Abstract: Introduction: Peripheral arthropathy and entrapment neuropathy are well-recognised manifestations of acromegaly. Distal symmetrical peripheral neuropathy and axial arthropathy producing myeloradiculopathy form a rare combination of manifestations in acromegaly. Case presentation: A 61-year-old male presented with progressively worsening upper and lower limb numbness and weakness for eight months. There was pain, swelling and restriction of movements of bilateral knee joints for 30 years. Change in facial appearance with prominent jaws, forehead, and nose as well as hypertension for more than 20 years had not been evaluated for. He was acromegaloid with severe bilateral knee joint osteoarthritis. There was symmetrical quadriparesis with greater involvement of distal muscle groups and glove and stocking type sensory loss. Lower limb reflexes were diminished while an inverted supinator reflex was elicited. Elevated IGF-1 and non-suppressed growth hormone after oral glucose administration confirmed acromegaly. MRI-pituitary showed a pituitary macroadenoma. There was imaging evidence of cervical and lumbar spondylosis with radiculomyelopathy and cauda equina syndrome. Nerve conduction studies suggested sensory and motor axonal polyneuropathy. Nerve cross-sectional areas were increased. He underwent trans-sphenoidal excision of pituitary tumour and anterior cervical discectomy and fusion which partially improved his neurological manifestations. Conclusions: This patient’s disabling and partly irreversible rare neurological consequences re-iterate the need for early recognition and intervention for this curable endocrinopathy. At this late presentation, diagnostic and management challenges call for careful clinical judgment to avoid expensive and potentially risky interventions without clinical benefit. Published on 2022-06-28 00:00:00
Abstract: We reported a 12-year girl who presented with congenital hypertrichosis, gingival hypertrophy and massively pendulous enlargement of breasts with normal biochemical and hormonal reports. Reduction mammoplasty, long pulsed Nd: YAG laser were done to reduce the breasts’ size and hypertrichosis respectively. The histopathology of the resected breast tissue was compatible with virginal macromastia. This patient presented with a rare combination of several unusual features and requires multidisciplinary approach to improve the quality of her life. Published on 2022-06-28 00:00:00
Abstract: Primary hyperparathyroidism (PHPT) has become one of the commonest endocrine disorders during past few decades. Clinical presentation varies according to the extent to which the biochemical screening is being routinely carried out in clinical evaluation. Even though data from western countries show increased incidence, PHPT is still under-diagnosed in Sri Lanka. Here we report a case of PHPT detected during the evaluation of an incidentally found hypercalcemia in a postmenopausal female patient. Published on 2022-06-28 00:00:00
Abstract: Background: Medication errors are known to occur during prescribing, transcribing, dispensing, administration and monitoring. Look-alike medications can be an important cause of dispensing errors. We report a case of a look-alike medication error occurring in a patient presenting with hypoglycaemia. Case presentation: A 68-year-old female with a past history of rheumatic heart disease on warfarin, carvedilol and captopril, presented to hospital with three episodes of reduced level of consciousness. Hypoglycaemia was identified as the cause of the patient's episodic reduction in the level of consciousness and investigations were commenced. During the hospital stay her all usual medications were continued from the hospital ward, while carvedilol was substituted with verapamil to minimize hypoglycaemic unawareness. After hospital admission the patient did not develop any further episodes. All her investigations including fasting blood glucose, HbAlc, and prolonged fasting test were within normal limits. Detailed evaluation of the patient's medication history, laboratory evaluation of the medications and root-causes analysis confirmed that the identical appearance of both captopril and glibenclamide (colour, shape and size) and similarities in the two containers of the medications was responsible for a dispensing error at the local hospital pharmacy. In light of cases similar to our patient, preventive strategies to reduce look-alike dispensing errors need to be customised and tailor-made depending upon the requirements of the local hospital setting. Conclusions: As highlighted in the present case, clinicians need to be vigilant and consider medication errors in the differential diagnosis, especially when other possible causes have been reasonably eliminated. Published on 2022-06-28 00:00:00
Abstract: COVID-19 has become a major global health problem. COVID-19 teaches us many things, one of which is the relationship between COVID-19 and diabetes. Recent evidence suggests that the coronavirus may cause diabetes. In addition, the term new-onset diabetes in COVID-19 was introduced in 2020, and evidence has been reported. It poses a new challenge to the clinical management of COVID-19 patients. The pathophysiology of this disease is still not fully known. However, hypotheses have been proposed. Therefore, we write this literature review to add insight into new-on set diabetes in COVID-19 patients. Published on 2022-06-28 00:00:00
Abstract: Background: Zinc is an important element of our body which is thought to be involved in the etiopathogenesis of diabetes mellitus (DM). Low level of serum Zinc has been observed in person with DM. Very limited data are available regarding zinc level among young patients with newly detected DM. Aims: To determine the serum zinc level and its association with glycemic status in newly detected young patients with DM. Materials and Methods: In this observational case control study, 40 newly detected young patients with DM and equal number of matched controls with normal glucose tolerance (NGT), were recruited from the department of Endocrinology, Bangabandhu Sheikh Mujib Medical University (BSMMU) to see the serum zinc level and glycemic status. Serum zinc level was measured by using Atomic Absorption Spectrophotometry. Plasma glucose was measured by glucose oxidase method while HbA1c was measured using the national glycosylated hemoglobin standardization program (NGSP) certified Bio-Rad D-10TM Hemoglobin A1c Program 220-0101, USA. Results: Serum zinc level was significantly lower in persons with DM than NGT (DM vs. NGT; 0.87±0.10 vs. 0.93±0.12 mg/L, mean±SD; p=0.02). A significant inverse correlation was observed between serum zinc level & HbA1c (r=-0.370, p=0.019). Serum zinc level was significantly lower in low BMI group (BMI
Abstract: Background: Most chronic liver diseases are subclinical until advanced, delaying their detection and management. Population screening should be guided by prevalence, which determines cost-effectiveness. Autopsy studies are a valuable source to estimate population prevalence and associated factors, particularly for conditions that need invasive screening methods. No large-scale post-mortem studies on liver diseases have been reported from Sri Lanka previously. Aims to determine the prevalence and associated factors of liver diseases in an autopsy series of Sri Lankan adults. Methods: A cross-sectional autopsy study was performed on a series of post-mortems performed in the Institute of Forensic Medicine and Toxicology, Colombo between 2014 and 2016. Liver specimens were examined macroscopically and microscopically with Haemotoxylin and Eosin staining under the light microscope. Clinical and demographic data were collected from the next-of-kin and/or by review of medical records whenever available. Results: Of 441 autopsies performed (men 77.8%, age at death 52.5 ± 17.2 years), 431 specimens were examined macroscopically. Microscopic findings were available from 382 liver specimens. Fatty liver (56.8%), cirrhosis (7.1%) and granulomatous hepatitis (2.1%) were the main histological findings. Prevalence was not different between men and women. Only one specimen showed a neoplasm, which was an adenoma. Diabetes and alcohol use independently predicted the severity of fatty liver. Age, sex, diabetes and alcohol did not predict the presence of fatty liver or cirrhosis. Conclusions: Fatty liver and cirrhosis are common in this post-mortem series of urban-dwelling Sri Lankan adults. Diabetes and alcohol use independently predicted more severe fatty liver. Published on 2022-06-28 00:00:00
Open Access journal
[71 journals]
