Saudi Journal of Medicine (SJM) | Volume-6-Issue-10
Volume-6-Issue-10
Case Report
Oct. 2, 2021
A Rare Case of Plurihormonal GH-ACTH Pituitary Adenoma Resulting in Acromegaly and Cushing's Disease: From a Case Report
Rolly Junior Louzolo-Kimbembe, Farah EL Gharroudi, Sana RAFI, Ghizlane El Mghari, Nawal El Ansari
Page Numbers : 303-305
DOI : 10.36348/sjm.2021.v06i10.001
Plurihormonal pituitary adenomas are rare tumors that present cellular immunoreactivity for more than one pituitary hormone. The most common form is that combining growth hormone and prolactin, but the combination of growth hormone with adrenocorticotropic hormone causing Acromegaly and Cushing's disease is extremely rare and clinical signs may be subtle. We have demonstrated the clinicopathological characteristics of plurihormonal pituitary adenomas through the case of our 25-year-old patient who had a pituitary macroadenoma with an initial clinical picture dominated by acromegaly and mild cushingoid features.
Original Research Article
Oct. 7, 2021
A Study on the Mental Health Status of Mothers of Young Children in Urban Tamilnadu
Pon Padmanabhan, I. K. Annie, A. John William Felix
Page Numbers : 306-310
DOI : 10.36348/sjm.2021.v06i10.002
Background: Mental health is one of the major public health concerns today. Women, who play multiple active roles in their families experience stress at all levels. This study was conducted to assess the mental health status and its contributory factors in mothers having young children in the urban area of Tamilnadu, India. Methods: A descriptive cross-sectional study was conducted among 200 mothers of young children, regarding their mental health status. All relevant information was collected using a pre-tested, predesigned interview schedule and the parental stress scale. Results: This study has shown that 22% of the mothers were at moderate stress level. Correlation analysis has shown that magnitude of stress is higher in mothers with more number of children and the level of stress is high among mothers having low income for their family. Conclusions: A preventive program including screening of mothers for stress and other psychosocial hazard along with sensitising the need for identifying and seeking help in time will help them to have a better mental health.
Case Report
Oct. 9, 2021
Acquired Bartter’s Syndrome - A Rare Metabolic Abnormality Induced by Streptomycin
Dr. Shazia Durdana, Dr. Syed Hasan Amir
Page Numbers : 311-312
DOI : 10.36348/sjm.2021.v06i10.003
Streptomycin associated nephrotoxicity can manifest either as nonoliguric acute kidney injury, tubular dysfunction or electrolyte abnormalities including Fanconi-like syndrome or Bartter syndrome. We report a case of Streptomycin-induced renal electrolyte wasting mimicking Bartter’s syndrome.
Case Report
Oct. 14, 2021
Desmoid Fibroma: A Case Report and Literature Review
Olaya Hamidi, Othmane Bouanani, Amine Oussalem, Zeine Abidine Baba Hassene, Hafsa El Ouazzani, Nadia Cherradi, Malik Boulaadas
Page Numbers : 313-317
DOI : 10.36348/sjm.2021.v06i10.004
Desmoid fibroma is a rare benign tumor of fibrous tissue characterized by a high potential for locoregional invasion and recurrence. The mandibular location of this pathology is exceptional. In our work, we report a case of desmoid tumor observed in a 9-year-old boy. Clinically, he presented a large right cheek swelling that was immovable relative to the mandible. The diagnosis was based on clinical, radiological and pathological arguments. There is no therapeutic protocol for desmoid tumors, but surgery is the most commonly used treatment. Chemotherapy, radiotherapy and hormonotherapy are used in addition to surgery or in some cases of inoperable tumors.
Case Report
Oct. 16, 2021
Cardiac MRI Imaging in the Diagnosis of Acute Myocarditis in a Young Athlete
Acute myocarditis is inflammation of the myocardium most often following a viral infection. Its diagnosis is one of the most difficult to make with certainty in cardiology, due to the lack of specificity of the clinical presentation, ECG and ultrasound changes, and the restrictive use of myocardial biopsy (BM). For these reasons, we report the case of a 22-year-old athlete who presented with severe chest pain. Cardiac MRI allows direct characterization of myocardial damage; different diagnostic sequences make it possible to locate areas of inflammation, edema, and necrosis, and the distribution of lesions in the muscle makes it possible to distinguish between ischemic and inflammatory damage.
Case Report
Oct. 16, 2021
Primary Hyperparathyroidism: A Case Report
Dr. Vatsal Agarwal, Dr. Ankit Grover, Dr. Mahesh Kr Mehrotra, Dr. Smita Gupta
Page Numbers : 322-324
DOI : 10.36348/sjm.2021.v06i10.006
Primary hyperparathyroidism (PHPT) is a common endocrine disorder, with prevalence of one to seven cases per 1000 adults. It is believed to be the most common cause of hypercalcemia, predominantly affecting elderly populations and women two to three times as often as men. Here we report a case of 75 year old male who presented to Medicine OPD with complaints of constipation, abdominal pain and occasional irrelevant talks. Investigation showed hypercalcemia. PTH levels were markedly raised with borderline 1,25 DIHYDROXYVIT D. Patient was dialysed and managed conservatively. Later follow-up reports revealed microoadenoma and underwent surgery.
Original Research Article
Oct. 19, 2021
An Assessment of the Risk Factors for Retinopathy of Prematurity in Preterm Very Low Birth Weight Babies
Md. Abu Talha, Shahida Akhter, Ferdous Akhter Jolly, Tasnima Ahmed, Abdul Baki, Noorjahan Begum, Nadia Huq, Nazia Tabassum
Page Numbers : 325-330
DOI : 10.36348/sjm.2021.v06i10.007
Introduction: Retinopathy of prematurity (ROP) is a vasoproliferative disorder of the retina among preterm infants which is the main cause of blindness in premature infants but recognized as leading cause of preventable blindness and visual impairment in children if treated early. It is a multifactorial disease in which retinal blood vessels of premature preschoolers fail to grow and develop normally, resulting in visual impairment and blindness. Objectives: The objective of the study is to assess the risk factors for retinopathy of prematurity in preterm very low birth weight babies. Material & Methods: This was a prospective observational study conducted at Special Care Baby Unit (SCABU), Department of Neonatology and Pediatrics, Department of Ophthalmology; Bangladesh Institute of Research and Rehabilitation for Diabetes, Endocrine and Metabolic Disorders (BIRDEM) from October 2016 to March 2017. One hundred and twenty-nine (129) preterm very low birth weight infants admitted in SCABU, BIRDEM during the study period were selected considering the inclusion and exclusion criteria. Data were analyzed using SPSS version 20.0 and were expressed as mean ± standard deviation. Results: All babies weighed less than 1500 gm, among them 11 (12.2%) were < 1000 gm and 79 (87.8 %) were ≥1000-1500gm. Forty-three, 43(47.8%) baby’s gestational age was ≤32 weeks and forty-seven 47(52.2%) baby’s gestational age was >32 weeks, 74(82.2%) were inborn, 16 (17.8%) were out born. Seventy-nine, 79 (87.8%) were delivered by LUCS and 11(12.2%) by NVD. Conclusion: This study concluded that overall frequency of ROP was 30% among screened infants. Among the ROP diagnosed cases 11.1% required anti VGEF injection, 14.8 % received laser therapy. Lower gestational age, use of mechanical ventilator and frequent blood transfusions were found to be the most significant risk factors. There are few studies on the incidence and risk factors of this important morbidity in the developing countries. Taking known preventive measures, early detection and management of ROP can prevent blindness. The prognosis for maintaining functional vision is poor in advanced cases of ROP even with the application of currently available methods of treatment.
Case Report
Oct. 19, 2021
Groove Pancreatitis- A Secret Masquerader
Dr. Shazia Durdana, Dr. Umair Shamsul Hoda
Page Numbers : 331-333
DOI : 10.36348/sjm.2021.v06i10.008
Groove pancreatits is a type of chronic pancreatitis that affects the area between pancreatic head, duodenum and the common bile duct. It usually affects alcoholic males between the ages of 40-50 years. Patient presents with typical symptoms of chronic pancreatitis such as weight loss, upper abdominal pain, vomiting, and steatorrhea. Groove pancreatitis is thought to occur from the obstruction of minor papilla which leads to impaired pancreatic juice outflow. Differentiating groove pancreatitis from peripancreatic cancer is very important. Imaging by EUS, CT and MRI can reveal characteristic findings such as cystic lesions in duodenal wall and smooth stenosis of bile duct. In cases where there is a diagnostic dilemma, biopsy through duodenum is confirmatory. Characteristic findings on biopsy include cystic lesions in duodenal wall, Brunner gland hyperplasia, dilation of Santorini’s duct and protein plaques in pancreatic duct. Treatment options include conservative management with endoscopic stenting and invasive approach with pancreaticoduodenectomy. In the following case report we present to you a case of non-alcoholic young female with morbid obesity who presented to us with complaints of pain abdomen and vomiting for 1 month, with no significant derangements in lab investigations. Her abdominal ultrasonography revealed diffuse thickening of the second and third parts of the duodenum with fine inflammatory strands extending to the head and uncinate process of the pancreas with a narrowing of the duodenal lumen, which was later confirmed to be groove pancreatitis on CECT-abdomen and patient was successfully managed conservatively.
Original Research Article
Oct. 28, 2021
Dexmedetomidine's Pain Relief Safety and Effectiveness in Brachial Plexus Block in Supraclavicular Area: A Prospective Study
Dr. Md. Moshiur Rahman, Dr. A. K. M. Tanvirul Haque, Dr. Mohammad Ali Chowdhury, Dr. Md. Abul Ehsan, Dr. Bidhan Kumar Fowjdar, Dr. Md. Ashraful Alam, Dr. Indrasis Sanyel
Page Numbers : 334-340
DOI : 10.36348/sjm.2021.v06i10.009
Background: The objective of this research was to see how Dexmedetomidine affected the onset and duration of brachial plexus block and postoperative analgesia in individuals having upper limb procedures. Methods: This quasi-experimental study was conducted in the Department of Anaesthesia, Rajshahi Medical College Hospital, and Tertiary Hospital in Rajshahi, Bangladesh. From June 2018 to December 2020. There were two groups of (n=60) adult patients randomly assigned to upper-limb and hand procedures each. When it came to the control group, they were given the same amount of Dexmedetomidine (dexmed) as the dexmedetomidine (dexmed) group. Still, they were also given the same amount of 0.75% bupivacaine and 2% lidocaine (with adrenaline) as the dexmedetomidine (dexmed) 1 μg/kg. Ultrasound-guided supraclavicular brachial plexus block administered a total of 0.5 mL/kg in both groups. In addition to hemodynamic stability, patients were monitored for postoperative pain, analgesia duration, and side effects. Results: The dexmed group had a faster onset of motor blockade and a longer duration of sensory and motor blockade (P < 0.0001). For the dexmed group, the postoperative analgesic period was also prolonged compared to that of controls 12 [10.5–13.5] hours and 17 [10.5–19.5] hours in the control and dexmed group, respectively [95% confidence interval, −5 {−5, −4}, P < 0.0001]). Within the first 24 hours following surgery, the dexmed group used rescue analgesics less frequently. (P < 0.0001). Except for 8 and 10 hours after surgery, postoperative pain scores were equivalent between groups when pain levels were lower in the dexmed group. More sedated individuals in the dexmedetomidine group remained sedated for 2 hours longer. (P < 0.0001). We did not have any occurrences of bradycardia, hypotension, respiratory depression, or disorientation. Conclusions: According to our findings, adding Dexmedetomidine to Bupivacaine-lidocaine increased the duration of the supraclavicular brachial plexus block and reduced postoperative analgesia in patients with upper limb surgery.
Case Report
Oct. 30, 2021
Unusual Case of Biliary Tract Obstruction; a Spectacular ‘Christ Sign’ on MRI
Ascariasis, a worldwide common parasitic disease, caused by ascaris lumbricoidesaffecting mainly the small intestine. This worm could invade the gallbladder and be responsible of an acute cholangitis. Our case report describes this particular condition in which our patient of 23 years old had his gallbladder invaded with Ascariasis and in which the Bili-MRI showed spectacular images. We choose to call it ‘Christ sign’.
Original Research Article
Oct. 30, 2021
Diagnostic Accuracy of Risk of Malignancy Index (RMI) in Pre-Operative Evaluation of Ovarian Masses
Bushra Liaqat, Tehmina Zafar, Lamia Yusuf
Page Numbers : 343-347
DOI : 10.36348/sjm.2021.v06i10.011
Ovarian masses are a frequent cause of gynaecological malignancy. The risk of the Malignancy Index (RMI) is widely studied for the prediction of malignant pelvic masses. The objective of this study was To determine the diagnostic accuracy of RMI in diagnosing ovarian masses preoperatively for malignancy keeping histopathology as the Gold standard.it was a Cross-sectional study conducted in Gynae and Obs unit 1 Fauji Foundation Hospital Rawalpindi. Duration of study was months after approval of synopsis, non-probability consecutive sampling was used approval obtained from ethical committee. A total of 87 expected patients of having ovarian masses reporting in outpatient (OPD) and were admitted in wards were enrolled for the study. Informed written consent was taken from all the patients. Ultrasonography (USG) and serum CA-125 levels of all the patients were done and scores were assigned to each parameter. The RMI was calculated for each patient. Histopathology was obtained and all the information was recorded on a predesigned Performa. RMI 25(28.7%) had positive and 62(71.3%) had negative findings. On histopathology findings, there were 25(28.7%) malignant and 62(71.3%) were benign masses. The sensitivity, specificity, PPV and NPV of RMI was 92%, 96.77%, 92% and 96.77% with a diagnostic accuracy of 95.4%. The likelihood ratio for positive and negative was 28.52 and 0.082 respectively. RMI is a highly sensitive (92%) and specific (96.77%) method to identify ovarian carcinomas.
