A case report: Giant cystic parathyroid adenoma presenting with parathyroid crisis after Vitamin D replacement

Background: Parathyroid adenoma with cystic degeneration is a rare cause of primary hyperparathyroidism. The clinical and biochemical presentation may mimic parathyroid carcinoma. Case presentation: We report the case of a 55 year old lady, who had longstanding history of depression and acid peptic disease. Serum calcium eight months prior to presentation was slightly high, but she was never worked up. She was found to be Vitamin D deficient while being investigated for generalized body aches. A month after she was replaced with Vitamin D, she presented to us with parathyroid crisis. Her corrected serum calcium was 23.0 mg/dL. She had severe gastrointestinal symptoms and acute kidney injury. She had unexplained consistent hypokalemia until surgery. Neck ultrasound and CT scan revealed giant parathyroid cyst extending into the mediastinum. After initial medical management for parathyroid crisis, parathyroid cystic adenoma was surgically excised. Her serum calcium, intact parathyroid hormone, creatinine and potassium levels normalized after surgery. Conclusion: This case of parathyroid crisis, with very high serum calcium and parathyroid hormone levels, is a rare presentation of parathyroid adenoma with cystic degeneration. This case also highlights that Vitamin D replacement may unmask subclinical hyperparathyroidism. Consistent hypokalemia until surgery merits research into its association with hypercalcemia

Impact of assistive technologies in supporting people with dementia.

In recent decades, many Assistive Technologies (ATs) have been developed to promote independence among people with dementia (PWD). Although there is a high rate of AT abandonment, only a handful of studies have focused on AT usability evaluation from the user point of view. The aim of this thesis is to empirically investigate the usability of ATs from the PWD and to measure its impacts on their lives. Following the Multi-methods research approach, the first part of the thesis uses secondary research methods including literature review and systematic mapping studies. The second part uses primary research methods including interviews (N=20) and questionnaire (N=327) based surveys for data collection and requirements elicitation. The third part is based on the design, development, and testing of an assistive software application through case studies (N=8). The first mapping study categorised existing general ATs into five major categories: robotics, monitoring, reminders, communication, and software. The second mapping study categorised software-based ATs into nine categories: cognitive help, reminders, health/activity monitoring, socialization, leisure, travel help, dementia detection, dementia prevention, and rehabilitation. The qualitative results showed that most of the PWD use ATs for socialization, and highlighted user interface efficacy, tailoring individual needs, and simplified functions as the major limitations of existing ATs. The quantitative results identified eleven factors for ATs usage: operational support, physical support, psychological support, social support, cultural match, reduced external help, affordability, travel help, compatibility, effectiveness, and retention. The statistical analysis showed that improved (social, psychological and travel) support and reduced need of external help for operating ATs, greatly impact AT effectiveness and retention. Based on PWD requirements, an assistive software application named E-Community for Dementia (ECD) was developed and tested through case studies involving 8 PWD and 40 volunteers. The participants were able to get their daily needed items in less time and with a friendlier manner through the help of their neighbours. The involvement of the caregivers for medication, meals, prayers etc. reduced significantly. The painting function helped evoke their memories, and encouraged them to perform activities from their youth. The news and weather functions kept them updated about the world around them. The travel tutor guided them in safe travel outside home and made sure that they got back home independently. The enhanced interaction between the PWD and their neighbours significantly reduced their social isolation. The results support the idea to create dementia-friendly communities at street levels, which is a cost-effective and reliable solution. The major outcomes from this thesis are AT categorization, evaluation of user experiences, factor identification and ranking, user requirements elicitation, assistive software application development, and case studies. This thesis helps considerably towards empirical investigation of the impact of ATs in supporting the PWD. The implementation of the ECD contributes towards the wellbeing of the PWD and saves costs spent on caregivers and carer companies. In future, the same study could be conducted in other settings to analyse the role of culture in AT acceptance

Development of skin hypopigmentation in a patient with metastatic papillary carcinoma thyroid treated with Sorafenib.

Background: Sorafenib can be considered as the effective option of treatment in patients with metastatic radioiodine refractory differentiated thyroid cancers. The cutaneous manifestations of Sorafenib include rash, desquamation, hand foot skin reactions, pruritus, alopecia and erythema. We report the first case of hypopigmentation related to sorafenib therapy. Case presentation: We report the case of a middle aged gentleman with metastatic papillary carcinoma of thyroid diagnosed in 2005. He was managed with total thyroidectomy, radioactive iodine and TSH suppressive therapy. Despite receiving radioactive iodine 530 mci cumulative dose, patient had persistant disease with lung metastasis. Therefore a TKI, sorafenib, was started. He developed hypopigmentation of the skin more prominent on face six weeks after starting sorafenib treatment.He also developed diarrhea, desquamation of hands and feet, hair loss over scalp, eye brows and moustache. Sorafenib treatment was discontinued. His diarrhea stopped in one week and after four weeks his skin became normalized whereas he regained his hairs in six weeks. Conclusion: To our knowledge, hypopigmentation in our patient appears to be the first reported of its kind in the literature to date. Sorafenib is used in Renal cell carcinoma, Hepatcellular carcinoma and radioactive iodine refractory thyroid carcinoma therefore it is very important to be aware of hypopigmentation as a potential side effect for both physicians and patients

Moe the Monkey: A Fun Way to Educate Children

This paper presents the development and usability testing of Evoke, an interactive avatar that can see, hear and respond to children in pitch-altered voice in real-time. The system uses Moe, a stylised monkey, as an interaction point between the teacher and children. Children remained fully engaged, responded more openly, and friendlier to the avatar (Moe), which was controlled by their teacher in a separate room. The user testing showed that the children listened to the character and were eager to ask questions, they grabbed and retained information given by Moe