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Diagnosing a Rare Case of Lymphocytic Infiltration of the Pituitary Gland Without the Invasive Procedure of Pituitary Biopsy
Hamad Haider Khan,
Hameed Ullah,
Hui Guo,
Siraj Ulhaq Khan,
Shida Hussain,
Zahid Nadeem,
Faiz Ullah Khan,
Ayesha Jamil,
Nawab Ali,
Irfan Mansha,
Safiullah Khan Achakzai,
Mirwais Khan,
Khan Alam,
Bingyin Shi
Issue:
Volume 6, Issue 6, November 2021
Pages:
83-87
Received:
12 October 2021
Accepted:
30 October 2021
Published:
17 November 2021
Abstract: Background: Lymphocytic infiltration of the pituitary is an unusual inflammatory disorder of the pituitary and indicated to be autoimmune in origin. Presentations depend on the site of involvement and degree of destruction of the cellular population of the pituitary and may range from an asymptomatic state to pan-hypopituitarism with or without mass effects. In the present study, we represent a rare case of lymphocytic infiltration of the pituitary gland who was diagnosed with such condition and the subsequent management. Case presentation: A 22-year-old male who was admitted with symptoms of increased thirst and excessive fatigue. Following a thorough physical, clinical, laboratory, biochemistry, and imaging examinations a timely diagnosis of lymphocytic infiltration of the pituitary was made without using the invasive procedure of pituitary biopsy. In light of the diagnosis prompt management with the mainstay of glucocorticoid was started along with replenishing the other deficient hormones. In this study we describe a rare case of lymphocytic infiltration of the pituitary discussing in terms of epidemiology, sign and symptoms, laboratory evaluation, imaging studies, histopathology, management, and the usual outcome. Conclusion: lymphocytic infiltration of the pituitary gland can be diagnosed with the clinical presentation along with lab evaluation and imaging but without pituitary biopsy, which could help in an early and accurate diagnosis which is the basis for better management of the rare condition.
Abstract: Background: Lymphocytic infiltration of the pituitary is an unusual inflammatory disorder of the pituitary and indicated to be autoimmune in origin. Presentations depend on the site of involvement and degree of destruction of the cellular population of the pituitary and may range from an asymptomatic state to pan-hypopituitarism with or without mas...
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Hoffmann Syndrome, Manifestation of Hypothyroidism: Case Report
Asmell Ramos Cabrera,
Alexis Culay Perez,
Yamila Rodriguez Sanchez,
Alexis Gregori Caballero
Issue:
Volume 6, Issue 6, November 2021
Pages:
88-90
Received:
6 June 2021
Accepted:
7 July 2021
Published:
23 November 2021
Abstract: Hoffmann syndrome is defined since 1897 as the combination of hypothyroidism with myopathy, mioedema, rigidity, muscle cramps, and hypertrophy. The objective of this publication is to describe a typical case of thyroid disease with clinical, hormonal, and muscular characteristics of a Hoffmann syndrome, as an exceptional manifestation of hypothyroidism. The clinical challenge consisted in linking the apparent ambiguity of the clinical symptoms such as: generalized weakness, fatigue, muscle cramps in a young patient, without personal record of previous disease, apparently healthy and well-nourished with favorable muscle development. Additionally, manifestation of pituitary gland dysfunction was found, such as headache and galactorrhea, bibliography reviewed showed mainly, male patients patter and not any comment concerning hypophysis impairment. all clinical manifestations disappeared after replacement treatment with levothyroxine, including the goiter and pituitary macroadenoma. The management of the case involved a multidisciplinary team and involved internists, cardiologist, endocrinologists, radiologist, and neurosurgeons. This form of thyroid myopathy is rare and usually accompanies adult patients with severe and long-standing hypothyroidism, is different from those that begin in early childhood and are associated with cretinism and muscle hypertrophy.
Abstract: Hoffmann syndrome is defined since 1897 as the combination of hypothyroidism with myopathy, mioedema, rigidity, muscle cramps, and hypertrophy. The objective of this publication is to describe a typical case of thyroid disease with clinical, hormonal, and muscular characteristics of a Hoffmann syndrome, as an exceptional manifestation of hypothyroi...
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Community-Based Active Case Finding to Increase Tuberculosis Case Detection and Treatment Success Rate in High Tuberculosis Burden Areas of Arsi Zone, Oromia
Merga Gonfa Bati,
Bizuayehu Gurmessa Ejeta
Issue:
Volume 6, Issue 6, November 2021
Pages:
91-100
Received:
5 October 2021
Accepted:
28 October 2021
Published:
7 December 2021
Abstract: Background: More than 9 million new cases of tuberculosis (TB) occur per year and about two million people die of TB. The probable cause of death is delay in diagnosis, low case detection rate and treatment success rate. Due to the low potential of tuberculosis (TB) microscopic examination and the need to increase rate of new TB case identification is also increased. Objective: To determine magnitude of active tuberculosis cases, evaluate the performance of LED-FM and X-pert MTB/RIF assay and characterize treatment outcome Methods: The door-to-door survey for TB in high TB burden areas of Arsi zone was performed. The participants were screened based on typical TB symptoms. The sputum samples were collected and transported to the laboratories. Culture, LED-FM and X-pert MTB/RIF assay were performed to confirm tuberculosis infection. Result was communicated through cell phone or short message system (SMS) for issuing of positive results. The health extension worker would contact diagnosed patients referred to their local health center for care. Finally, the performance of diagnostic tests, case detection rate and treatment success were determined. Result: In this study 344 pulmonary TB suspected study participants were involved from the three study sites. Based on the LED microscope results the general prevalence of pulmonary TB among the current study participants was 2.3%. On the other hand Gene X-pert MTB/RIF assay could show that 9 (2.6%) of the study participants became positive for pulmonary TB cases. There was 1 (0.3%) discordant result between the two assay methods. LED microscope missed one TB suspected case which was detected by Gen X-pert MTB/RIF assay and then confirmed by LJ culture media and become positive for pulmonary TB. Hence, the overall prevalence of pulmonary TB in our current study became 2.6% with 95% CI (1.2-4.5) using LJ culture media as tiebreaker. Of 344 study participants in this study, 9 (2.6%) were positive for pulmonary TB and given first line anti-TB drugs. Of the nine pulmonary TB test positive study participants who had prescribed with first line anti-TB drugs in which 2 (22.2%) were known to be cured as well as 7 (77.8%) had completed the treatment regimen prescribed for them.
Abstract: Background: More than 9 million new cases of tuberculosis (TB) occur per year and about two million people die of TB. The probable cause of death is delay in diagnosis, low case detection rate and treatment success rate. Due to the low potential of tuberculosis (TB) microscopic examination and the need to increase rate of new TB case identification...
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Excessive Gestational Weight Gain Precedes Incident HELLP Syndrome Among Nigerian Women
Collins Amadi,
Bright Amadi
Issue:
Volume 6, Issue 6, November 2021
Pages:
101-106
Received:
18 November 2021
Accepted:
3 December 2021
Published:
9 December 2021
Abstract: Background: Excessive gestational weight gain (GWG) have been theorized to precede HELLP syndrome (HELLPs) among Caucasian women mostly of western populations. This theory has not been validated among women of Nigerian origin. Hence, the current study evaluated the relationship between excessive GWG and the incidence of HELLPs among Nigerian women. Methods: The retrospective study was conducted among 108 supervised nulliparous pregnant women who were diagnosed with complete HELLPs by term (37-42 gestational age) in the University of Port Harcourt Teaching Hospital from 2011-2020. The relevant data of eligible cases were extracted from case notes, nurses’ charts, laboratory, and other medical files using a pre-tested research template and analyzed using the Statistical Package for Social Sciences software version 25. Results: During the study, 108 eligible cases were identified. At booking, the majority of the HELLPs patients were found to be overweight (n=49; 45.4%). At diagnosis by term, the HELLPs patients had markedly higher mean weight compared to their mean booking weight (booking weight: 74.32 ± 7.13 vs. term weight: 105.74 ± 7.59; p<0.001). The majority of the HELLPs patients had GWG above the Institute of Medicine (IOM) recommendations (n=67; 62.1%; p<0.001) by term. The underweight, ideal weight, overweight, and the obese with GWG below the IOM recommendations were less likely [adjusted odd ratio (aOR)<1.0] to develop HELLPs while those with GWG above the IOM recommendations were more likely (aOR>1.0) to develop HELLPs. However, the lower chance of incident HELLPs among those with GWG below the IOM recommendations was attenuated with increasing BMI status while the more likelihood of incident HELLPs among those with GWG above the IOM recommendations becomes amplified with increasing BMI status. Conclusion: The present study findings indicate that excessive GWG seemed to precede incident HELLPs among at-risk women in Nigeria. However, further studies are recommended to verify the conclusions of this study.
Abstract: Background: Excessive gestational weight gain (GWG) have been theorized to precede HELLP syndrome (HELLPs) among Caucasian women mostly of western populations. This theory has not been validated among women of Nigerian origin. Hence, the current study evaluated the relationship between excessive GWG and the incidence of HELLPs among Nigerian women....
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Association of Lipid Ratios and Neutrophil-lymphocyte Ratio in Type 2 Diabetic Moroccan Patients Without Chronic Kidney Disease
Siham Aboulmakarim,
Abderrahmane Boukhira,
Sanae Sayagh,
Saliha Chellak
Issue:
Volume 6, Issue 6, November 2021
Pages:
107-113
Received:
10 November 2021
Accepted:
30 November 2021
Published:
24 December 2021
Abstract: Background: Atherogenic dyslipidemia and currently chronic inflammation are among the factors of atherosclerosis in type 2 diabetes mellitus patients (T2DM). This retrospective study conducted at Mohammed VI University Hospital, Morocco, from January 2020 to June 2021, aimed to investigate the association between the lipid profile, lipid ratios and neutrophil to lymphocyte ratio (NLR), among T2DM Moroccan patients without chronic kidney disease and to find out the possible correlation between these parameters and glycated hemoglobin (HbA1c). Methods: 274 T2DM patients and 88 non-diabetic controls aged over 40 years old were analyzed. Fasting plasma glucose, lipid profile tests, liver and renal function tests, and HbA1c test were measured. The NLR and lipid ratios including total cholesterol / HDL-c, non- HDL-c and atherogenic index of plasma were calculated. Results: There was no significant difference in median level of all lipid profile parameters between the poor controlled T2DM group (HbA1c > 7%) compared to the well controlled group (HbA1c ≤ 7%) and control group (all P > 0.05). All lipid ratios were lower in the good controlled group compared to the poor controlled diabetes group, but the difference did not reach statistical significance (all P > 0.05). HbA1c was correlated with FPG, and neutrophils (r = 0.655, r = 0.263, P < 0.001 respectively). NLR was weekly correlated with HDL (r = -0.14, P = 0.01). By using multivariate logistic regression, FPG was the only factor significantly predictive of well diabetic control. Conclusion: This study did not show significant association between HbA1c, lipid ratios and NLR.
Abstract: Background: Atherogenic dyslipidemia and currently chronic inflammation are among the factors of atherosclerosis in type 2 diabetes mellitus patients (T2DM). This retrospective study conducted at Mohammed VI University Hospital, Morocco, from January 2020 to June 2021, aimed to investigate the association between the lipid profile, lipid ratios and...
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Laboratory Indicators of AKI in the Setting of HELLP Syndrome in Resource-constrained Backgrounds
Collins Amadi,
Bright Amadi
Issue:
Volume 6, Issue 6, November 2021
Pages:
114-119
Received:
23 November 2021
Accepted:
10 December 2021
Published:
24 December 2021
Abstract: Background: Acute Kidney Injury (AKI) in the setting of HELLPs (HELLP syndrome) brings in a high rate of maternal and perinatal morbidity/mortality. Its diagnosis depends on proper evaluation of relevant laboratory indices; a factor that is very limited in resource-constrained environs. Hence, the current study evaluated some routine laboratory indices of AKI in the setting of HELLPs in resource-constrained backgrounds. Methods: The study was conducted retrospectively at a tertiary hospital in Nigeria among 198 pregnant women diagnosed/managed for HELLPs from 2011-2020. Relevant variables and data were extracted from laboratory and other medical files using a well-designed research pro forma and analyzed using standard guidelines. Results: Among those evaluated, 57.1% (n=115) developed AKI. The AKI cohorts had higher mean plasma creatinine (PCr) and plasma uric acid (PUA) levels but lower 24-hour urine volume (UV) compared to the non-AKI cohorts (p<0.05). PCr and PUA levels increased while 24-hour urine volume (UV) decreased with advancing AKI stages (p<0.05). The PCr, PUA, and 24-hour UV predicted AKI on univariate logistic regression analysis (LRA) (p<0.05). However, on multivariate LRA, PUA level and the 24-hour UV lost their statistical significance while that of PCr level was significantly amplified (OR: 9.440; 95%CI: 6.733-11.202). At a cut-off value of 106.7 µmol/L, PCr level maintained a robust predictive potential (AUC: 0.938; 95%CI: 0.859-1.000; p<0.001) for AKI. Conclusion: PCr had a robust predictive potential of AKI among the studied population. Hence, timely measurement of PCr level should be considered during the management of HELLPs to reduce the burden of AKI among this at-risk group, especially in resource-constrained settings.
Abstract: Background: Acute Kidney Injury (AKI) in the setting of HELLPs (HELLP syndrome) brings in a high rate of maternal and perinatal morbidity/mortality. Its diagnosis depends on proper evaluation of relevant laboratory indices; a factor that is very limited in resource-constrained environs. Hence, the current study evaluated some routine laboratory ind...
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