Lymphocytic Hypophysitis: Case Report

The lymphocytic hypophysitis is a rare autoimmune process; its diagnosis is difficult because of the low specificity of the clinical signs. The diagnosis is based on the association of clinical, radiological, hormonal and immunological data.We report the case of a 43 years old female patient suffering from chronic headache with decreased visual acuity for 1 year, amenorrhea and galactorrhea, and progressive fatigue.The complete hormonal examination showed adrenocorticotropic failure, thyrotropic deficiency, moderate hyperprolactinaemia and normal FSH.MRI showed a nodular intrasellar mass extending to the upper border, measuring 11x11x13 mm, enhancing after contrast injection. The mass was filling the optochiasmatic space and lifting the optic chiasm. There was an associated thickening of the pituitary, which was not displaced and was still taking the contrast.Lymphocytic hypophysitis was suspected and the patient was treated with Prednisone 1mg / kg / day (60 mg) with reduction of dosage over six months, and substitution by thyroid hormones with a dosage of about 75 μg per day.The treatment was followed by reestablishment of menstruation and by the disappearance of headaches. The control MRI showed a reduction in the size of pituitary process

P-Wave Morphology, Amplitude, Duration and Dispersion in Atrial Arrhythmias

The detailed analysis of the P-wave duration and dispersion by means of conventional electrocardiography with the 12 standard surface leads in the stratification of patients suffering from AF is a recognized universal approach. P-wave dispersion (PWD) has received increasing attention in the field of non-invasive electrophysiology studying atrial arrhythmias and has been examined in a broad range of clinical settings including cardiovascular and non-cardiovascular diseases. It is well accepted that, not only the P-wave duration, but also the P-wave morphology and dispersion have the potential to give information about the anatomical substrate predisposing to AF. Patients with diseased atrial myocardium with fibrotic changes may develop abnormal electrophysiological alterations. Therefore, these atrial anisotropic characteristics may play an important role in creating reentry circuits by causing inhomogeneous and discontinuous propagation of the impulse in the atrial tissue. The altered atrial myocardium may generate unidirectional block, conduction delay and reentrant atrial rhythms. The P-wave of the electrocardiogram may show alterations that can be associated with atrial arrhythmias and AF. PWD is considered a noninvasive electrocardiographic marker for atrial remodeling and predictor for AF. It has been shown that increased P-wave duration and PWD reflect prolongation of intra-atrial and inter-atrial conduction time. In patients prone to develop atrial arrhythmias and AF, PWD reflects prolonged, inhomogeneous and anisotropic distribution of connections between myocardial fibers resulting in discontinuous anisotropic propagation of sinus impulses and atrial conduction. PWD is considered as a sensitive and specific ECG marker and predictor of atrial arrhythmias and paroxysmal AF

Evaluation of Current HIV Contributions toward Progress in HIV management

Editoria

Plastic Surgery of Male External Genitalia after a Trauma Caused by a Mill in Rural Area

The trauma of the external genital organs is a common urological emergency that can affect the patient's functional and psychosocial prognosis as well as his family. We report a case of direct trauma of the external genitalia of a 27-year-old by a mill, requiring a recover plastic surgery in rural area. The examination at admission revealed a significant damage of penile and scrotal skin, denuding testes and cavernous bodies. A cover plastic surgery was performed. After a year of follow up, the outcome was good

Prevalence of Hepatitis B and C Viral Infection among Patients Attending to the Endoscopic Clinic at Al-Thowrah Hospital in Sana'a City, Yemen

Background: Hepatitis B and C are major public health problems worldwide. It is generally believed that hepatitis B (HBV) and C (HCV) viruses are highly prevalent in the Republic of Yemen.Aim: to determine the prevalence of hepatitis B and C viral infection among patients attending the endoscopic clinic at Al-Thowrah hospital in Sana'a City, Yemen.Methods: The descriptive cross-sectional study was carried out among patients attending to the endoscopic clinic at Al-Thowrah hospital in Sana'a city from January to December 2017. 1592 patients attending the endoscopic clinic at Al-Thowrah hospital were selected. The data were collected through a structured questionnaire were administered as a face to face interview. The questionnaire was included the following data: demographic data (age, sex, and marital status), and laboratory tests (HBsAg and HCV antibodies).Results: Overall 95.1% of the patients had never been exposed to HBV or HCV infections while 3.4% had HBsAg and 1.5% had HCV infection. The prevalence of HBV and HCV infection among patients according to sex showed that in male 46.2% of the patients had HBsAg and 12.8% had HCV antibodies compared to 23.1% of the patients had HBsAg and 17.9% had HCV infection in females.Conclusions: It is essential to promote awareness of these risks among everyone

Acceptability of HIV Rapid Testing in Diverse Clinical Settings in Iran

Introduction: Rapid HIV testing in clinical settings can identify previously undiagnosed persons and link them to care, as well provide patients with knowledge of their serostatus and risk reduction counseling. We conducted a survey to characterize factors affecting the acceptance or declining of rapid HIV testing among Iranian patients.Methods: This cross-sectional survey was conducted from October 2014 to December 2014 with patients in three different health care centers (an emergency department in an urban hospital, a rural health centre, a voluntary counseling and testing centre (VCT) within Imam Khomeini Hospital, Tehran, Iran and a rural health centre). Participants completed a semi-structured face-to-face questionnaire and were tested by an HIV rapid test (Chembio Sure Check).Results: Of 222 participants, 25 participants were from the urban emergency department, 40 from the urban VCT program, and 157 from the rural health care centre. All did the rapid HIV test; all were HIV negative. HIV-related risk profiles found the urban emergency department patients more likely to have multiple partners (26%, P<0.01) and history of sexually transmitted diseases (27%, P<0.001) compared to VCT patients (9% and 3%, respectively) and rural clinic patients (4% and 1%, respectively). Emergency department patients were also more willing to pay for a HIV rapid test (44%, P<0.01), doing a rapid self-test at home (84%,P=0.01), preferring pharmacies as a place for providing rapid tests (80%, P=0.001). Also level of participants’ awareness was considerably different between mentioned centres (median=11, 12, 10 for emergency department, VCT and rural Health care centre respectively; P=0.012).Conclusions: Increasing knowledge about HIV rapid testing, its availability, and keeping costs low can expand the desire to use the test and ultimately prevent the spread of HIV through lack of knowing one’s serostatus and lack of treatment. Emergency departments in urban Iran may be an opportunity to test persons at high risk for HIV infection

Latent Autoimmune Diabetes in Adults Associated with Von Recklinghausen’s Disease (Neurofibromatosis Type 1)

Introduction: Endocrine disorders during Von Recklinghausen’s Disease or neurofibromatosis type 1 (NF1) are rare and particularly observed in children. However, autoimmune diabetes mellitus (DM) remains exceptional and unusual during this phacomatosis. We report an original case of Latent Autoimmune Diabetes in Adults (LADA) associated with NF1.Case Report: A 32-year-old Tunisian male, known to have NF1 since childhood, was admitted for significant recent weight loss (10 kg in one month) with high blood glucose levels. The biological tests confirmed the diagnosis of DM with marked ketoacidosis: fast blood glucose at 16 mmol/l, postprandial glucose at 21 mmol/l, and HbA1c at 9.9%. Radiological and endoscopic investigations did not indicate pancreatic and/or duodenal tumors. Anti-GAD and anti-IA2 autoantibodies were positively confirming the diagnosis of LADA. The assessment of degenerative complications and screening for possible other autoimmune diseases were negative. The evolution was favorable under intensive insulinotherapy.Conclusion: The association of DM type 1 with NF1 remains exceptional and only four cases are found in the literature, all pediatrics. Our observation is, to our knowledge, the first reporting this association in adult (LADA with NF1)

Detecting GPC3-Expressing Hepatocellular Carcinoma with L5 Peptide-Guided Pretargeting Approach: An In Vitro MRI Experiment

Background and Aim: Glypican-3 (GPC3) is a novel molecular target for hepatocellular carcinoma (HCC). This study investigated the potential of an L5 peptide-guided pretargeting approach to identify GPC3-expressing HCC cells using ultra-small super-paramagnetic iron oxide (USPIO) as the MRI probe.Methods: Immunofluorescence with carboxyfluorescein (FAM)-labeled L5 peptide was performed in HepG2 and HL-7702 cells. Polyethylene glycol-modified ultrasmall superparamagnetic iron oxide (PEG-USPIO) and its conjugates with streptavidin (SA-PEG-USPIO) were synthesized, and hydrodynamic diameters, zeta potential, T2 relaxivity, and cytotoxicity were measured. MR T2-weighted imaging of HepG2 was performed to observe signal changes in the pretargeting group, which was first incubated with biotinylated L5 peptide and then with SA-PEG-USPIO. Prussian blue staining of cells was used to assess iron deposition.Results: Immunofluorescence assays showed high specificity of L5 peptide for GPC3. SA-PEG-USPIO nanoparticles had ≈36 nm hydrodynamic diameter, low toxicity, negative charge and high T2 relaxivity. MR imaging revealed that a significant negative enhancement was only observed in HepG2 cells from the pretargeting group, which also showed significant iron deposition with Prussian blue staining.Conclusion: MR imaging with USPIO as the probe has potential to identify GPC3-expressing HCC through L5 peptide-guided pretargeting approach

Bariatric Surgery and its Place in Modern Diabetology

This short presentation includes recent international information. Obesity became a very difficult problem of the public health in the last decades. Bariatric surgery seems useful in appropiately selected patients. It determines an important weight loss in obese patients with type 1 diabetes and an improve in their insulin requirements and glycemic status. Obesity is associated with low-grade inflammation of the adipose tissue, insulin-resistance and type 2 diabetes mellitus. The remission of type 2 diabetes may be achieved after bariatric surgery, but rates vary according to subjects’ baseline characteristics. Although the mechanisms underlying the efficacy of bariatric surgery are not totally clear, gastrointestinal and pancreatic peptides are considered to play an important role. The landscape of bariatric surgery rapidly evolved in the past few years. Recently, bile acids emerged as an important factor for explaining the benefits of bariatric surgery and its perspectives

Estimation of Caffeine in Tea Samples of Southern Region of India

Caffeine is a bitter, white crystalline purine derivative that closely related to adenine and guanine. Caffeine is used to reduce physical fatigue and to prevent or treat drowsiness. It produces increased wakefulness and focus, improves thought-processing, and better general body coordination. The amount of caffeine needed to produce these effects varies from person to person, depending on body size and degree of tolerance. Hence, it is of importance to estimate the quantity of caffeine present in various types of tea and coffee products. Accordingly, a simple and efficient approach has been done on a variety of tea samples from various places in the southern region of India to understand the quantity of caffeine with respect to the region of cultivation. Among the samples from Nilgiris/ Valparai/ Kodaikanal of Tamilnadu, Munnar of Kerala, and Coorg of Karnataka, the Garden green tea from Coorg (Sample 8) is the best in terms of caffeine quantity (2.37%)