A rare case of macroprolactinoma in a patient with Mayer–Rokitansky–Kuster–Hauser (MRKH) syndrome

Summary A 17-year-old lady presented with primary amenorrhoea, headache, nausea and lethargy. She had delayed pubertal development that also includes under-developed breast (Tanner Stage 2). Hormonal investigations showed a high serum prolactin level of 1 680 000 mIU/L (normal value: 45–375 mIU/L), with low oestradiol, progesterone, follicular-stimulating hormone and luteinizing hormone. Early morning cortisol level was 206 nmol/L (normal value: >450 nmol/L), thyroxine was 7.5 pmol/L (normal value: 9.0–24.0 pmol/L) with TSH 5.091 mIU/L (normal value: 0.4–4.5 mlU/L). A pituitary MRI showed a 2.7 (AP) × 3.7 (W) × 4.6 cm (CC) macroadenoma, with invasion into the left cavernous sinus and encasement of cavernous portion of the left internal carotid artery. MRI pelvis showed absent uterus, cervix and 2/3 upper vagina confirming Mullerian hypoplasia. Cytogenetics showed 46XX. These findings were suggestive of Mayer–Rokitansky–Kauser–Hauser (MRKH) syndrome with the presence of a pituitary macroprolactinoma and panhypopituitarism. She was treated with hydrocortisone, levothyroxine and cabergoline. Repeated MRI showed a reduction in tumour size by approximately 50%. This case illustrated a rare coexistence of these two conditions, being only the third reported case in the world. In addition, this would be the first case of a functioning pituitary adenoma in a patient with MRKH syndrome. Learning points Comprehensive hormonal and radiological investigations are important in the management of a young patient with primary amenorrhoea. Coexistence pathology of two separate pathologies should be considered in patient presenting with primary amenorrhoea. Early diagnosis of MRKH or any disorders of sex development should be treated early, providing pharmacological, surgical, psychological and emotional support to the patient and reducing risk of associated complications. Abnormal pituitary hormones, particularly panhypopituitarism, would impose greater impact not only psychologically but also metabolically leading to cardiovascular, morbidity and mortality risks in this patient if not treated early. A multidisciplinary approach is necessary for patients presenting with MRKH to ensure appropriate treatments and follow-up across the lifespan of the patient.

Comparison of inner macular thickness and superficial macular capillary vessel density acquired using classic and high-definition optical coherence tomography angiography scans

Background: In ophthalmology, thickness and vessel density (VD) measurements for the 6 x 6 mm inner macular retinal area have received increasing attention in glaucomatous progression research. For this area, the Angiovue optical coherence tomography system introduced a 304 x 304 A/B scans function (classic Angio Retina scan) in 2014, and a 400 x 400 A/B scans function (high-definition [HD] Angio Retina scan) in 2017. These scan types cannot be used in combination for the software provided for progression analysis.Purpose: Since losing data for 3 years may negatively influence progression analysis, we investigated whether clinically significant differences exist between consecutive measurements acquired with these scan types on the same eyes.Methods: As a part of our noninterventional prospective glaucoma imaging study, primary-open-angle glaucoma patients (POAG group), and ocular hypertensive and healthy control participants (structurally undamaged group) were imagedusing both the classic and the HD Angio Retina scans, respectively, without changing the patients’ position. High-quality images were obtained on 12 POAG eyes of 12 consecutive POAG patients, and 10 healthy and ocular hypertensive eyes of 10 consecutive participants before the data collection had to be suspended due to the new coronavirus epidemic.Results: For Early Treatment Diabetic Retinopathy Study image area, the mean difference (classic minus HD value) was 0.02 ± 0.37 μm for inner retinal thickness (P = 0.869) and 0.33 ± 1.33 % (P = 0.452) for superficial capillary VD in the structurally normal group (between-methods difference: ≤ 0.8% of the respective normal value). In the POAG group, the corresponding figures were -0.07 ± 1.22 μm for inner retinal thickness (P = 0.854; between-methods difference: 0.6% of the normal value) and 1.12 ± 2.58 % for superficial capillary VD (P = 0.158; classic scan value minus HD scan value: 1.12 ± 2.58 %; 2.3% of the normal value).Conclusion: Our results suggest that combined use of thickness and VD values for structurally normal eyes and thickness values for POAG eyes derived from classic and HD scans, respectively, for progression analysis can be reasonable since the differences between the corresponding values are small. However, combining the corresponding VD parameters for POAG eyes is useful only when the follow-up time before the scan type change is long enough to counterbalance the effect of the change on the result.

DETERMINATION OF NORMAL THYROID TECHNETIUM-99M UPTAKE VALUE IN A SINGLE CENTRE PAKISTANI POPULATION

Objective: To determine the normal value of thyroid Technetium-99m uptake value in a single centre Pakistani population. Study Design: Cross-sectional study. Place and Duration of Study: Nuclear Medical Centre, Armed Forces Institute of Pathology, Rawalpindi, from Feb 2019 to Apr 2020. Methodology: A total of 90 patients who presented to Nuclear Medical Centre for parathyroid dual radiopharmaceutical scintigraphy were included in study and selected by non-probability consecutive sampling technique. Thyroid uptake studies were calculated via gamma camera acquisition. Pre injection counts were taken from the Technetium-99m pertechnetate filled syringe, thyroid counts were taken from the anterior thyroid image 20 minutes post injection and to look for any residual radiopharmaceutical counts of the empty syringe were also taken. Results: Out of total of 90 patients, 32 (35.6%) were male while 58 (64.4%) were female with male to female ratio of 1:2. The mean age was 38.4 ± 12.7. Mean Thyroid Stimulating Hormone values were 1.6 ± 0.8 and mean T4 values were 11.9 ± 3.5. The 5th-95th percentile range was 0.4-2.2% and median was 1.2%. The interquartile range was calculated to be 0.9-1.5%. Conclusion: Normal value of thyroid Technetium-99m uptake value in a single centre Pakistani population values varies significantly as compared to global figures i.e. 0.3-4.5% and is different than the one used in our own department i.e. 0.5-2.0%.

Normal Exophthalmometry Values in Iranian Population: A Meta-analysis

There are limited studies on the normal values of eye protrusion in Iran. Systematic efforts to provide acceptable normal exophthalmometry values for Iranian population are required for a proper approach to orbital diseases. English and Farsi language publications in PubMed, the ISI Web of Knowledge database, Iranian SID, and Iran Medex were searched using the following keywords: “proptosis”, “eye protrusion”, “exophthalmous”, “Hertel exophthalmometer” and “Iran”. Four articles from 1995 to 2010 were found and included in the meta-analysis. Statistical analysis was performed using the Metan command within Stata 15.0 software. It included 3,696 subjects in whom the average eye protrusion was 16.5 mm (95% CI: 15.1–17.8) in men and 16.2 mm (95% CI: 14.6–17.7) in women (P = 0.5). Mean left and right eye protrusion were 16.3 (95% CI: 14.7–18.1) and 16.4 mm (95% CI: 14.8–17.7), (P = 0.3), respectively. While Iranian teenagers (13–19 years old) showed a mean value of 17.1 mm (95% CI: 15.0–19.1), older age group (≥20 years) showed a lower mean eye protrusion of 16.3 mm (95% CI: 14.8–17.7). Considering the two standard deviations, the highest normal value of eye protrusion in Iranian population is 20.1 mm. In conclusion, Iranian normal eye protrusion values were higher than Asians and lower than Caucasians.

Organoleptic Test of Green Mustard Leaf Flour (Brassica juncea) Due to Various Types of Preliminary Treatments

This study aims to determine the effect of preliminary treatment on the quality of organoleptic green mustard leaf flour.This research was conducted in the Laboratory of prodak development of Muhammadiyah University sidoarjo from February to April 2020 using descriptive methods. The experiment was compiled in a Complete Randomized Design with variations of preliminary treatment conducted ie without blanching (TPP), water blanching (PPR), water blanching with soaking salt solution 1% (PPRG 1), water blanching with soaking salt solution 2% (PPRG 2), water blansing by immersion of 0.1% na metabisulfite solution ((PPRN 1), water blanching by immersion of 0.2% na metabisulfite solution (PPRN 2), steam blanching (PPK) and microwave blanching (PPM). Based on organoleptic tests showed that the preliminary treatment had a noticeable different effect on color and aroma.The best treatment in the manufacture of mustard flour hijua with preliminary treatment is steam blansing that gives a normal value of 0.98 with organoleptic characteristics of color 6.04 (likes-very likes) and organoleptic aromas of 6.12 (likes-very likes).

AN IOT BASED APPROACH IN PARALYSIS PATIENT HEALTHCARE SYSTEM

In today’s world many people are suffering from physical disabilities due to paralysis or some accidental problem. Most of these patients are dependent on care taker. Paralysis is a condition in which there is impairment of one or more muscles in body. In order to assist these patients’ microcontrollerbased circuitry plays major role in system. Sometime appliances are also controlled by patient’s hand motion. This system also monitors patient’s heartbeat, if it exceeds normal value then buzzer will be activated and message will be shown on LCD to doctors and caretakers to attend patient.

Case Report: Postmortem bone histomorphometric analysis in a 38-year-old Japanese man with immobilization osteoporosis because of orthostatic hypotension related to amyloid light chain amyloidosis

We performed a postmortem bone histomorphometric analysis of iliac bone on a 38-year-old man who had been bedridden for the nine months before his death because of orthostatic hypotension and severe malnutrition related to amyloidκ-light-chain amyloidosis. Cancellous bone volume was greatly decreased, with a trabecular bone volume to total bone volume ratio of 6.77% (normal value, 19.56% ± 5.62%). Trabecular thinning was also apparent, with a trabecular thickness of 78.9 μm (normal value, 131.3 ± 28.1 μm), although the trabecula was still preserved. Cortical bone width was normal, although areas of porosity area were clear throughout the cortical bone. Our findings indicate that immobilization-related osteoporosis may be closely associated with loss of cancellous bone.