Type 1 diabetes in DKA with hypogonadotropic hypogonadism and pituitary apoplexy � A diagnostic dilemma

A 17-year-old underweight boy came with a classical emergency of diabetic ketoacidosis associated with two additional clinical features; persistently low blood pressure despite adequate fluid resuscitation and hypogonadal features with Tanner stage 3 pubic hair, absent facial, and axillary hair along with a high-pitched voice. These findings triggered an endocrine workup which revealed hypogonadotropic hypogonadism. Suspecting primary pituitary pathology, an magnetic resonance imaging brain, was done which showed a well-defined hyperintense lesion in the pituitary suggestive of pituitary apoplexy. In the absence of headache, diplopia, and visual field defects, this incidental finding posed a dilemma regarding the diagnosis and management of diabetic ketoacidosis in the presence of apoplexy.

Identification of suitable mungbean genotypes for hilly terrains of India using GGE and AMMI biplot approaches

Aim: The present investigation was conducted to approximate the magnitude of genotype × environment interaction effects in mungbean crop and to identify suitable genotypes for northern hilly terrain of India. Methodology: Thirty one promising mungbean genotypes were evaluated in three diverse environments, viz., Srinagar, Berthin and Imphal of northern hilly terrains of India. The individual genotype was planted in 5 rows of 4m length in 3 replications in randomized block design. The statistical analysis was done for Additive Main effect and Multiplicative Interaction (AMMI) and genotype main effect plus genotype-by-environment interaction (GGE) biplots analysis. Results: ANOVA devised that the genotypes, environment and genotype × environment interactions were significant for grain yield. The first two principal components, PC1 and PC2 described 73.65 and 26.35 percent variations, respectively, of total variation. According to AMMI I, the genotypes such as Pant M 6, RMG 1092, TMB 134, CoGG 13-19, KM 2349, DGG-8, TRCM 87-6-2-1, KM 2241 and MDGGv-16 were highly stable genotypes. GGE biplot analysis revealed that Pant M 6 and TMB 134 as winning genotypes for Berthin while NMK 15-12 and MDGGV-16 were the best genotypes for Srinagar. The genotypes IPM 14-7 and GAM 5 were found best for Imphal. Overall, high yield and most stable genotype was DGG-8 for northern hilly terrains of India. Interpretation: GGE biplot and AMMI approach could be instrumental in appraising the genotypes performance in multi-environments/locations testing for efficient selection of the stable genotypes.

A review of the drug pregabalin.

Pregabalin (PGB) is a well-established anticonvulsant and analgesic agent. The stydy reviewed the mechanism of action, pharmacokinetics, adverse drug reactions, contraindications, and various uses of PGB. Literature search was done to identify the relevant studies. PGB is an antagonist of voltage-gated calcium channels and specifically binds to α2-δ subunit to produce antiepileptic and analgesic activity. It has less protein binding activity and lacks hepatic metabolism. It is unlikely to cause pharmacokinetic drug-drug interactions. It has a wide safety margin and does not require serum drug monitoring. The above-mentioned favorable pharmacological benefits of PGB makes it a first-line or adjunctive therapy in various conditions like diabetic peripheral neuropathy, post-herpetic neuralgia, in partial seizures and generalized anxiety disorders.

An unusual foreign body tooth brush in esophagus: a case report.

We report a rare case of accidental toothbrush swallowing by a normal adult which was successfully removed by rigid esophagoscope. A 25 year young man presented to casualty of KIMS, Hubli, with ingestion of toothbrush accidentally half an hour before. Patient’s general physical examination and systemic examination was normal. Oral cavity, oropharynx and indirect laryngoscopic findings were normal. An emergency upper GI Endoscopy was done and foreign body was confirmed to be present at 35 cm from upper incisor teeth. Foreign body was removed by rigid esophagoscope under GA. Otolaryngologist is the most common medical faculty consulted for management of aero digestive foreign bodies. Toothbrush swallowing in normal adults is a rare accident. Most of them are found in esophagus and spontaneous passage is unknown and hence the need for early removal.