Clinical and hormonal response of patients with galactorrhea syndrome treated with bromergocryptine

Tne patients with galactorrhea syndrome were treated with two different daily dosages (5 mg and 7.5 mg) of Bromergocryptine. The 5 mg daily dosage often did not produce the desired hormonal and clinical response. Five patients were treated with this regimen for 38 to 90 days, with treatment extending over more than one menstrual cycle. However, the 7.5 mg daily dosage resulted in complete cessation of galactorrhea in all patients, restoration of menstrual cycles in five patients, and pregnancies in four patients. Disappearance of lactation proved to be a very good indicator of the general responsiveness of patients. Nausea, vomiting, and occasional dizziness were side effects of the drug. The case histories and hormonal findings of four typical patients are reported.

Lipoprotein Glomerulopathy With Complete Resolution With Fenofibrate: Report of First Case From Pakistan

Background: Lipoprotein glomerulopathy is an infrequent glomerular disorder that culminates in nephrotic syndrome and often progresses to kidney failure. Whereas most patients have been reported in Japan and China, limited reports have been documented outside these regions. This patient represents the first report of lipoprotein glomerulopathy in Pakistan. Case Presentation: A 25-year-old male patient, hypertensive for 2 years, presented with progressive body edema, frothy urine, and fatigue. Examination revealed elevated blood pressure, bilateral pedal edema, and positive shifting dullness. Laboratory results showed significant proteinuria and elevated cholesterol and triglyceride levels. Renal biopsy revealed enlarged glomeruli with a dilated capillary lumen filled with pale-staining mesh-like material "lipoprotein thrombi." Mild tubular atrophy and interstitial inflammation were observed. No interstitial fibrosis was evident. Electron microscopy detailed the lipoprotein thrombi with lipid granules and vacuoles of various sizes. A diagnosis of lipoprotein glomerulopathy was rendered. Treatment with fenofibrate, rosuvastatin, and captopril led to notable improvements in symptoms, blood pressure, and lipid levels during a 6-month follow-up. Subsequent biopsy showed complete resolution of the lipoprotein thrombi and a significant reduction in subendothelial granular densities. However, the flocculent subendothelial material persisted to some extent despite the complete resolution of lipoprotein thrombi. Conclusion: This report underscores the rarity of lipoprotein glomerulopathy in Pakistan and contributes valuable insights into its histopathologic features and global epidemiology. This unique instance aims to raise awareness among healthcare professionals, aiding in improved recognition of this rare entity. The favorable response to fenofibrate treatment underscores its effectiveness in managing lipoprotein glomerulopathy.

Evaluating the comprehension and accuracy of ChatGPT's responses to diabetes-related questions in Urdu compared to English

Introduction

Patients with diabetes require healthcare and information that are accurate and extensive. Large language models (LLMs) like ChatGPT herald the capacity to provide such exhaustive data. To determine (a) the comprehensiveness of ChatGPT's responses in Urdu to diabetes-related questions and (b) the accuracy of ChatGPT's Urdu responses when compared to its English responses.

Methods

A cross-sectional observational study was conducted. Two reviewers experienced in internal medicine and endocrinology graded 53 Urdu and English responses on diabetes knowledge, lifestyle, and prevention. A senior reviewer resolved discrepancies. Responses were assessed for comprehension and accuracy, then compared to English.

Results

Among the Urdu responses generated, only two of 53 (3.8%) questions were graded as comprehensive, and five of 53 (9.4%) were graded as correct but inadequate. We found that 25 of 53 (47.2%) questions were graded as mixed with correct and incorrect/outdated data, the most significant proportion of responses being graded as such. When considering the comparison of response scale grading the comparative accuracy of Urdu and English responses, no Urdu response (0.0%) was considered to have more accuracy than English. Most of the Urdu responses were found to have an accuracy less than that of English, an overwhelming majority of 49 of 53 (92.5%) responses.

Conclusion

We found that although the ability to retrieve such information about diabetes is impressive, it can merely be used as an adjunct instead of a solitary source of information. Further work must be done to optimize Urdu responses in medical contexts to approximate the boundless potential it heralds.

A novel case report of benign recurrent intrahepatic cholestasis-associated USP53 genetic mutation in a Pakistani girl

Benign recurrent intrahepatic cholestasis is an autosomal recessive disorder presenting with intermittent episodes of cholestatic jaundice. The initial episode of benign recurrent intrahepatic cholestasis tends to occur within the first two decades of a patient's life. Episodes can occur unprompted but can often be precipitated by infections or pregnancy. We report an interesting case of a 13-year-old girl presented with recurrent intrahepatic cholestasis. The patient has a unique homozygous USP53 genetic mutation, the first patient to present with this mutation within the South Asian region. The patient was initially misdiagnosed as a case of autoimmune hepatitis, and when presenting to our set-up was diagnosed as a case of benign recurrent intrahepatic cholestasis. The patient has since been managed on medication and remains regular in follow-up, responding well to treatment.

Non-Alpine Thyroid Angiosarcoma Presenting with Unique Spinal Metastasis: A Rare Case Report from Pakistan

Thyroid angiosarcoma is an extraordinarily sparse malignancy, often populating alpine regions. Clinically, thyroid angiosarcomas tend to be nonspecific in presentation, starkly dependent on site, size, extension, and metastases. Tumors are locally aggressive and can present with sudden onset pain due to intra-nodular hemorrhage and compressive symptoms from sudden expansion. Due to the disease being a scarcely reported entity, there is little scholarship regarding its management. We report an interesting case of a 63-year-old man presenting with a swelling in the neck, incidentally found to be a thyroid angiosarcoma with a first-time reported associated spinal metastasis. The patient has a uniquely presenting thyroid angiosarcoma and is the first patient to present as such within a non-alpine South Asian region.

661 Improving Antibiotic Prescribing in a District General Hospital: A Closed Loop Audit

Aim

Broad-spectrum antibiotics are effective in decreasing wound infection and postoperative intra-abdominal abscesses for patients undergoing appendicectomy. Compliance with local hospital antibiotic guidelines is important in ensuring antibiotic efficacy and reducing potential for toxicity and antibiotic resistance. The aim was to assess the impact of educational interventions on the adherence to local antibiotic guidelines in patients undergoing appendicectomy at a Scottish district general hospital.

Method

Preoperative antibiotic prescribing in consecutive adult patients aged ≥ 16 years undergoing appendicectomy were audited against hospital guidelines over a four-month period between March 2019 and July 2019. We implemented change through antibiotic prescribing teaching for doctors in the surgical team and anaesthetic team. This change was subsequently evaluated through a re-audit over a three-month period between December 2019 and February 2020.

Results

The baseline audit demonstrated 68.8% (n = 11/16) compliance to local antibiotic guidelines among patients undergoing appendicectomy. The remaining patients had the correct choice of antibiotics, but gentamicin was prescribed in different doses. Gaps in prescriber awareness of antibiotic guidelines were identified. Following departmental teaching sessions regarding antibiotic prescribing and use of the gentamicin dosing calculator, the re-audit showed 93.8% (n = 15/16) compliance with local antibiotic guidelines among prescribers in the surgical team and anaesthesic team.

Conclusions

Education interventions were instrumental in improving adherence to antibiotic prescribing guidelines. This highlights the importance of regular audit and prescriber education in the promotion of antibiotic stewardship in hospitals.

"A call to action: amplifying the role of men in bridging the gender gap in live kidney donations"- A Letter to the Editor

Dear Editor, We are writing this letter to expound upon an underreported and rarely talked about issue referencing the gender bias invloving the live kidney donations. That being said, the purpose of this letter is purely to underscore the fact that women are less likely to receive a living donor transplant as compared to men. However, they are more likely to serve as living donors for kidney transplantation. [1] Multiple contributory factors including societal stigmas and cultural biases can be attributed to this approach. The evidence of this sex disparity is much more prominent in south Asian countries where men have a 10 times more likely chance to receive a kidney transplant than women. [2] Apart from the male dominance influenced by the socioeconomic reason, this gender imbalance is difficult to quantify. Many women feel obliged to accept the traditional role to care for sick family members. They are less able to refuse the appeal for help within the family compared to men. This is especially true for mothers and spouses. [3] When it comes to men, documented instance in literature show that men in situations where they needed to donate silently disappear from the scene and only show up once the transplantation is over, leaving the women to step forward in this situation. This, cowardice of men is cemented by a recent story of a 36-year-old man with end- stage renal failure. Although one of his healthy brothers was a perfect match, the burden of the transplant still befelled on their old mother. [4] Kidney donation is an act of altruism and devotion. As evidenced by the statistics, the local literature also have frequently portray that women are the frontrunners in this race, while the men are falling far behind. Here the authors need to make it very clear that our purpose is not to say that all men would react this way, but it is to highlight the huge contrast between men and women stepping up as donors for their families. The primary objective of this letter is to accentuate the importance of enhanced access to care for women requiring transplantation while fostering within the male population a deeper understanding of the myths surrounding organ donation and the vital importance of supporting the women in their lives during such critical moments.