Asymptomatic patient with “lumpy and bumpy” airways. A case of pulmonary MALToma

Primary pulmonary lymphoma is a rare disease. The most frequent primary pulmonary lymphoma (PPL) is extranodal marginal zone B-cell lymphoma of MALT. About half of the patients are asymptomatic at diagnosis. We report a case of a 62-year-old male referred to us for preoperative assessment of surgery for Benign Prostatic Hyperplasia (BPH). He had no respiratory complaints but on evaluation was detected to have Pulmonary MALToma. Our case highlights the importance of tissue diagnosis

Using a simple open-source automated machine learning algorithm to forecast COVID-19 spread: A modelling study

Introduction: Machine learning algorithms have been used to develop prediction models in various infectious and non-infectious settings including interpretation of images in predicting the outcome of diseases. We demonstrate the application of one such simple automated machine learning algorithm to a dataset obtained about COVID-19 spread in South Korea to better understand the disease dynamics.Material and methods: Data from 20th January 2020 (when the first case of COVID-19 was detected in South Korea) to 4th March 2020 was accessed from Korea’s centre for disease control (KCDC). A future time-series of specified length (taken as 7 days in our study) starting from 5th March 2020 to 11th March 2020 was generated and fed to the model to generate predictions with upper and lower trend bounds of 95% confidence intervals. The model was assessed for its ability to reliably forecast using mean absolute percentage error (MAPE) as the metric.Results: As on 4th March 2020, 145,541 patients were tested for COVID-19 (in 45 days) in South Korea of which 5166 patients tested positive. The predicted values approximated well with the actual numbers. The difference between predicted and observed values ranged from 4.08% to 12.77% . On average, our predictions differed from actual values by 7.42% (MAPE) over the same period.Conclusion: Open source and automated machine learning tools like Prophet can be applied and are effective in the context of COVID-19 for forecasting spread in naïve communities. It may help countries to efficiently allocate healthcare resources to contain this pandemic

Hyponatremic hypertensive syndrome (HHS) in an 18-month old-child presenting as malignant hypertension: a case report

BACKGROUND: The combination of hyponatremia and renovascular hypertension is called hyponatremic hypertensive syndrome (HHS). Malignant hypertension as a presentation has been reported in adults with HHS but is rare in children. CASE PRESENTATION: An eighteen month-old male presented with drowsiness, sudden onset status epilepticus and blood pressure of 210/160. The electrolytes on admission revealed sodium of 120 mEq/L and potassium of 2.1 mEq/L. The peripheral renin activity (PRA) was 172 ng/ml/min (normal 3–11 ng/ml/min) and serum aldosterone level was 91 ng/dl (normal 4 to 16 ng/dl). Patient underwent angioplasty with no success, followed by surgical correction. Two years since the diagnosis, the blood pressure is controlled with labetolol and amlodipine (at less than sixth of the pre-operative dosages). The PRA is 2.4 ng/ml/min and aldosterone 15.5 ng/dl. The child not only had three renal arteries on left but all of them were stenosed which to best of our knowledge has not been described. CONCLUSION: As uncommon as HHS with malignant hypertension may be in adults it is under-reported in children and purpose of the case report is to raise its awareness

Characteristics and Outcomes of Patients With Acute Decompensated Heart Failure Developing After Hospital Admission

There are limited data on ADHF that develops after hospital admission. This study sought to compare patient characteristics, comorbidities, mortality, and length of stay by timing of acute decompensated heart failure (ADHF) onset. The surveillance component of the Atherosclerosis Risk in Communities Study (2005–2011) sampled, abstracted, and adjudicated hospitalizations with select ICD-9-CM discharge codes from 4 U.S. communities among those aged 55 years and older. We included 5,602 validated ADHF hospitalizations further classified as pre- or post-admission onset. Vital status was assessed up to 1 year since admission. We estimated multivariable-adjusted associations of in-hospital mortality, 28-day case fatality, and 365-day case fatality with timing of ADHF onset (post-versus pre-admission). All analyses were weighted to account for the stratified sampling design. Of 25,862 weighted ADHF hospitalizations, 7% had post-admission onset of ADHF. Patients with post-admission ADHF were more likely to be older, white, and female. The most common primary discharge diagnosis codes for those with post-admission ADHF included diseases of the circulatory or digestive systems or infectious diseases. Short-term mortality among post-admission ADHF was almost 3 times that of pre-admission ADHF (in-hospital mortality: odds ratio: 2.7, 95% confidence interval: 1.9–3.9; 28-day case fatality: odds ratio: 2.6, 95% confidence interval: 1.8–3.7). The average hospital stay was almost twice as long among post-admission as pre-admission ADHF (9.6 vs. 5.0 days). In conclusion, post-admission onset of ADHF is characterized by differences in comorbidities and worse short-term prognosis, and opportunities for reducing post-admission ADHF occurrence and associated risks need to be studied

Genetic regulation of pituitary gland development in human and mouse

Normal hypothalamopituitary development is closely related to that of the forebrain and is dependent upon a complex genetic cascade of transcription factors and signaling molecules that may be either intrinsic or extrinsic to the developing Rathke’s pouch. These factors dictate organ commitment, cell differentiation, and cell proliferation within the anterior pituitary. Abnormalities in these processes are associated with congenital hypopituitarism, a spectrum of disorders that includes syndromic disorders such as septo-optic dysplasia, combined pituitary hormone deficiencies, and isolated hormone deficiencies, of which the commonest is GH deficiency. The highly variable clinical phenotypes can now in part be explained due to research performed over the last 20 yr, based mainly on naturally occurring and transgenic animal models. Mutations in genes encoding both signaling molecules and transcription factors have been implicated in the etiology of hypopituitarism, with or without other syndromic features, in mice and humans. To date, mutations in known genes account for a small proportion of cases of hypopituitarism in humans. However, these mutations have led to a greater understanding of the genetic interactions that lead to normal pituitary development. This review attempts to describe the complexity of pituitary development in the rodent, with particular emphasis on those factors that, when mutated, are associated with hypopituitarism in humans

Acute Pulmonary Histoplasmosis Masquerading As Miliary Tuberculosis in A Non-Endemic Region

A 28-year-old female who worked as a house maid presented with fever, troublesome cough, progressive breathlessness, and anorexia which had been present for 25 days [...