Steroid responsive encephalopathy associated with autoimmune thyroiditis (SREAT) presenting as subacute psychosis: Case report and literature review.

Clinicians should consider autoimmune thyroiditis in patients presenting with neuropsychiatric symptoms and promptly initiate appropriate investigations and treatment, such as corticosteroids, to improve clinical outcomes.

Thyroid Storm-Induced Refractory Multiorgan Failure Managed by Veno-Arterial Extracorporeal Membrane Oxygenation Support: A Case-Series.

BACKGROUND Severe hyperthyroidism, including thyroid storm, can be precipitated by acute events, such as surgery, trauma, infection, medications, parturition, and noncompliance or stoppage of antithyroid drugs. Thyroid storm is one of the serious endocrinal emergencies that prompts early diagnosis and treatment. Early occurrence of multiorgan failure is an ominous sign that requires aggressive treatment, including the initiation of extracorporeal membrane oxygenation (ECMO) support as a bridge to stability and definitive surgical treatment. Most adverse events occur after failure of medical therapy. CASE REPORT We described 4 cases of fulminating thyroid storm that were complicated with multiple organ failure and cardiac arrest. The patients, 3 female and 1 male, were between 39 and 46 years old. All patients underwent ECMO support, with planned thyroidectomy. Three survived to discharge and 1 died after prolonged cardiac arrest and sepsis. All patients underwent peripheral, percutaneous, intensivist-led cannulation for VA-ECMO with no complications. CONCLUSIONS Early recognition of thyroid storm, identification of the cause, and proper treatment and support in the intensive care unit is essential. Patients with thyroid storm and cardiovascular collapse, who failed to improve with conventional supportive measures, had the worst prognosis, and ECMO support should be considered as a bridge until the effective therapy takes effect. Our case series showed that, in patients with life-threatening thyroid storm, VA-ECMO can be used as bridge to stabilization, definitive surgical intervention, and postoperative endocrine management. Interprofessional team management is essential, and early implantation of VA-ECMO is likely beneficial in patients with thyroid storm after failure of conventional management.

Expression of microRNA-181a and microRNA-196b in Egyptian Pediatric acute Lymphoblastic Leukemia.

BACKGROUND: Differential expression of miRNA provides important insights into pathogenesis of cancer including leukemia. Deregulation of microRNA may contribute to hematopoietic malignancies. In this study, we aimed to evaluate the role of miR-181a and miR-196b in acute lymphoblastic leukemia (ALL) and correlate their expression with clinical and laboratory data. METHODS: The study was performed on bone marrow samples of 70 consecutive newly diagnosed pediatric (ALL) patients, of which 56 were evaluated for both miR-181a and miR-196b (all 70 for miR-181a) by real-time quantitative reverse transcriptase polymerase chain reaction (RT-qPCR). In addition, bone marrow from seven age and sex matched healthy controls derived from donors of bone marrow transplantation were assessed. RESULTS: miR-181a expression was significantly up-regulated in ALL patients compared with healthy controls (p <0.001). However, miR-196b expression was significantly down-regulated in patients compared with healthy controls (p=0.038). CONCLUSION: Our results suggest that miR-181a has an oncogenic, while miR-196b has a tumor suppressive role in pediatric ALL patients. A finding which demonstrate the potential role of these microRNAs in pathogenesis of pediatric ALL. Also, estimation of their expression level may provide a tool for confirmation of a diagnosis of childhood ALL and could be a possible predictor of early relapse.
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Metformin-treated-GDM has lower risk of macrosomia compared to diet-treated GDM- a retrospective cohort study.

Background: The diagnosis of gestational diabetes (GDM) has undergone several revisions. The broad adoption of the 2013 WHO criteria for hyperglycemia in pregnancy has increased the prevalence of GDM with no apparent benefit on pregnancy outcomes. The study aims to investigate the pregnancy outcomes in women with GDM diagnosed based on the WHO criteria compared to a control group; the impact of other confounders; and the difference in outcomes between GDM women who needed pharmacotherapy (GDM-T) and those who did not (GDM-D).Methods: This is a retrospective cohort study that included GDM women compared to normoglycemic controls between March 2015 and December 2016 in the Women's Hospital, Qatar.Results: The study included 2221 women; of which 1420 were normoglycemic, and 801 were GDM (358 GDM-D and 443 GDM-T). At conception, GDM women were older (mean age 32.5 ± 5.4 versus 29.6 ± 5.6 years, p<.001) and had higher prepregnancy BMI (mean BMI 32.2 ± 6.2 versus 28.2 ± 6.1 kg/m2, p<.01) compared to the controls, respectively. After correction for age, prepregnancy weight, and gestational weight gain (GWG); women with GDM had a higher risk of preterm labor (OR: 1.72; 95% CI: 1.32-2.23), large for gestational age (GA) (OR: 1.67; 95% CI: 1.22-2.29), neonatal ICU admission (OR: 1.57; 95% CI: 1.15-2.13), and neonatal hypoglycemia (OR: 3.22; 95% CI: 2.06-5.03). At conception, GDM-T women were older (mean age 33.3 ± 5.0 versus 31.5 ± 5.7 years, p<.001) and had higher BMI (mean BMI 32.9 ± 6.3 versus 231.2 ± 6.0 kg/m2, p=.01) compared to GDM-D, respectively. Metformin was used in 90.7% of the GDM-T women. Women in the GDM-T group had lower GWG/week compared to GDM-D (-0.01 ± 0.7 versus 0.21 ± 0.5 kg/week; p<.001). After correcting for age, prepregnancy weight and GWG; GDM-T had a higher risk of preterm labor (OR: 1.66; 95% CI: 1.20-2.22), and C-section (OR: 1.37, 95% CI: 1.02-1.85) and reduced risk of macrosomia (OR: 0.56; 95% CI: 0.32-0.96) and neonatal hypoglycemia (OR: 0.49; 95% CI: 0.28-0.82).Conclusion: In addition to hyperglycemia, the adverse effects of GDM on pregnancy outcomes are multifactorial and includes maternal age, maternal obesity, and gestational weight gain. Treatment with metformin reduces maternal weight gain, the risk of macrosomia and neonatal hypoglycemia compared to diet alone.

A CASE OF HYPERPARATHYROIDISM TREATED WITH CINACALCET DURING PREGNANCY.

OBJECTIVE: Hyperparathyroidism during pregnancy is associated with increased maternal and neonatal complications. Cinacalcet is a calcimimetic medication that is used in the treatment of hyperparathyroidism; its use in pregnancy is limited to a few case reports. METHODS: Case report and literature review. RESULTS: We are reporting on a 37-year-old patient who was admitted to the hospital with dyspnea at 24 weeks gestation. A routine blood test revealed hypercalcemia; corrected calcium level was 3.17 mmol/L, and parathyroid hormone was elevated at 168 pg/mL. The patient was asymptomatic. Following her last delivery 10 years previously, her newborn developed severe tetany and needed treatment with intravenous (IV) calcium. Neck ultrasound was normal. Due to obesity and history of recurrent deep venous thrombosis, neck exploration was not favored. Initial treatment included calcitonin and IV fluids. The aim was to keep her calcium level as normal as possible to avoid any fetal complications. She was started on cinacalcet 15 mg once per day, which was increased later to 15 mg twice daily. By 36 weeks gestation, corrected calcium levels were down to <2.60 mmol/L. The patient was scheduled to deliver via elective cesarean section at 38 weeks, but she presented at 37 weeks in labor pain and delivered via emergency cesarean section. Postdelivery, the neonate calcium levels remained normal. CONCLUSION: During pregnancy, parathyroid surgery is the recommended treatment. Cinacalcet could be one of the options in severe cases of hypercalcemia if surgery cannot be performed. Further studies are needed to examine the safety of cinacalcet in pregnancy.