Sheehan's like syndrome in a man

An 84-year-old physician self-diagnosed that he had a pituitary tumour when he was found to have a bilateral upper quadrantanopia on routine eye testing. Magnetic resonance imaging (MRI) confirmed a large non-functioning pituitary macroadenoma associated with chiasmal compression. Investigation showed partial hypopituitarism with disconnection hyperprolactinaemia [prolactin 1095 mU/L (60–300)]. He was treated with hormonal replacement consisting of thyroxin 100 µg and prednisolone 3 mg and was offered transphenoidal hypophysectomy, but chose a conservative approach. Two years later, his visual fields worsened (Figure 1A) corresponding to an increase in macrodenoma size. Subsequently, he fell and fractured his left shoulder, which became infected, requiring surgery. Immediately after the shoulder surgery, he became hypotensive and vomited several times, and his visual fields became restricted. MRI showed pituitary infarction (Figure 1B), and he did not require surgical intervention. A few weeks later, he noticed dramatic improvement in his vision. His prolactin level dropped from a peak level of 1095 to 48 mU/L (60–300), suggesting lactotroph infarction. Repeated pituitary MRI showed dramatic reduction in the height of the pituitary macroadenoma consistent with the improvement in his visual fields (Figure 1C)

Operational amplifiers revisited for low field magnetic resonance relaxation time measurement electronics

Advances in permanent magnet technology has seen more reports of sensor applications of low field magnetic resonance. Whilst most are either in the 10–20 MHz range or in the earth’s field, measurements at below 1 MHz are beginning to become more widespread. This range is below the need for careful radio frequency electronics design but above the audio domain and represents an interesting cross over. Many commercial spectrometers do not include the pulse power amplifier, duplexer and preamplifier as these depend on the frequency range used. In this work we demonstrate that, with the current specifications of the humble operational amplifier, the most simple form of an inverting design using only two resistors and decoupling, can effectively provide this ‘front end’ electronics. The low powers used mean crossed Ge diodes provide an excellent duplexer and it is suitable for battery powered applications

Utility of cannulated prolactin to exclude stress hyperprolactinemia in patients with persistent mild hyperprolactinemia

Background: Stress-induced hyperprolactinemia can be difficult to differentiate from true hyperprolactinema and may result in patients having unnecessary investigations and imaging. We report the results of cannulated prolactin tests with serial prolactin measurements from an indwelling catheter to differentiate true from stress-induced hyperprolactinemia in patients with persistently mildly elevated prolactin levels in both referral and repeat samples. Methods: Data were collected for 42 patients who had a cannulated prolactin test between January 2017 and May 2018. After cannula insertion, prolactin was measured at 0, 60, and 120 minutes. Normalization is defined as a decline in prolactin to gender-defined normal ranges. Results: The mean age was 33.8 years (SD ± 9.9), and 37 (88%) were female. Menstrual irregularities were the main presenting symptom in 28.57% of the patients. Prolactin normalized in 12 (28.6%) patients of whom cannulated prolactin test was done. Repeat random prolactin levels were significantly higher in patients whose prolactin did not normalize during the cannulated prolactin test. MRI of the pituitary gland showed an abnormality in 23 out of 28 (82%) patients who did not normalize prolactin, a microadenoma in the majority of patients (18 patients). Conclusion: The cannulated prolactin test was useful in excluding true hyperprolactinemia in 28.6% of patients with previously confirmed mildly elevated random prolactin on two occasions, thus avoiding over-diagnosis and unnecessary imaging

Novel food-safe spin-lattice relaxation time calibration samples for use in magnetic resonance sensor development

Magnetic Resonance (MR) sensors are an area of increasing interest for the measurement and monitoring of material properties. There are two relaxation times associated with samples that can be measured with MR sensors: The spin-lattice and spin-spin relaxations. When developing new sensors, it is desirable to have a series of standards by which instruments can be assessed. The standard calibration materials available typically comprise different concentrations of Nickel Sulphate, which is carcinogenic and toxic. In this work, we report the use of solutions containing full fat milk powder as a safe and inexpensive material that shortens the longitudinal relaxation time of water over a wide range of values. We demonstrate that concentrations in distilled water from 5% W/V to 64% W/V give T1 values from 1.7 s down to 469 ms respectively in a 1.5T clinical MRI, while within an MR sensor, these times were from 1.6 s down to 431 ms. In addition, both systems have the same exponential coefficient (-0.022*concentration) that demonstrates the effectiveness of the NMR sensor in comparison to the clinical MRI

Rare case of chemotherapy-refractory metastatic vaginal squamous cell carcinoma with complete response to concurrent pembrolizumab and radiotherapy- case report and literature review

Primary vaginal cancer is a rare malignancy with a lack of international guidelines and supporting clinical trial evidence to guide decision making. Historical results have shown poor outcomes with chemotherapy for stage IVB vaginal squamous cell carcinoma (SCC). The evolving role of checkpoint inhibitors in rare gynaecological cancers prompted us to investigate the role of pembrolizumab in this setting. The efficacy of pembrolizumab in vaginal SCC has never been investigated in any clinical trial. There is established data to support the use of concurrent chemoradiotherapy in gynaecological cancers, however, the data for concurrent use of immunotherapy and radiotherapy is still lacking but is the subject of several clinical trials. We herein present the first reported case of chemotherapy refractory vaginal SCC with complete response to pembrolizumab and concurrent pelvic radiotherapy. We also present wall-eyed bilateral internuclear ophthalmoplegia (WEBINO) as a rare but new immune related adverse event

Crime reconstruction and the role of trace materials from crime scene to court

Crime reconstruction takes place in a complex ecosystem and needs to be responsive to the context of each case. For accurate, reproducible and transparent crime reconstructions to take place, a holistic approach is needed that considers the different stakeholders, different types of trace material, integral human decision‐making and interconnected nature of the forensic science process. For robust reconstruction, there needs to be a consideration of both the distinctive types of trace material that can contribute to the reconstruction, and an understanding of the interplay of human decision‐making within reconstruction approaches. In addition, it is also necessary to consider source attribution of a trace material in addition to the activities that led to the generation, identification, transfer, and persistence of the trace. This requires explicit and tacit forms of knowledge, and an incorporation of the inherent uncertainty and risk in the reconstruction approach. The communication of conclusions reached in a crime reconstruction that address what the evidence means is also an important consideration given the different requirements of intelligence and evidence. Therefore, undertaking a crime reconstruction within a holistic framework that seeks to incorporate the complexity of the forensic science ecosystem is valuable for achieving a problem solving approach that offers reproducible, transparent reconstructions with a clear articulation of risk and uncertainty that can be of value to investigators and the courts. This article is categorized under: Forensic Science in Action/Crime Scene Investigation > Crime Scene Reconstruction Forensic Science in Action/Crime Scene Investigation > From Traces to Intelligence and Evidenc

The state of HRM in the Middle East:Challenges and future research agenda

Based on a robust structured literature analysis, this paper highlights the key developments in the field of human resource management (HRM) in the Middle East. Utilizing the institutional perspective, the analysis contributes to the literature on HRM in the Middle East by focusing on four key themes. First, it highlights the topical need to analyze the context-specific nature of HRM in the region. Second, via the adoption of a systematic review, it highlights state of development in HRM in the research analysis set-up. Third, the analysis also helps to reveal the challenges facing the HRM function in the Middle East. Fourth, it presents an agenda for future research in the form of research directions. While doing the above, it revisits the notions of “universalistic” and “best practice” HRM (convergence) versus “best-fit” or context distinctive (divergence) and also alternate models/diffusion of HRM (crossvergence) in the Middle Eastern context. The analysis, based on the framework of cross-national HRM comparisons, helps to make both theoretical and practical implications

Synacthen stimulation test following unilateral adrenalectomy needs to be interpreted with caution

Background: Cortisol levels in response to stress are highly variable. Baseline and stimulated cortisol levels are commonly used to determine adrenal function following unilateral adrenalectomy. We report the results of synacthen stimulation testing following unilateral adrenalectomy in a tertiary referral center. Methods: Data were collected retrospectively for 36 patients who underwent synacthen stimulation testing one day post unilateral adrenalectomy. None of the patients had clinical signs of hypercortisolism preoperatively. No patient received pre- or intraoperative steroids. Patients with overt Cushing’s syndrome were excluded. Results: The median age was 58 (31-79) years. Preoperatively, 16 (44%) patients had a diagnosis of pheochromocytoma, 12 (33%) patients had primary aldosteronism and 8 (22%) patients had non-functioning adenomas with indeterminate/atypical imaging characteristics necessitating surgery. Preoperative overnight dexamethasone suppression test results revealed that 6 of 29 patients failed to suppress cortisol to <50 nmol/L. Twenty (56%) patients achieved a stimulated cortisol ≥450 nmol/L at 30 minutes and 28 (78%) at 60 minutes. None of the patients developed clinical adrenal insufficiency necessitating steroid replacement. Conclusions: Synacthen stimulation testing following unilateral adrenalectomy using standard stimulated cortisol cut-off values would wrongly label many patients adrenally insufficient and may lead to inappropriate prescriptions of steroids to patients who do not need them

DataSheet_1_Foliar spray of silica improved water stress tolerance in rice (Oryza sativa L.) cultivars.pdf

Rice (Oryza sativa L.) is a major cereal crop and a staple food across the world, mainly in developing countries. Drought is one of the most important limiting factors for rice production, which negatively affects food security worldwide. Silica enhances antioxidant activity and reduces oxidative damage in plants. The current study evaluated the efficiency of foliar spray of silica in alleviating water stress of three rice cultivars (Giza178, Sakha102, and Sakha107). The seedlings of the three cultivars were foliar sprayed with 200 or 400 mg l-1 silica under well-watered [80% water holding capacity (WHC)] and drought-stressed (40% WHC)] conditions for two summer seasons of 2019 and 2020. The obtained results demonstrated that drought stress caused significant decreases in growth, yield, and physiological parameters but increases in biochemical parameters (except proline) of leaves in all rice cultivars compared to well-irrigated plants (control). The roots of drought-stressed seedlings exhibited smaller diameters, fewer numbers, and narrower areas of xylem vessels compared to those well-watered. Regardless of its concentration, the application of silica was found to increase the contents of photosynthetic pigments and proline. Water relation also increased in seedlings of the three tested rice cultivars that were treated with silica in comparison to their corresponding control cultivars when no silica was sprayed. Foliar application of 400 mg l-1 silica improved the physiological and biochemical parameters and plant growth. Overall, foliar application of silica proved to be beneficial for mitigating drought stress in the tested rice cultivars, among which Giza178 was the most drought-tolerant cultivar. The integration of silica in breeding programs is recommended to improve the quality of yield and to provide drought-tolerant rice cultivars under drought-stress conditions.</p