Hypogonadotropic Hypogonadism in a Boy with Myopathy.

Hypogonadism is seldom seen together with myopathy, although testosterone contributes to muscle strength. We present here a rare case of hypogonadotropic hypogonadism with myopathy in a 20 year old male. He had flaccid quadriparesis with raised creatinine phosphokinase. Hormone assays revealed low testosterone as well as low luteinising hormone and follicle stimulating hormone levels. Tests to exclude androgen deficiency should be carried out in male patients with myopathy.

Central Precocious Puberty: A Case Report.

Precocious puberty in a male child is uncommon. Moreover, a predominantly luteinising hormone secreting pituitary tumor is rare. We report a case of predominantly luteinising hormone secreting pituitary adenoma causing precocious puberty in a three year old boy. A thorough systematic investigation including serum gonadotropins and imaging should be done to search for an underlying cause, even in the absence of pressure symptoms. Surgery with long term follow up is the recommended treatment for functioning gonadotrophin tumors.

A middle aged lady with recurrent low trauma fracture due to parathyroid adenoma.

A 48 year old lady was referred to BIRDEM Hospital, Dhaka, Bangladesh by her local physician for evaluation of hypercalcaemia and increased serum parathyroid hormone (PTH) in the background history of low trauma fracture. Ultrasound of neck and parathyroid scintigraphy with 99mTc-MIBI revealed a parathyroid adenoma. Parathyroidectomy was done. Histopathology report showed features consistent with parathyroid adenoma. Primary hyperparathyroidism should be kept in mind in all patients presenting with history of bone problems ranging from simple bone pain to spontaneous or low trauma fracture associated with hypercalcemia. By the help of appropriate localization technique it can be localized and cured by parathyriodectomy.

Beneficial effects of coconut oil (Cocos nucifera) on hematobiochemicl and histopathological markers in CCL4-intoxicated rabbits.

The study was designed to investigate the effect of Coconut Oil on the levels of some liver and hematological parameters in carbon tetrachloride intoxicated rabbits. Also the antioxidant capacity of Coconut Oil for various concentrations was assessed on the basis of percent scavenging of (DPPH) free radical. Experimental animals were divided into five groups, eight rabbits in each group. These were: group A (Normal control), group B (Toxic control), group C (Standard control), group D (Treated with Coconut Oil 50 mL/kg body weight after CCl4 intoxication), group E (Treated with Coconut Oil 200 mL/kg body weight after CCl4 intoxication). The effects observed were compared with a standard hepatoprotective drug silymarine (50 mL/kg body weight). The Coconut Oil (200 mL/kg body weight) significantly (P<0.05) reduced the elevated serum levels of alanine transaminase (ALT), aspartate transaminase (AST) and alkaline phosphatase (ALP) when compared to a toxic control rabbits. The results of extract treated rabbits were similar to silymarine administered rabbits group. Treatment with Coconut Oil root and silymarine caused no significant changes in RBC, Platelets, (Hb), (MCH) concentration and (HCT) values. However, significant (P<0.05) increase was observed in the total WBC count. The present study suggested that Coconut Oil can be used as an herbal alternative (need further exploration i.e to detect its bioactive compound and its efficacy) for hepatoprotective activity.

Antidiabetic and hepato-renal protective effects of medicinal plants in STZ induced diabetic rats.

The antidiabetic and hepato-renal protective effects of Citrullus colocynthis and Momordica charantia ethanol extracts were investigated in streptozotocin (STZ) induced diabetic male albino rats. Diabetic rats were treated with C. colocynthis, M. charantia or C. colocynthis + M. charantia mixed extract at a dose of 250 mg /kg body weight per oral per day for 21 days. The mean body weight of all the diabetic rat groups on day 1 of treatment (day 10 of diabetes) was significantly lower than the normal control rat group (P<0.05). The blood glucose level of all the diabetic rat groups on day 1 of treatment (day 10 of diabetes) was significantly (P<0.05) higher (> 200 mg/dl) than the normal control rat group (95.5 ± 2.7). At the end of treatment (day 21), the diabetic rats treated with plant extracts showed significant increase (P<0.05) in body weight and significant (P<0.05) reduction in blood glucose level when compared to diabetic control animals. Significant increase (< 0.05) was observed in the serum bilirubin, alanine transaminase (ALT), aspartate transaminase (AST), alkaline phosphatase (ALP), urea and creatinine levels of diabetic control rat group. The serum levels of these liver and kidney-related parameters of diabetic rats treated with plant extract were significantly lower when compared to diabetic control rat group (p < 0.05). Photomicrographs of liver and kidney microsections from diabetic rats treated with these plant extracts showed amelioration in the hepato-renal histoarchitectures. It was concluded that the C. colocynthis and M. charantia methanol extracts are antidiabetic and hepato-renal protective in STZ induced diabetic male rats. Treatment of the diabetic rats with C. colocynthis + M. charantia mixed extract is more effective in the amelioration of diabetes and hepato-renal injuries in STZ induced diabetic male rats.

Hypothyroidism in Bangladesh: Is Autoimmunity the Next Big Threat?

In many low and middle-income countries, iodine-deficient hypothyroidism leads to complex public health consequences. However, increasing evidence from population-based studies has linked thyroid autoimmunity with excess iodine intake. The iodine supplementation program in Bangladesh was a success story. This cross-sectional study aims to assess the pattern and predictors of autoimmunity among Bangladeshi hypothyroid patients. In this study, 154 consecutive, newly detected, biochemically-confirmed patients with primary hypothyroidism were recruited from the Endocrinology outpatient department of Bangabandhu Sheikh Mujib Medical University and tested for anti-thyroid peroxidase and anti-thyroglobulin antibody levels from October 2015 and November 2016. Patterns of thyroid autoimmunity were assessed via descriptive statistics. Predictors of autoimmunity were assessed with multivariable mixed-effect logistic regression. The mean age of participants was 36.1±11.0 years, and 70.1% were female. The frequency of thyroid autoimmunity in the study subjects was very high, 89.0% were positive for either anti-TPO or anti-Tg antibodies and 48.7% were positive for both. More participants were positive for anti-TPO antibodies (82.5%) than anti-Tg antibodies (55.2%). The risk of autoimmunity was associated with the thyroid's structural abnormalities but not with functional status. Weight gain and hypertension were associated with autoimmunity, whereas diabetes was protective against autoimmunity.

Mosquitocidal activities of Chenopodium botrys whole plant n-hexane extract against Culex quinquefasciatus.

This research aimed to investigate various mosquitocidal activities of Chenopodium botrys whole- plant n-hexane extract against Culex quinquefasciatus. The extract showed remarkable larvicidal, pupicidal, adulticidal, oviposition deterrent and adult emergence inhibitory activities against Cx. quinquefasciatus. During the larvicidal and pupicidal activities, the 24-hour lethal concentration (LC50) of extract against 2nd instar larvae, 4th instar larvae and pupae were 324.6, 495.6 and 950.8 ppm, respectively. During the CDC (Centers for Disease Control and Prevention) bottle bioassay for adulticidal activity, the median knockdown times (KDT50) at 1.25% concentration was 123.4 minutes. During the filter paper impregnation bioassay for adulticidal activity, the KDT50 value at 0.138 mg/cm2 concentration was 48.6 minutes. The extract was fractionated into 14 fractions through silica gel column chromatography which were then combined into six fractions on the basis of similar retention factor (Rf) value. These fractions were screened for adulticidal activity by applying CDC bottle bioassay. The fraction obtained through 60:40 to 50:50% n-hexanes-chloroform mobile phase with 0.5 Rf value showed 100% adulticidal activity at 0.2% concentration. During oviposition deterrent activity, the highest concentration (1000 ppm) showed 71.3 ± 4.4% effective repellence and 0.6 ± 0.1 oviposition activity index. During adult emergence inhibition activity, the median emergence inhibition (EI50) value was 312.3 ppm. From the outcome of the present investigation, it is concluded that the n-hexane extract of C. botrys whole- plant possesses strong larvicidal, pupicidal, adulticidal, oviposition deterrent and adult emergence inhibitory activities against Cx. quinquefasciatus.

Oral immunization with a recombinant bacterial antigen produced in transgenic plants.

The binding subunit of Escherichia coli heat-labile enterotoxin (LT-B) is a highly active oral immunogen. Transgenic tobacco and potato plants were made with the use of genes encoding LT-B or an LT-B fusion protein with a microsomal retention sequence. The plants expressed the foreign peptides, both of which formed oligomers that bound the natural ligand. Mice immunized by gavage produced serum and gut mucosal anti-LT-B immunoglobulins that neutralized the enterotoxin in cell protection assays. Feeding mice fresh transgenic potato tubers also caused oral immunization.

Clinics in diagnostic imaging (102).

A 19-year-old man presented with cough and haemoptysis of ten days duration. He also had mild right hypochondrial pain. Chest radiograph and computed tomography (CT) showed a rounded soft tissue density opacity with an air crescent sign. CT showed multiple cystic lesions in the liver with a daughter cyst in its lateral wall. Diagnosis of hydatid disease of lung and liver was made. The contents of the liver cyst were aspirated, hypertonic saline instilled, re-aspirated, and absolute alcohol injected. Hydatid disease is endemic in certain parts of the world. Although the lungs and liver are most frequently affected, the disease can arise in any part of the body and should be kept in differential diagnosis whenever a cystic lesion is encountered. Hydatid cysts typically demonstrate characteristic imaging findings, however, the appearances may become complicated due to cyst rupture or secondary infection. Ultrasonography is the imaging modality of choice particularly in hepatic disease. CT best demonstrates cyst wall calcification and cyst infection.

The effect of pre-anaesthetic fasting on blood glucose level in children undergoing surgery.

Blood glucose concentrations were measured in 104 children aged 6 months- 10 years (mean 3.1 years) undergoing inpatient anaesthesia. The mean fasting period was 10.87 +/- 2.68 hours. Mean preanaesthetic and 1/2 hour post-anaesthetic blood glucose levels were 4.8 +/- 0.8 and 6.1 +/- 1.9 mmoles/L respectively. Pre- anaesthetic low blood glucose level (2.7-3.3 mmoles/L) could only be detected in 3.8% cases. Post-anaesthetic increase in blood glucose level was the same as reported in adults.

Radiologic feeding gastrostomy placement: experience in 23 patients.

OBJECTIVE: To evaluate the safety, efficacy and complications of percutaneous gastrostomy catheter placementunder flouro guidance for long-term enteral feeding. MATERIALS AND METHODS: Between April 1998 to May 2002, 23 patients who had percutaneous gastrostomy catheter placement were retrospectively reviewed. Clinical indications for catheter placement included patients with neurologic disease, head and neck malignancy, and pulmonary disease patients. Placement of 12 - 14 Fr gastrostomy catheter was then accomplished with the Seldinger technique. The technical success, procedural complications were recorded. RESULTS: Twenty seven procedures, including revisions, were performed. The success rate for catheter placement was 100%. Revision was necessary in 7 (30%) instances in 7 patients. There was one (3.8%) major and 4 (14.8%) minor complications. CONCLUSION: Fluoroscopically directed percutaneous placement of gastrostomy catheters is a safe and effective procedure.

Percutaneous transhepatic biliary stenting.

OBJECTIVE: Bilary stenting with endoprosthesis is a palliative procedure to relieve malignant biliary obstruction. Percutaneous transhepatic technique has been employed whenever endoscopic technique was not possible or had failed. SETTING: Angiography/intervention suite, department of radiology, Aga Khan University hospital, Karachi. METHODS: We present retrospective analysis of 17 patients with malignant jaundice who were treated with percutaneous techniques after the endoscopic route had failed. RESULTS: The success rate was 94% with placement of single plastic stent in 14 patients, double stents in 3 patients and self-expandable stent in one patient. The overall complication rate was 41% including sepsis, liver abscess, biloma formation, biliary leakage and stent occlusion. There was one procedure related death due to severe sepsis. CONCLUSION: Percutaneous transhepatic biliary stenting is an alternative procedure to relieve malignant biliary obstruction with high complication rate and should be reserved for selected patients in whom endoscopic route has failed.

Acute vertebrobasilar artery thrombosis: long-term benefit of vertebral artery stenting.

Acute vertebrobasilar artery occlusion is a life-threatening event, even after thrombolytic treatment with local intraarterial (IA) recombinant tissue plasminogen activator. We report a 70-year-old man with acute vertebral artery occlusion in which IA thrombolysis resulted in partial recanalisation and revealed pre-existing severe stenosis as the underlying cause. Stenosis was managed with stenting with excellent long-term clinical as well as angiographical outcomes.

Transjugular intrahepatic cavoportal shunt for Budd-Chiari syndrome.

Budd-Chiari syndrome (BCS) is characterized by obstruction of the hepatic venous outflow tract. Therapeutic options for BCS are limited. We report a case of a 21-year-old woman with protein S and C deficiency with gross ascites. Treatment with transjugular intrahepatic portosystemic shunt (TIPS) was attempted, which revealed occluded hepatic veins, so transcaval TIPS was performed. No serious procedure-related complication occurred. After successful shunt creation, the patient's symptoms subsided and she was discharged and followed up for 6 months.