Clinico- Biochemical Profile of Neonates with Birth Asphyxia in Eastern Nepal.

Introduction: Perinatal asphyxia is a common problem with the incidence varying from 0.5 – 2% of live births. It is an important cause of neonatal mortality and is a frequent cause for admission to neonatal intensive care units (NICU). The aims of this study were to find out the clinical and biochemical alterations in different stages of HIE. Materials and Methods: This was a prospective hospital based observational study performed during the period of February, 2010 to January, 2011. Results: Sixty inborn neonates satisfying the criteria for birth asphyxia requiring admission to pediatric wards and neonatal intensive care unit were studied. There were 13(21.7%) cases of mild hypoxemic ischemic encephalopathy (HIE), 27 (45%) moderate and 20 (33.3%) severe HIE. Seizures 41(68.3%), respiratory distress 32(53.3%) and shock 29(48.3%) were predominant manifestations observed. Meconium aspiration syndrome was found in 13.3% of neonates. Hypoglycemia 11(18.3%), hypocalcaemia 7(11.7%), hyponetremia 14 (23.3%) and hyperbilirubinemia 9(15%) were associated biochemical abnormalities. Twenty cases (33.3%) had acute renal failure and they belonged to moderate and severe stages of HIE. Seizures (P< 0.001), respiratory distress (P=0.015), shock (P<0.001) and serum creatinine (P=0.004) were found to be significant among different HIE stages. Conclusion: Neonates having birth asphyxia had HIE, seizures, respiratory distress, shock, hypoglycemia hypocalcaemia, hyponetremia, hyperbilirubinemia and acute renal failure mostly in moderate and severe stages

Foreign body penetration: a missed diagnosis

Healing of the injured site is a complex biological process of carefully orchestrated cellular events. Presence of any foreign body at the site of injury delays the healing along with inducing biological response such as inflammation, infections, allergic reactions, toxic events and tissue alterations. Such body reactions against an exogenous materials depends upon the mode of entry, chemical composition of material, quantity of material its physical form and also depends upon the body site. A careful history, clinical examination and imaging techniques should be considered for patients with any suspected penetrating injuries.

Etiological profile of short stature.

OBJECTIVE: To study the frequency of various causes of short stature and their etiological contribution in a referral endocrinology and metabolism clinic at a tertiary care hospital. METHODS: 352 children with growth retardation attending endocrine clinic between Feb 1999 to Mar 2001 were investigated for etiology of short stature. Agrawal's growth chart was used for percentiles and height velocity. Various relevant radiological, biochemical and hormonal investigations were performed. RESULTS: Normal variant short stature was the most common cause of short stature followed by endocrine causes. CONCLUSION: In males most common cause of short stature was constitutional growth delay, while in females most common cause of short stature was familial short stature.

Cerebral salt wasting syndrome in a patient with a pituitary adenoma.

Cerebral salt wasting syndrome (CSWS) is often an unrecognized cause of hyponatremia that occurs in the setting of intracranial lesions. It is important to differentiate CSWS from the syndrome of inappropriate ADH secretion, as this would alter the management of hyponatremia. We describe a case of CSWS that occurred in association with a non-functioning pituitary adenoma.

Immunoreactive insulin response to a single dose of glimepiride in lean type 2 diabetic subjects.

BACKGROUND: The best method for glucose lowering in lean type 2 diabetes remains controversial and this study was undertaken to study the 24 hour insulin response of these diabetics to glimepiride, a sulfonylurea with distinctive properties. METHODS: Twenty five consecutive newly diagnosed diet-unresponsive lean type 2 diabetics (BMI < 19 kg/m2) without any vascular complications were given single dose (1 mg) of glimepiride and insulin responses were measured 2,4,8,12 and 24 hours later. Pre and post-glimepiride blood glucose levels were also measured. RESULTS: All the post-glimepiride insulin levels were significantly higher than basal values. Increase in insulin secretion peaked at four hours and benefits lasted for at least 24 hours. This was accompanied by clinically and statistically significant reductions in fasting and postprandial blood glucose levels. Maximum secretory response correlated positively with beta cell function (HOMA) and negatively with fasting glucose. CONCLUSIONS: Glimepiride improved insulin secretion and hyperglycemia in lean type 2 diabetic subjects, with benefits lasting for 24 hours. The degree of response was proportional to the beta cell reserve, and occurred irrespective of the presence or absence of markers of insulin resistance.

Clinical and biochemical profiles of young diabetics in North-Eastern India.

OBJECTIVE: We compared the clinical and biochemical profiles of young diabetics in North Eastern India. METHODS: Seventy diabetics who were detected at less than 30 years of age were studied. Patients with ketoacidosis or ketonuria on insulin withdrawal were grouped as insulin dependent diabetes mellitus (IDDM), patients with history of chronic abdominal pain with or without exocrine pancreatic dysfunction who either on ultrasonography (USG) or endoscopic retrograde cholangiopancreaticoduodenography (ERCP) revealed pancreatic calcification and/or ductal dilatation were grouped as fibrocalculous pancreatic diabetes (FCPD), those having BMI < 19 kg/m2 with history or stigmata of childhood malnutrition and who were ketosis resistant were taken to be protein deficient diabetes mellitus (PDDM)/malnutrition modulated diabetes mellitus (MMDM) and those who neither had ketonuria nor history of chronic abdominal pain, malabsorption or stigmata of malnutrition were grouped as NIDDM of young (NIDDY). RESULTS: Amongst the young diabetics studied FCPD constituted 32.9%, IDDM 28.6%, MMDM 21.4% and NIDDY 17.11%. USG abnormalities were observed in 21 of the 23 patients of FCPD. Seven out of these showed pancreatic head calcification on X-ray while 14 showed pancreatic duct dilatation and calcification or calculi on USG. In the two remaining patients, ERCP revealed tortuousity of main pancreatic duct and calcification which were not detected on USG. Majority of FCPD and MMDM patients revealed insulin resistance on insulin tolerance test (ITT). HDL was significantly lower in NIDDY, while VLDL and triglycerides were significantly higher in FCPD and MMDM as compared to controls. Microvascular complications of diabetes were seen in all these groups, with peripheral neuropathy being more common in FCPD (43.5%) and background diabetic retinopathy in NIDDY (41%). CONCLUSIONS: We conclude that FCPD and MMDM together form majority (54.29%) of young diabetics at our center and a sizeable proportion of them may have microvascular complications, even at the time of diagnosis.

Unilateral frosted branch angiitis with vitreous haemorrhage.

Idiopathic retinal frosted branch angiitis is a rare bilateral condition and presents with an acute reduction of vision. Unilateral affection is rare. We report an unusual case of unilateral frosted branch angiitis where the patient developed total vitreous haemorrhage.

Cranial irradiation--an unusual cause for diabetes insipidus.

Central diabetes insipidus frequently occurs due to tumours in the region of pituitary or hypothalamus or following surgical trauma to these regions. Rarely it has been reported following cranial irradiation. We report the case of a middle aged woman who underwent surgical removal of a frontal capillary hemangioblastoma and received cranial irradiation. She presented ten months later with features of diabetes insipidus which was confirmed to be of central origin. She responded well to desmopressin nasal spray. Radiation induced damage to the hypothalmo-pituitary axis presents usually with anterior pituitary hormone deficiencies, most commonly that of growth hormone. Presentation as central diabetes insipidus is very uncommon.

Histoplasmosis: an unusual presentation.

Histoplasma capsulatum (HC) infection is rare in India. We document a case of unilateral adrenal histoplasmosis in a 56 year male. The patient presented with hepatosplenomegaly, unilateral adrenal mass and significant weight loss. Since FNAC of adrenal mass was inconclusive, he underwent splenectomy, adrenalectomy and liver biopsy, histology of these specimens revealed HC only in adrenal mass. Subsequently, histoplasmin test was also performed which was also found to be positive. He responded well to parenteral amphotericin B and is under regular follow-up with no complaints now.

Robinow syndrome.

Robinow syndrome is a rare congenital abnormality. It is characterized by mesomelic brachymelia, hemivertebrae, dysmorphic facies, genital hypoplasia, micropenis, clinodactyly, camptodactly, hypoplastic nails and moderate short stature. We are documenting the case on the account of its rarity and additional features.

Laparoscopic management of hydatid cyst of liver.

We describe the laparoscopic excision of a hydatid cyst in the liver. During the procedure, done after treatment with the scolicidal agents praziquantel and albendazole, care was taken to prevent spillage of scolices during evacuation of contents and to excise the entire germinal epithelium. The patient had no immediate or short-term complications and is asymptomatic 3 months later.