Tumour induced osteomalacia

Tumour-induced osteomalacia [TIO] is a rare paraneoplastic syndrome usually presenting with bone pain, fracture of bones and muscle weakness. It is caused by high serum levels of fibroblast growth factor 23 [FGF-23], which is a hormone-regulating phosphate, and vitamin D. FGF-23 is secreted by several tumours, especially benign mesenchymal tumours which are very small and difficult to locate. There is a significant delay from onset of symptoms to the diagnosis of this entity due to occult nature of this disease. We present a case of young male who presented with long history of progressively worsening muscular pain and weakness, rendering the patient confined to bed. Our aim of presenting this patient as a case report is to make physicians realise that any patient with unexplained muscular weakness and pain must undergo workup for TIO, including serum phosphate measurement, as this is a rare but potentially curable disease

Male hypogonadism at a tertiary care hospital in Karachi, Pakistan

Male hypogonadism is defined as 'inadequate gonadal function, manifested by deficiency in gametogenesis and/or secretion of gonadal hormones'. Signs and symptoms of hypogonadism depend primarily on the age of onset. It can be classified according to the site primarily involved: the gonads, the hypothalamus, or the pituitary gland. The objective this study was to determine the presentation and aetiology of male hypogonadism seen in a tertiary care hospital. This cross-sectional study was conducted at Endocrine Clinics, Aga Khan University Hospital Karachi. Data of male patients with hypogonadism who attended clinics during January 2009 to August 2011 were reviewed. All male patients with clinical and biochemical evidence of hypogonadism were included in the study. Patients with Diabetes Mellitus, Metabolic Syndrome, Andropause, AIDS, Chronic Renal Failure, and Cirrhosis were excluded. Mean +/- SD were computed for quantitative variables. Frequency and percentages were computed for qualitative variables. Aetiology of male hypogonadism was categorised as primary and secondary hypogonadism. A total of 85 patients with male hypogonadism attended the endocrine clinic. Mean age of patients was 25 +/- 10 years. Clinical presentations were small genitalia [65%], absent secondary sexual characteristics [53%], not attained puberty [47%], infertility [53%], erectile dysfunction [41%] and loss of libido [29%]. Seventy-three [86%] patients had hypogonadotrophic hypogonadism [secondary hypogonadism] and 12 [14%] patients had hypergonadotrophic hypogonadism [primary hypogonadism]. Among the patients with hypogonadotrophic hypogonadism 38 had idiopathic hypogonadotrophic hypogonadsim, 7 had pituitary adenoma, 6 had empty sella syndrome, 3 had Kallman's syndrome, and 1 patient had haemosiderosis due to thalassaemia major; 18 patients did not undergo brain imaging. Small genitalia, absent secondary sexual characteristics and infertility were the main presenting features of hypogonad men. Majority of patients had hypogonadotrophic hypogonadsim.

Diagnostic validity of leukocyte esterase dipstick test for diagnosis of spontaneous bacterial peritonitis in cirrhotic patients

Spontaneous bacterial peritonitis [SBP] is defined as an ascitic fluid infection without an evident intra-abdominal surgically treatable source. Spontaneous bacterial peritonitis [SBP] is one of the severe complications in patients with cirrhosis and ascites. Without early antibiotic treatment, this complication is associated with high mortality rate, so early diagnosis and treatment of SBP is therefore necessary for survival. Leukocyte esterase dipstick test can rapidly diagnose the SBP. Objectives were to find out the diagnostic accuracy of leukocyte esterase dipstick test for the diagnosis of spontaneous bacterial peritonitis. This cross-sectional, validation study was conducted from January 2009 to June 2009 at Medical Unit-II, Chandka Medical College Hospital Larkana. All the Patients with cirrhosis and ascites of either gender were included in this study. Paracentesis were performed on admission. The ascitic fluid obtained at bedside was immediately tested with reagent strip Multistixregistered 10 SG. Ascitic fluid was then analysed for PMN cell count. The result of reagent strip was compared with ascitic fluid PMN cell count for determination of sensitivity, specificity, PPV and NPV of the test, while taking ascitic fluid PMN count >/= 250/mm[3] as standard for diagnosis of SBP. Leukocyte esterase dipstick read positive from +1 to +3 reaction while negative and trace reaction regarded as negative test result. Total ninety four patients were enrolled in this study. Ninety-four Ascitic fluid samples were obtained. SBP was diagnosed in 52 [55.3%] patients, 42 [44.7%] patients were negative for SBP by manual cell count. The sensitivity, specificity, PPV, NPV of leukocyte esterase dipstick test to diagnose SBP were 92%, 95%, 96%, 90% respectively. The leukocyte esterase dipstick test can be used as rapid test for diagnosis of SBP due to its high diagnostic validity