Non-insulinoma pancreatogenous hypoglycemia syndrome (NIPHS)/Nesidioblastosis as the underlying cause of recurrent hypoglycemia in a diabetic adult

ABSTRACT Non-insulinoma pancreatogenous hypoglycemia syndrome (NIPHS), without previous bariatric surgery, is a rare form of hypoglycemia in adult patients and is associated with nesidioblastosis. Adult-onset nesidioblastosis in diabetic patients is rare and histologically identical to "non-insulinoma pancreatogenous hypoglycemia syndrome (NIPHS)". Nesidioblastosis is rare in adults and clinically and biochemically mimics Insulinoma. In the literature, there have only been four cases of adult nesidioblastosis that followed diabetes mellitus. We report a case of nesidioblastosis in a 36-year-old diabetic female presenting with dizziness, sweating, and palpitations for three years. Selective non-invasive techniques failed to detect a tumor. Based on the pursuit of an insulinoma, a distal pancreatectomy specimen was received at our laboratory, and a diagnosis of nesidioblastosis was made. She is currently on follow-up with a favorable outcome. The definitive diagnosis of nesidioblastosis is made on a histological basis. The preferred form of treatment is pancreatic surgical resection. Nesidioblastosis should be taken into consideration in cases where diabetes transforms into hyperinsulinemic hypoglycemia.

Clinical outcome and course of Tenon’s patch graft in corneal perforation and descemetocele

Purpose: To assess the efficacy and clinical outcome of Tenon’s patch graft (TPG) in corneal perforation and descemetocele. Methods: In this retrospective study, medical records of 83 patients (85 eyes) who underwent TPG for corneal perforation (58, 68%) or descemetocele (27, 32%) between July 2018 and October 2021 were reviewed. Clinical examination and anterior segment optical coherence tomography (AS?OCT) were performed on every follow?up visit. Anatomical success was considered as the restoration of the structural integrity with the formation of scar and anterior chamber (AC). Results: The mean size of the corneal lesions (corneal perforation or descemetocele) was 4.20 ± 1.01 mm. The mean follow?up period was 9.2 ± 5.48 months. The common underlying etiologies were infectious keratitis in 48% and autoimmune disorders in 35% of cases. TPG successfully restored the globe integrity in 74 (87%) eyes (83% in perforation and 96% in descemetocele). Anatomical failure occurred in 11 eyes (13%). The failures were due to graft dehiscence (8 eyes), graft ectasia (1 eye), and scarring with flat AC (2 eyes). The median time to epithelialization and scar formation were 3 and 15 weeks, respectively. Logistic regression analysis showed few predictors for a successful outcome: descemetoceles, noninfective causes, viral keratitis in infectious etiology, and paracentral or peripheral lesions. Conclusion: TPG can be considered an effective and inexpensive treatment for restoring the structural integrity in the eyes with perforations and descemetoceles, particularly when the donor tissue is unavailable. AS?OCT is a valuable noninvasive tool for monitoring the graft status

Fluoride in fish flesh, fish bone and regular diet in south-coastal area of Karnataka state of India

The objective of the study was to estimate the fluoride content in regular food items available, including fish, in a coastal area of the South Karnataka state of India. Materials and Methods: Fish and food samples were collected from a local market, i.e., Deralakatte, Mangalore of Karnataka State, India. Commonly consumed different species of fish (eight types are included in the study) and popular food items (twelve types) were collected through a random sampling strategy and then processed for the study. The flesh and bones of fish were separated from individual fish. Samples of flesh, bones, and food (nonfish, vegetarian food consumed by a proportion of Karnataka population) were homogenized separately, dried, and the pH of the processed samples was adjusted to neutrality (pH 7.0). Fluoride anion was determined using a fluoride ion selective electrode (ISE, Nico2000 Ltd., UK). Although the ingredients of the different fish and food items explored differed, the same processing technique and analytical laboratory bench-work procedure were performed for each sample, i.e., as per published research elsewhere. This ensured the accurate estimation of fluoride for each food item. Results: Concentrations of fluoride in foods (Nonfish, vegetarian food) was estimated to ranging from 0.85 to 7.09 ppm and that in fish samples ranged from 1.45 to 2.30 ppm. The highest concentration was estimated 3.16 ppm in Rohu fish flesh, and 7 ppm in rava dosa (a vegetarian food). Conclusion: In conclusion, the Rohu (Labeo rohita) fish species were found to contain higher concentrations of bone fluoride. Fluoride determined in fish flesh was also high in concentration 2.28 ppm. Among the regular food items, rava dosa (a thin and crispy crepe made from rava and rice flour) preparation has a higher level of fluoride. These values would provide valid information regarding the future development of recommended dietary allowance strategy for a population.