad015

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Research suggests brain receptor linked to PCOS symptoms - Mirage News

Endocrinology

Suicidal Thoughts Decline in Endocrinologists: 2023 Survey – Medscape

Rates of suicidal thoughts and attempted suicide among endocrinologists declined from 2022 and now rank similar to the average rate among physicians overall, but these rates are still higher than the general public, according to survey findings.

The current report about suicide among endocrinologists, entitled, "Doctors' Burden: Endocrinologist Suicide Report 2023," prepared by Medscape, was recently published.

A report about suicide among physicians overall, based on the same survey, entitled, "Doctors' Burden: Medscape Physician Suicide Report 2023," was published previously.

In the 2022 survey of a representative national sample of 13,069 US physicians, 10% of endocrinologists reported having suicidal thoughts, ranking the specialty sixth among 29 medical specialties that year.

The 2023 survey found that in a representative national sample of 9175 US physicians, 8% of endocrinologists reported having suicidal thoughts, roughly the average rate among clinicians overall,ranking it 20th among 29 medical specialties.

The highest rates of thoughts of suicide in the latest survey were reported by physicians in otolaryngology (13%), followed by physicians in psychiatry, family medicine, anesthesiology, obstetrics/gynecology, and emergency medicine (roughly 12% in each specialty).

The rate of attempted suicide was 1% among endocrinologists, which was also the rate among physicians overall.

More female than male endocrinologists reported contemplating suicide (8% versus 5%). In addition, 1% of male endocrinologists reported that they had attempted suicide and 2% of female endocrinologists replied they preferred not to answer the question about attempted suicide.

In contrast, in 2020, an estimated 4.9% of US adults aged 18 and older had serious thoughts about suicideand 0.5% attempted suicide, according to the National Institutes of Health website, the latest report states.

Rates of suicidal thoughts and suicide attempts among physicians overall "are worryingly high numbers," Peter Yellowlees, MBBS, MD, emeritus professor of psychiatry at University of California, Davis Health, and chief executive officer, Asynchealth, said in the report.

In the 2023 survey, half of the endocrinologists who had thought about suicide had confided in a therapist and 41% had spoken to a family member, but none had told a colleague or a friend, or phoned a suicide hotline.

On the other hand, 7% of male and 10% of female endocrinologists, and 9% of male and 11% of female physicians overall reported that a colleague had shared suicidal thoughts with them.

"It's pleasing that physicians overall have shown themselves slightly more likely to bring ideas about suicide to a therapist and less likely to keep their distress entirely to themselves," Yellowlees said.

"It's possible that the need for healthcare is becoming less stigmatized nationally, with large and increasing emphasis on physician well-being during and after the COVID-19 pandemic," he suggested.

Endocrinologists reported that to keep happy and have good mental health, they engaged in activities and hobbies (70%), exercised (66%), spent time with family and friends (63%), got enough sleep (56%), ate healthy (48%), went to therapy (11%), or did other things (8%), which was similar to that reported by physicians overall.

The report lists several resources that are specific for physicians having suicidal thoughts (Physician Support Line, 988 Suicide and Crisis Lifeline, Peer RxMed, International Association for Suicide Prevention, and the American Foundation for Suicide Prevention) along with contact information.

The 2023 survey was conducted from June 28, 2022, to October 3, 2022, and the 2022 survey was conducted from June 29, 2021, to September 26, 2021.

Doctors' Burden: Endocrinologist Suicide Report 2023.

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Suicidal Thoughts Decline in Endocrinologists: 2023 Survey - Medscape

Endocrinology

More than 210 VCU Health doctors recognized as Richmond Top … – VCU Health

Richmond Magazinehas published its annual list of top doctors in the Richmond region. VCU Health made the top of the list with more than 210 providers being featured. There was also a special recognition for one ofVCU Massey Cancer Centers team members.

Vanessa Sheppard, Ph.D., associate director for community outreach and engagement and health disparities research at Massey Cancer Center, was the magazines cover story for this years special edition. Sheppard was named theAmerican Cancer Societys Researcher of the Yearfor her innovative community studies on health disparities and breast cancer. She is also theinaugural interim deanof the recently announced Virginia Commonwealth UniversitySchool of Population Health.

Of the VCU Health providers named to Richmond Magazines list this year, about 20 were listed as Top Docs in multiple specialties, including those serving patients at theChildrens Hospital of Richmond at VCU,VCU Massey Cancer Center,VCU Hume-Lee Transplant CenterandVCU Health Pauley Heart Center.

This special recognition highlights the compassionate care our doctors provide as well as the innovative technology and inclusive approaches they use to treat our patients.

Addiction Medicine

Allergy and Immunology

Anesthesiology

Cardiac Electrophysiology

Cardiology (Interventional)

Dermatology

Emergency Medicine

Endocrinology, Diabetes and Metabolism

Family/General Practice

Gastroenterology

Genetics

Geriatric Medicine

Gynecology/Obstetrics (General)

Hematology and Oncology

Hepatology

Gynecologic Oncology

Hospice Care

HospitalistAdult

Infectious Diseases

Intensivist

Internal Medicine

MaternalFetal Medicine/High-Risk Pregnancy

NeonatalPerinatal Medicine

Nephrology

Neurology

Neurosurgery

Nurse Practitioner

Oncologic Surgery

Ophthalmology and Ophthalmologic Surgery

Optometry

OrthopedicsGeneral

Otolaryngology and Otolaryngologic Surgery

Pain Management

Palliative Care

Pathology

Pediatric Adolescent Medicine

Pediatric Allergy/Immunology

Pediatric Cardiology

Pediatric Emergency Medicine

Pediatric Endocrinology

Pediatric Gastroenterology

Pediatric Hematology/Oncology

Pediatric Hospitalist

Pediatric Infectious Disease

Pediatric Intensivist

Pediatric Nephrology

Pediatric Neurology

Pediatric Otolaryngology

Pediatric Palliative and Hospice Care

Pediatric Pulmonology

Pediatric Rheumatology

Pediatrics (General)

Pediatrics Neurodevelopmental/Behavioral

Pediatric Sports Medicine

Pediatric Surgery (General)

Pediatric Surgical Specialist

Pediatric Urology

Pediatrics Child Abuse

Physical Medicine and Rehabilitation

Physician Assistant

Plastic/Cosmetic Surgery

Plastic/Reconstructive Surgery

Podiatry

Psychiatry/Adult

Psychiatry/Child and Adolescent

Psychiatry/Geriatric

Psychology (Doctor of Psychology)

Pulmonology

Radiation Oncology

Radiology Diagnostic

Radiology Interventional

Reproductive Endocrinology/Infertility

Rheumatology

Sleep Medicine

Sports Medicine

Surgery (Bariatric)

Surgery (Breast)

Surgery (Cardiac)

Surgery (Colon and Rectal)

Surgery (General)

Surgery (Hand)

Surgery (Mohs, Skin Cancer)

Surgery (Orthopedic)

Surgery (Spine)

Surgery (Thoracic)

Surgery (Transplant)

Surgery (Trauma)

Surgery (Vascular)

Urogynecology

Urology and Urological Surgery

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