A case of pituitary adenoma presenting with normal hormone levels

We report a case of pituitary adenoma with normal hormone levels in a 34-year-old female. She presented to OP with headache, milky discharge from nipples and secondary amenorrhea with transient loss of vision. Patient had hyperprolactinemia with normal levels of all other pituitary hormones. MRI revealed space occupying lesion in sellar and suprasellar region. Neurological consultation suggested Rathke抯 cyst/ craniopharyngioma/ macroadenoma. Excised lesion was diagnosed as pituitary adenoma during histopathological analysis.

An interesting case of COVID induced multi system inflammatory syndrome

COVID-19 derives from infection with Coronavirus [severe acute respiratory syndrome (SARS)-CoV-2] is associated with high morbidity and mortality. These hazardous impacts are due to the release of a storm of pro-inflammatory cytokines and thrombogenic agents. Increasing evidences about multi organ involvement in COVID infection have started pouring in, where patients who either recovered from or had mild symptoms after COVID-19, exhibit diffuse multi organ related symptoms. We describe a case of a 23-year-old male who presented to emergency room with intermittent high-grade fever, sudden onset of breathlessness, giddiness and weakness. His COVID RTPCR was negative. He was unvaccinated but his covid antibodies were increased multifold. Further examination revealed active multi organ involvement which suggestive for multisystem inflammatory syndrome (MIS). With appropriate diagnosis and treatment patient improved clinically over a course of 3 weeks and discharged and is under regular follow up.

Association of anemia and hypoalbuminemia with mortality among patients undergoing routine hemodialysis

Background:The progressivity of chronic kidney disease (CKD) is associated with several clinical conditions which contribute to high morbidity and mortality, including anemia and hypoalbuminemia. This study aimed to assess the association of anemia and hypoalbuminemia with the mortality of CKD patients undergoing routine hemodialysis (HD) in Siloam Hospital Kupang.Methods:We conducted a retrospective cohort study based on Indonesia renal registry data system and hospital medical records. We studied the following variables: gender, age, etiology of CKD, vascular access of HD, and prevalence of anemia and hypoalbuminemia. All analysis was performed using SPSS software version 22.Results:There were 128 patients enrolled in this study. Of the total patients who died, most of them died within the first 3 months since the initiation of HD (62.1%). The majority of patients had anemia (67.2%) and hypoalbuminemia (69.5%). The bivariate analysis showed that anemia (p value=0.192), and hypoalbuminemia (p value=0.336) were notstatistically significant associated with mortality among patients undergoing routine HD.Conclusions:Anemia and hypoalbuminemia are not statistically associated with mortality outcome of CKD patients in Siloam Hospital Kupang. However, these conditions may still have prognostic importance for CKD patients undergoing routine HD. Further studies with larger size of cohort and longer period of time are warranted.

Analysis of the relation between elevated neutrophil lymphocyte ratio, and erythrocyte sedimentation ratein Helicobacter pyloripositive chronic gastritis patients

Background:Aim of the study was to analyse the relation between elevated neutrophil lymphocyte ratio (NLR), and erythrocyte sedimentation rate (ESR) in Helicobacter pylori(H. pylori)positive chronic gastritis patients, as compared to the control group containing H. pylorinegative chronic gastritis patients.Methods:Chronic gastritis patients were segregated in equal numbers based on H. pyloristatus. NLR was calculated, and ESR noted from the observations, comparison was done between the control and the study groups.Results:A total of 100 patients were included in the study. The 50 each from the control and study group. An observation of elevation in NLR and ESR in H. pyloripositive chronic gastritis patients, as compared to the control group was seen. With an average NLR of 2.43 and 1.43, in the control and study group, respectively.Conclusions:Raise in NLR in H. pyloripositive chronic gastritis patients with an associated raise in ESR suggests, the severity of the infection and the need for eradication and prevent complications

A rare case of pancreato-pleural fistula with left sided massive pleural effusion

Pancreaticopleuralfistula is a very rare complication of acute and chronic pancreatitis. High index of suspicion is needed to diagnose in patients with alcohol induced pancreatitis, presenting with recurrent or persistent pleural effusion. Patient typically presented with pulmonary symptoms, rather than abdominal complaints, leading to delay in the diagnosis. Here we present a case of a known chronic pancreatitis who presented to us with massive left sided pleural effusion. Blood coloured pleural fluid analysis showed lipase and amylase levels in hundred thousand and ten thousand ranges. Diagnosis was made by CECT abdomen and confirmed with MRCP. Patient was treated with first line medical management of thoracocentesis and ERCP with pancreatic duct stenting.

A case of Osler-Weber-Rendu syndrome associated with portal hypertension

Osler-Weber-Rendu syndrome is a rare autosomal dominant vascular disorder, characterised by multiple telangiectasesof the skin and mucous membranes with recurrent nasal and gastrointestinal bleedings and arteriovenous malformations of various organ systems. It is also called as hereditary hemorrhagic telangiectasia (HHT). The occurrence of telangiectases in the stomach and small bowel can result in chronic bleeding and anaemia. We report a rare case of 39 year old female with Osler Weber Rendu syndrome associated with portal hypertension. She had recurrent nasal and gastrointestinal bleeding, and presented with complaints of progressive dyspnea NYHA class III. On further evaluation she was found to have portal hypertension, which is a rare association.

Immunization of Children with Cancer in India Treated with Chemotherapy – Consensus Guideline from the Pediatric Hematology-Oncology Chapter and the Advisory Committee on Vaccination and Immunization Practices of the Indian Academy of Pediatrics

Justification: Children with cancer need to be immunized against the common vaccine-preventable diseases after completion andsometimes during ongoing treatment of cancer. However, the immunization schedule for these children needs to be altered due todisease and treatment related immune-suppression. Consequently, there are many guidelines/practice statements from around theworld to address this issue, however, there is no such comprehensive guideline from India catering to the need of Indian children withcancer. Process: A guideline was drafted after reviewing the available literature. The draft guideline was discussed and modified in ameeting attended by pediatric oncologists from the PHO chapter and vaccine experts from the ACVIP of the IAP. Subsequently, themodified draft was reviewed and recommendations were finalized.Objective: To review the current evidence and generate a nationallyrelevant guideline for immunization of children receiving chemotherapy for cancer. Recommendations: Live vaccines arecontraindicated during and up to 6 months after end of chemotherapy. Non-live vaccines are also best given after 6 months from the endof treatment for durable immunity. Annual inactivated influenza vaccine is the only vaccine recommended for all children duringchemotherapy whereas hepatitis B vaccine is recommended only for previously unimmunised children with risk of transfusion associatedtransmission of infection. Post-treatment re-immunization/catch-up schedule largely depends on the pre-chemotherapy immunizationstatus. Sibling immunization should continue uninterrupted except for oral polio vaccine which needs to be substituted by the injectablevaccine. Inactivated influenza vaccine is recommended and varicella vaccine is encouraged for all contacts including siblings