Kigali's experiment in e-diplomacy, e-procurement and urban agriculture

A Rome-Kigali urban agriculture project aims to be a showcase for glocalization' e-strategie

Kigali expérimente l'e-diplomatie, les cybermarchés publics et l'agriculture urbaine

Un projet d'agriculture urbaine unissant Rome à Kigali se présente comme la vitrine des cyberstratégies de « glocalisation »

A Case of Burnt-Out Langerhans Cell Histiocytosis Presenting as Postpartum Hypopituitarism

Objective: To evaluate the case of a woman who presented with central hypogonadism and diabetes insipidus and further developed a persistent cough leading to an unexpected diagnosis of burnt-out Langerhans cell histiocytosis (LCH). Methods: Clinical and laboratory endocrine evaluation, magnetic resonance imaging, high-resolution computed tomography, and open-lung biopsy results are discussed. Results: A 28-year-old woman presented at 10 months postpartum with polydipsia, polyuria, and amenorrhea for 3 months. Her results showed a prolactin level of 25 μg/L (reference,<23.5 μg/L), estrogen level of 91 pmol/L (reference, 110-180 pmol/L), follicle-stimulating hormone level of 6 IU/L (reference, 2-20 IU/L), and luteinizing hormone level of 6 IU/L (reference, 2-70 IU/L). A water-deprivation test found a sodium concentration of 148 mmol/L (reference, 135-145 mmol/L), serum osmolality of 310 mmol/kg (reference, 275-295 mmol/kg), and urine osmolality of 107 mmol/kg (reference, 50-1450 mmol/kg) that improved to 142 mEq/L, 295 mmol/kg, and 535 mmol/kg, respectively, after desmopressin administration. Gadolinium-enhanced pituitary magnetic resonance imaging demonstrated a markedly thickened stalk with uniform enhancement. Chest high-resolution computed tomography confirmed bilateral upper-zone cystic lung disease suggestive of either pulmonary lymphangioleiomyomatosis or LCH. Eventual histology showed CD1a-positive burnt-out LCH. This differentiation was crucial as pulmonary lymphangioleiomyomatosis exacerbates with estrogen therapy and pregnancy, which the patient was able to successfully pursue without disease exacerbation. Conclusion: The patient's initial presentation was considered as lymphocytic hypophysitis, but subsequent cystic changes on high-resolution computed tomography led to a unifying definitive diagnosis of burnt-out LCH. This case highlights the importance of investigating for uncommon secondary causes of hypophysitis

Obesity in the elderly diabetic patients: Townsville Hospital experience

Background / Aims: Although the increase in the prevalence of obesity among Australian diabetics (DM) generally is well documented, little information has been published specifically about the situation among older Australians living in North Queensland. This is despite the reportedly growing geriatric population in the region. The main aim of the study is to determine prevalence of obesity in the elderly subjects with DM. Methods: Hospital-based cross sectional study was prospectively conducted on patients admitted at the Townsville Hospital aged >70 years. Questionnaire was administered and anthropometric measurements were recorded in subjects with DM (study group) and non-DM (control group). Results: Data of 68 subjects were analysed comprising of 31 DM and 37 non-DM. Prevalence of obesity (BMI>25 kg/m2) was 74.7% compared with 45.9% in non-DM X2 = 5.6, P = 0.018. The mean BMI and body weight were higher in DM than in non-DM, 28.2 + 6.7 vs 25 .2 + 5.3 kg/m2 and 78.5 + 18 vs 68.6 + 17 kg, both P < 0.05. Gender, mean age, and prevalence of other co -morbidities were similar in both groups. Conclusion: We report high prevalence of obesity in diabetes elderly population. Prevention of DM may likely reduce rate of over weight in our geriatric subjects. This being pilot project further prospective studies on a larger population are needed to confirm our findings

Primary Adrenal Lymphoma as a Rare Cause of Primary Adrenal Insufficiency: Challenges in Management and a Review of the Literature

Background/Objective: Primary adrenal lymphoma (PAL) is an aggressive form of lymphoma associated with adrenal insufficiency (AI) in most cases. It requires a histologic confirmation unlike other cases of primary AI. Case Report: We report a case of a 66-year-old man who presented with AI with symptomatic hypotension and hypo-osmolar hyponatremia. Ultrasound and computed tomography scans revealed bilateral bulky adrenal masses that were avid on fluorodeoxyglucose positron emission tomography scan. The diagnosis of PAL was confirmed with adrenal biopsy. He was treated with rituximab-based chemotherapy, which was complicated by several endocrine challenges, including worsening diabetes, multiple adrenal crises, prolonged hyponatremia, and refractory hypokalemia requiring spironolactone. He eventually developed central nervous system disease and was treated with palliative intent. Discussion: AI in the setting of PAL can constitute both diagnostic and therapeutic challenges, including significant electrolyte imbalances as discussed in this case report. Conclusion: It is important to have a high suspicion for PAL, especially in the presence of bilateral adrenal masses and AI. Early adrenal biopsy is required for diagnosis. Multidisciplinary care is vital to manage complications that arise during the disease course and treatment

Pattern of diabetes limb amputations: review of two regional centres in Queensland

Background / Aims: Diabetes limb amputation (DLA) is common in Australia's Queensland with notable regional variations in clinical features. Despite this, there is no comparative study of DLA in the 2 regions -north and south Queensland. The aim of the study was to determine clinical characteristics of DLA at The Townsville Hospital (TTH) compared with South Queensland's Gold Coast Hospital (GCH). Methods: Clinical data for all DLAs from the 2 tertiary hospitals were retrospectively reviewed for a 3 year-period from 2009 to 2011. Results: Fifty DLAs were recorded at GCH and 31 for TTH. 35% of the subjects at TTH who had DLAs were Aboriginal and Torres Strait Islanders (ATSI) compared to 2% in GCH X2 = 17.3, P<0.001. The mean age, number of previous amputations and male-female ratio were similar in both centres. Conclusion: We reported high proportion of DLAs in the ATSI's North Queensland. Primary prevention of diabetes foot ulcer in the Indigenous Australian diabetic population may reduce DLA in the region. Further studies on larger population are suggested to confirm our findings

Environmental Response and Genomic Regions Correlated with Rice Root Growth and Yield under Drought in the OryzaSNP Panel across Multiple Study Systems

Funding: This research was funded by the Generation Challenge Program (GCP) project G3008.06, “Targeting Drought-Avoidance Root Traits to Enhance Rice Productivity under Water-Limited Environments". The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.Peer reviewedPublisher PD

Environmental Response and Genomic Regions Correlated with Rice Root Growth and Yield under Drought in the OryzaSNP Panel across Multiple Study Systems

The rapid progress in rice genotyping must be matched by advances in phenotyping. A better understanding of genetic variation in rice for drought response, root traits, and practical methods for studying them are needed. In this study, the OryzaSNP set (20 diverse genotypes that have been genotyped for SNP markers) was phenotyped in a range of field and container studies to study the diversity of rice root growth and response to drought. Of the root traits measured across more than 20 root experiments, root dry weight showed the most stable genotypic performance across studies. The environment (E) component had the strongest effect on yield and root traits. We identified genomic regions correlated with root dry weight, percent deep roots, maximum root depth, and grain yield based on a correlation analysis with the phenotypes and aus, indica, or japonica introgression regions using the SNP data. Two genomic regions were identified as hot spots in which root traits and grain yield were co-located; on chromosome 1 (39.7–40.7 Mb) and on chromosome 8 (20.3–21.9 Mb). Across experiments, the soil type/ growth medium showed more correlations with plant growth than the container dimensions. Although the correlations among studies and genetic co-location of root traits from a range of study systems points to their potential utility to represent responses in field studies, the best correlations were observed when the two setups had some similar properties. Due to the co-location of the identified genomic regions (from introgression block analysis) with QTL for a number of previously reported root and drought traits, these regions are good candidates for detailed characterization to contribute to understanding rice improvement for response to drought. This study also highlights the utility of characterizing a small set of 20 genotypes for root growth, drought response, and related genomic regions

Exenatide for treatment of obese type 2 diabetes: the Townsville Hospital experience

Background / Aims: Exenatide is a glucagon-like peptide-type 1 (GLP-1) approved for treatment of diabetes. Unlike insulin it has an added advantage of lowering body weight in obese type 2 diabetics. Literature for its therapeutic usefulness in Australian population is scanty and in North Queensland is lacking despite reportedly high prevalence of diabetes, obesity in the region. The aim of the study was to document metabolic effects of exenatide in our local diabetes population.\ud \ud Methods: We conducted a retrospective review of 221 patients with type 2 diabetes mellitus treated with exenatide for 24 months at the Townsville Hospital Diabetes Clinic.\ud \ud Results: These are the preliminary results. Range (Mean) HbA1c(%) at start 7.3-13 (10.15). Latest HbA1c 6.5-10.8 (8.65). Change in HbA1c +0.7 till -3.5 (-1.4). Weight(Kg) at start 94-184 (139). Change in weight -20 till +2 (-9).\ud \ud Conclusion: The preliminary results are favourable with fall in HbA1c by 1.4% and 9 kg weight loss. These results are from a small sample of the total patients and are comparable to the studies published

Severe hypertriglyceridaemia: a North Queensland experience

Background / Aims: Hypertriglyceridaemia (HTG) is a component of the metabolic syndrome and therefore very commonly seen in association with type 2 diabetes mellitus. Severe HTG can lead to acute pancreatitis and is more likely to be triggered when serum triglyceride (TG) level exceed 10mmol/L. There is a paucity of clear treatment guidelines for this presentation.\ud \ud Methods: We reviewed 5 cases of severe HTG, 4 of whom presented with pancreatitis to the Townsville Hospital from 2010-mid 2012. The management and clinical course of these cases and available literature will be reviewed.\ud \ud Results: All were male, overweight type 2 diabetic patients with age range 39-48 years. Four patients were Caucasians and one was a Torres Strait Islander (TSI). The serum TG level at time of presentation was around 100 mmol/L in all cases. Lipid electrophoresis revealed Frederickson type III hyperlipidaemia in 2 cases, type V in 2 cases. The four subjects were homozygous for apolipoprotein E3. Family history of hyperlipidaemia was negative except in one patient. Patients were managed with variable treatment modalities that included a combination of nil per oral (NPO), insulin, heparin, and lipid lowering medications. Serum triglyceride level in the first 24 hours decreased more rapidly in those patients who were managed with NPO and IV insulin compared to those who were not. Treatment was uncomplicated in all except one patient who subsequently developed a pancreatic pseudocyst.\ud \ud Conclusion: Combination of NPO and IV insulin seems to be an important treatment strategy in acute management of severe hypertriglyceridaemia. L arger studies are needed to confirm our finding