Severe hypocalcaemia episodes in a patient of primary hypoparathyroidism precipitated by underlying stress due to haemophagocytic lymphohistiocytosis (HLH) secondary to pulmonary tuberculosis.

A man in his 20s who had previously experienced multiple episodes of transient loss of consciousness, majorly attributable to the seizures, presented with a 1-month history of increased seizure frequency, high-grade fever and weight loss. Clinically, he had postural instability, bradykinesia and symmetrical cogwheel rigidity. His investigations revealed hypocalcaemia, hyperphosphataemia, inappropriately normal intact parathyroid hormone, metabolic alkalosis, normomagnesemic magnesium depletion, and increased plasma renin activity and serum aldosterone concentration. CT scan of the brain revealed symmetrical calcification of the basal ganglia. The patient had primary hypoparathyroidism (HP). A similar presentation of his brother indicated a genetic cause, most likely autosomal dominant hypocalcaemia with Bartter's syndrome type 5. The patient's fever was caused by underlying haemophagocytic lymphohistiocytosis secondary to pulmonary tuberculosis, which triggered acute episodes of hypocalcaemia. This case represents a complex interplay of a multifaceted relationship between primary HP, vitamin D deficiency and an acute stressor.

Where have the others gone? Impact of lockdown during COVID-19 pandemic on patient populations undergoing Computed Tomography imaging in a public tertiary care hospital in India.

CONTEXT: As a response to the CoronaVirus Disease 2019 (COVID-19) pandemic, India announced a nation-wide lockdown effective from March 25, 2020. Recent media reports and published studies from Western countries indicate a decrease in patients presenting to hospitals with stroke, acute coronary syndromes, and other emergencies. AIMS: The purpose of this study was to assess the impact of the lockdown on the number of patients undergoing Computed Tomography (CT) in a public tertiary care hospital in India, and thus indirectly assess the effect of the lockdown on medical conditions other than COVID-19. SETTINGS AND DESIGN: Retrospective observational study. MATERIALS AND METHODS: Analysis of the CT reports from the hospital's PACS for the first three months of lockdown was performed and compared with those of the month prior to the imposition of the lockdown. STATISTICAL ANALYSIS USED: Frequency tables and percentages were calculated. RESULTS: There was a 70% decrease in the number of total CTs in the first three months of lockdown compared to the month prior to lockdown. There was a decrease in CTs performed for various conditions such as tuberculosis follow up (decreased by 98%), brain infarcts, nontraumatic intracranial hemorrhage (decreased by 40%), and baseline CTs for neoplasms (decreased by 73%). CTs for trauma also decreased by 64% with a decrease in patients involved in road traffic accidents undergoing CT. CONCLUSION: Our study highlights the impact of the lockdown on medical conditions other than COVID-19 in India, with a substantial decrease in the number of patients undergoing CTs for a variety of conditions.