Persistent Primary Hyperparathyroidism Secondary to an Ectopic Mediastinal Adenoma in a Young Adult: A Case Report.

Primary hyperparathyroidism commonly affects elderly women. When present in the young population, it is usually asymptomatic, most frequently due to a parathyroid adenoma and the definitive management is surgical excision. Uncommonly, 5-10% of patients fail to achieve long-term cure after initial parathyroidectomy and 6-16% of them is due to an ectopic parathyroid adenoma that will require focused diagnostic and surgical approaches. We report a 21-year-old male who had bilateral thigh pain. Work-up revealed bilateral femoral fractures, brown tumors on the arms and multiple lytic lesions on the skull. Serum studies showed hypercalcemia (1.83 mmol/L), elevated parathyroid hormone [(PTH) 2025.10 pg/mL], elevated alkaline phosphatase (830 U/L), normal phosphorus (0.92 mmol/L) and low vitamin D levels (18.50 ng/mL). Bone densitometry showed osteoporotic findings. Sestamibi scan showed uptake on the left superior mediastinal region consistent with an ectopic parathyroid adenoma. Vitamin D supplementation was started pre-operatively. Patient underwent parathyroidectomy with neck exploration; however, the pathologic adenoma was not visualized and PTH levels remained elevated post-operatively. Chest computed tomography with intravenous contrast was performed revealing a mediastinal location of the adenoma. A repeat parathyroidectomy was done, with successful identification of the adenoma resulting in a significant drop in PTH and calcium levels. Patient experienced hungry bone syndrome post-operatively and was managed with calcium and magnesium supplementation. A high index of suspicion for an ectopic adenoma is warranted for patients presenting with hypercalcemia and secondary osteoporosis if there is persistent PTH elevation after initial surgical intervention. Adequate follow-up and monitoring is also needed starting immediately in the post-operative period to manage possible complications such as hungry bone syndrome.

Association of Vitamin D levels on the Clinical Outcomes of Patients Hospitalized for COVID-19 in a Tertiary Hospital.

Objectives: This study aimed to compare the severity of COVID-19, inflammatory parameters and clinical outcomes among patients with normal and subnormal levels of Vitamin D. Methodology: This is a retrospective cohort study of 135 patients admitted in a tertiary hospital for COVID-19. Patients were grouped according to their Vitamin D level. Primary outcome measure was the composite of all-cause mortality and morbidity. Other outcome measures determined were the comparison among the groups on the severity of COVID-19 infection, changes in inflammatory parameters, length of hospital stay and duration of respiratory support. Results: There was a significant trend of higher ICU admission (p=0.024), mortality (p=0.006) and poor clinical outcome (p=0.009) among the Vitamin D deficient group. No significant difference was found for most of the inflammatory parameters, duration of hospital stay and respiratory support. Overall, patients with deficient, but not insufficient Vitamin D level had 6 times higher odds of composite poor outcome than those with normal Vitamin D (crude OR=5.18, p=0.003; adjusted OR=6.3, p=0.043). Conclusion: The inverse relationship between Vitamin D level and poor composite outcome observed in our study suggests that low Vitamin D may be a risk factor for poor prognosis among patients admitted for COVID-19.

Factors associated with the Severity of Findings on Hepatic Transient Elastography among Persons with Type 2 Diabetes and Fatty Liver.

OBJECTIVE: This study aims to determine the relationship between the different factors associated with the severity of Fibroscan with CAP findings among patients with Type 2 diabetes and fatty liver. METHODOLOGY: This is a cross-sectional study. Seven hundred four Fibroscan with Controlled Attenuation Parameter (CAP) results were electronically retrieved from a diagnostic center. 285 charts of diabetic patients with fatty liver on ultrasound were reviewed. 164 patients with fatty liver on ultrasound and Fibroscan with CAP were included in the study. Several factors were analysed in relation to the severity of Fibroscan with CAP findings in the study group. RESULTS: Fifty five point five percent (55.5%) (91/164) had significant fibrosis and cirrhosis. Hepatic steatosis prevalence was 96% (158/164). Diabetes >5 years (OR 1.75), HbA1c >7% (OR 2.25) and high SGPT levels (OR 2.39) were associated with liver fibrosis and cirrhosis. BMI >25 kg/m2 (OR 1.45), triglyceride levels >150 mg/dl (OR 1.31) and HbA1c >7% (OR 1.74) were associated with hepatic steatosis. CONCLUSION: Factors associated with the severity of hepatic fibrosis, cirrhosis and steatosis included above normal BMI, disease duration of >5 years, poor glycemic control and elevated levels of ALT, and serum triglycerides.

Association of Dialysis Malnutrition Score with Hypoglycemia and Quality of Life among Patients with Diabetes on Maintenance hemodialysis.

OBJECTIVE: To determine the association between Dialysis Malnutrition Score (DMS), hypoglycemia and quality of life among patients with Diabetes on Maintenance Hemodialysis (MHD). METHODOLOGY: Ninety-two diabetic patients on maintenance hemodialysis were assessed using a standardized data collection tool, Dialysis Malnutrition Score, WHOQoL-BREF questionnaire, anthropometric measurements and hourly blood sugar monitoring during the dialysis session. Association among DMS, hypoglycemia and quality of life were assessed along with other associated variables. RESULTS: Based on the DMS, 62% of patients were malnourished. Those with malnutrition were significantly older (p=0.0006) and female (p=0.013). Only 6.5% of the participants developed hypoglycemia during dialysis. Those with poor nourishment in the DMS showed a significant trend of decrease in the quality of life (physical (p<0.001), psychological (p<0.001) and social (p=0.004) and is associated with the occurrence of hypoglycemia (p<0.001). CONCLUSION: Malnutrition is prevalent in diabetic patients on MHD using DMS. A higher DMS score is highly correlated with increased risk of hypoglycemia and decreased quality of life hence detection of malnutrition is important to prevent further nutritional depletion, hypoglycemia and poor patient outcomes by implementing preventive measures such as nutritional counselling and psychosocial interventions.

Knowledge and Practice of Diabetic Foot Care in Patients with Diabetes at Chinese General Hospital and Medical Center.

OBJECTIVE: The objective of this study is to measure the level of knowledge and practice of diabetic foot self-care and determine the factors that affect the level and knowledge and practice of diabetic foot self-care among among patients with diabetes.. METHODOLOGY: Three hundred thirty adult patients with diabetes at the outpatient clinics were given self-administered questionnaires on knowledge and practice of diabetic foot self-care. The scores were computed based on their answers. A score of >70% was gauged as good, 50 to 70% as satisfactory and <50% as poor. RESULTS: Of the subjects, 82.7% had good foot care knowledge, 22.4% had good foot self-care practice, and 71% had satisfactory practice score. Patients who received diabetes education were twice as likely to have a good knowledge score (OR 2.41, 95% CI, 1.09 to 5.32; p=0.03). Compared to patients who received diabetes care in private clinics, those who attended the charity outpatient clinic were nearly three times as likely to have a good knowledge score (OR 2.8, 95% CI, 1.32 to 5.96; p=0.007). Patients with known diabetes for more than ten years and those with a family history of diabetes were 50% less likely to have good practice scores (OR 0.50, 95% CI, 0.28 to 0.90; p=0.021 and OR 0.49, 95% CI, 0.29 to 0.83; p=0.008, respectively). CONCLUSION: The current state of foot care knowledge in Filipino respondents with diabetes is good but the level of foot self-care practice is only satisfactory.

Filipino normative data for thyroid ultrasonography: Correlates with weight, height and gender but not urinary iodine levels

OBJECTIVE: To establish a normal range of values for thyroid volume among adult Filipinos and to correlate thyroid dimensions with age, sex, weight, height, and urinary iodine.METHODS: This is a cross-sectional study conducted at the University of the Philippines-Philippine General Hospital. Out of 212 health personnel screened, 169 were included based on the following exclusion criteria: goiter stage Ib to III as defined by WHO, hyperthyroid or hypothyroid, hospitalization within the past month, chronic renal disease, chronic alcohol intake, more than 4 pack years of smoking, and abnormal laboratory profile. Laboratory parameters included FT3, FT4, TSH, creatinine, anti-thyroglobulin, anti-thyroid peroxidase, 24-hr urinary iodine , and thyroid ultrasonography. There were 55 males and 114 females with a mean age of 38.98 +/- 11.21 years old, mean weight of 59.84 +/- 11.91 kg.RESULTS: The size of the right lobe ranged from 3.58-5.09 x 1.15-1.89 x 1.01-1.90 cm (LxWxD) while the left lobe ranged from 3.62-5.01 x 1.15-1.93 x 1.03-1.84, comparable with established values in literature. Using Hotelling's T-squared, male sex was associated with a larger thyroid dimension, (p-value CONCLUSIONS: The normative thyroid dimensions established among Filipino adults were comparable with the accepted reference values. Thyroid dimensions were significantly correlated with weight, height, and sex but not with urinary iodide levels.