A Rare Occurrence of Ectopic Parathyroid Carcinoma Presenting as a Case of Recurrent Fractures

Ectopic parathyroid tumors are uncommon, accounting for only 6% of parathyroid adenomas, and even fewer cases are attributed to parathyroid carcinomas. While ectopic parathyroid carcinoma in the anterior mediastinum is a rare condition, the occurrence of recurrent skeletal fractures in the presence of mild hypercalcemia is even rarer. In this report, we present the case of a 52-year-old man with a medical history of hypertension, chronic kidney disease, and a previous right-sided intertrochanteric fracture of the femur one year earlier. He presented to the emergency room with left-sided hip pain and shortness of breath due to volume overload. Laboratory tests revealed mild hypercalcemia and hyperparathyroidism, with normal vitamin D levels. An X-ray showed a left neck of femur fracture. Further evaluation with a three-phase skeletal scintigraphy indicated the presence of metabolic bone disease. A contrast-enhanced computed tomography of the chest revealed a solitary soft tissue nodule in the anterior mediastinum, representing an ectopic parathyroid adenoma. The lesion was successfully removed using video-assisted thoracic surgery, and the histopathological analysis confirmed the diagnosis of parathyroid carcinoma. The combination of mild hypercalcemia and recurrent fractures is an unusual presentation of ectopic parathyroid carcinoma, underscoring the importance of considering this condition as a potential cause in similar cases to ensure timely and appropriate treatment

Prognosis of Severe Covid-19 patients after treatment with Therapeutic Plasma Exchange (TPE)

OBJECTIVE: To demonstrate the effective role of plasmapheresis in the treatment of Cytokine Release Syndrome associated with severe Covid 19 pneumonia. INTRODUCTION: Covid-19 disease is a deadly contagious disease with milder symptoms to a more severe form with acute respiratory failure, septic shock leading to even death. Literature study showed  that  in severe  Covid-19  patients, a hyper-inflammatory response  to  initial  infection could accelerate  to  severe  hyper-cytokinaemia that  could  lead to  an  underlying endothelial  dysfunction and multiple organ dysfunction. Thus, removal of these inflammatory cytokines by Therapeutic Plasma Exchange is considered to be an essential part of the treatment of critically ill patients in order to improve their survival rates. METHODOLOGY:  Retrospective observational study which included 150 RT-PCR positive patients admitted in Covid ITC, from the time period of 1st February 2021 to 31st July 2021 –removed for blind review---Data was analyzed using SPSS software version 16. Frequencies were calculated along with mean and standard deviation. Chi square and ANOVA test was applied to the data. P value <0.05 was considered statistically significant. Linear regression study was applied to predict the prognosis. RESULTS: Out of 150 patients, 51 patients (34%) were of severe ARDS category of whom 13 (25.5%) developed Cytokine Release Syndrome. They received plasmapheresis therapy subsequently and 7 out of those 13 (53.8%) patients got improved. P- value was found to be significant ( <0.05). Overall, the mortality rate was low with 120/150 (80%) getting discharged successfully. CONCLUSION:  Our findings suggest that Therapeutic plasma exchange is beneficial in Cytokine storm caused by SARS-CoV2 removing the inflammatory cytokines and improving symptoms, thereby, avoiding intubation. KEY WORDS: , Therapeutic plasma exchange, Hypercytokinaemia, Cytokine Release Syndrom

Role of Dexmedetomidine by Improving Sleep Quality and Pain Control in Covid-19 Patients

OBJECTIVE: To demonstrate the effective role of Dexmedetomidine as a sedative and analgesic agent in Covid-19 patients when used in conjunction with the established treatment of Acute Respiratory Distress Syndrome.  INTRODUCTION: Covid-19 disease is a deadly contagious disease with milder symptoms to a more severe form with acute respiratory failure, septic shock leading to even death. Literature study shows High Flow Nasal Oxygen therapy and prolonged prone position sessions to be beneficial in the treatment of ARDS, however, to facilitate those sessions, a sedative and anxiolytic agent must be added in the treatment. Therefore, this study was conducted to document the beneficial role of dexmedetomidine as a sedative agent.  METHODOLOGY: Retrospective observational study which included 150 PCR positive patients admitted in Covid ITC, from 1st February 2021 to 31st July 2021 residing in the premises of PAF Air Base, Mushaf, Sargodha. Data was analyzed using SPSS software.   RESULTS: Out of 150 patients, 120 (80%) were treated with High Flow Nasal Oxygen (HFNO), Dexmedetomidine infusion (DEXME) and long periods of prone position (PP) sessions. Among these 120 patients, 88 (73.3%) were discharged while 32 (26.67%) patients died of which 7 (21.875%) died while being on HFNO therapy and 25 (78.125%) patients were intubated. DEXME infusion was found to have a positive outcome (P-value <0.005) in the treatment of moderate to severe ARDS.  CONCLUSION: Our findings suggest that DEXME infusion is beneficial in moderate to severe ARDS caused by SARS-CoV2  when given along with HFNO therapy and prolonged PP sessions, thereby, avoiding intubation. 

Biallelic variants in CHST3 cause Spondyloepiphyseal dysplasia with joint dislocations in three Pakistani kindreds

Background Skeletal dysplasia is a heterogeneous group of disorders. Spondyloepiphyseal dysplasias comprise one subgroup. Deficiency of carbohydrate sulfotransferase 3 has been reported in a small number of patients with recessively inherited spondyloepiphyseal dysplasia with joint dislocation, short stature and scoliosis. We report here molecular and clinical findings of affected individuals in three consanguineous Pakistani families. Affected individuals in all three families had a uniform phenotype including severe short stature, multiple dislocated joints, progressive scoliosis and facial dysmorphism. Methods Clinical evaluation was done for three unrelated families. Radiological survey of bones was completed for patients from two of the families. Whole exome sequencing index patients from each family was performed followed by Sanger sequencing for validation of segregation of identified variants in respective families. In-silico analysis for determining pathogenicity of identified variants and conservation was done. Results Whole-exome sequencing revealed biallelic variants c.590 T > C;p.(Leu197Pro), c.603C > A;p.(Tyr201Ter) and c.661C > T;p.(Arg221Cys) in CHST3 (NM_004273.5) in the three families with eight, five and two affected individuals, respectively. Contrary to previous reports, affected individuals in none of the families exhibited a hearing loss. Conclusion We describe genotypic and phenotypic findings of three unrelated families with spondyloepiphyseal dysplasia. Our study confirms phenotypic variability and adds to the genotypic spectrum of spondyloepiphyseal dysplasia.Peer reviewe

Studies on Genetic Divergence of Rapeseed Genotypes Using SSR Markers

Thirty five Brassica napus genotypes were evaluated to check their genetic diversity on the basis of mapped 20 microsatellite markers. The genetic similarity values of coefficient ranged from 0.28 to 0.85. A dendrogram was generated based on UPGMA which showed that genotypes were divided into five major clusters. Cluster A had genotypes with higher similarity coefficient of 0.85 while Cluster E had only one genotype (pop 35) genetically distinct from other genotypes. PIC values were calculated for each of the 20 SSR primer pairs. Ten primers PIC value ranged from 0.30 (O110-A05) to 0.59 (Na10-D09 markers). This study would be helpful in assessing the genetic diversity. It was revealed that there was no correlation between the geographical distribution and genetic diversity of the studied germplasm, depicting their close genetic relationship

Impact of temporomandibular disorders on oral health-related quality of life: A systematic review and meta-analysis

Background: The management of temporomandibular disorders (TMDs) requires a comprehensive approach that considers multiple factors, including the impact of oral health-related quality of life (OHRQoL). Through this investigation we aim to assess the impact of OHRQoL played in a TMD-afflicted individual. Methods: Using keywords relevant to our research, such as "Oral health related quality of life," "Oral hygiene," "Temporomandibular joint" and "Temporomandibular disorders," a comprehensive search across multiple online databases was carried out, yielding a total of 632 studies at the preliminary stage of the review. Modified New Castle Ottawa scale was used to assess the quality of studies included. Results: Eight studies were included in the review, out of which six were eligible for further meta-analysis. The studies included in this review employed various OHRQoL measures, including the Oral Health Impact Profile-14 (OHIP-14), the Short-Form 36 Health Survey (SF-36) and the OHIP- 49. All the studies demonstrated significant effect of TMDs on the OHRQoL of the target population under study. Conclusion: The impact of OHRQoL on the management of TMD was deemed to be significant. The comprehensive management of TMD should consider the impact of the condition on the individual's daily life and incorporate interventions that address both the physical and psychological aspects of the condition. By improving OqL, individuals with TMD can experience improved overall well-being and quality of life