Yaasir Mamoojee

Short Communication: Low seroprevalence of cryptococcal antigenaemia in patients with advanced HIV infection enrolling in an antiretroviral programme in Ghana

Objectives  To determine the prevalence of cryptococcal antigenaemia in a clinic population with advanced HIV infection, with a view to giving antifungal therapy to those testing positive.

Diagnosis of treponemal co-infection in HIV-infected West Africans

Objectives  To evaluate the performance of two enzyme immunoassays (EIA), Murex and ICE, and the Determine TP point‐of‐care test (POCT) in diagnosing treponemal infection (syphilis or yaws) in patients attending a large HIV clinic in Ghana; to determine the prevalence of treponemal co‐infections; and to characterise demographic and clinical features of patients with infection.

Lesson of the month 2: Catecholamine-induced cardiomyopathy – pitfalls in diagnosis and medical management

Cardiomyopathy as the initial presentation of phaeochromocytoma (PCA) is uncommon. Diagnostic work-up and perioperative management may be challenging within this context. We report three cases of PCA presenting with cardiomyopathy to illustrate the pitfalls in diagnosis and management. None of the patients had typical adrenergic symptoms and all three were established on beta-blockers prior to diagnosis. Their fractionated plasma catecholamine levels were elevated and the diagnosis of PCA was confirmed with various imaging modalities and post adrenalectomy. Interpretation of fractionated catecholamine levels in the context of established cardiomyopathy is difficult as cardiac failure of any aetiology generates an adrenergic response. Hence screening all patients with idiopathic cardiomyopathy is likely to generate a high false-positive rate. However, a high index of suspicion should prompt further diagnostic work-up in patients with idiopathic cardiomyopathy for occult PCAs. Peer-reviewed guidelines are required to guide the investigation and management of suspected catecholamine-induced cardiomyopathy.

Challenges in the acute management of profound hyponatremia presenting with severe symptoms

ABSTRACT Currently available guidelines in the acute management of severely symptomatic hypotonic hyponatremia vary in their approach to the use of hypertonic saline. In the acute setting, deciding on when to implement available treatment algorithm using hypertonic saline may be difficult, given that the duration of hyponatremia and potential alternative diagnoses presenting with similar symptoms may be hard to establish promptly. We present the case of a young female with symptomatic profound hyponatremia who subsequently developed osmotic demyelination syndrome due to rapid overcorrection of serum sodium concentration. We discuss the interplay between the dynamic pathophysiological processes responsible for hypotonic hyponatremia in adrenal insufficiency and conduct a detailed analysis of currently available guidelines to highlight the challenges in acute and reactive treatment in clinical practice.

Qualitative analysis of ultrasound reports assessing radiological descriptors of thyroid nodules - a retrospective pilot audit

We conducted a retrospective audit at The James cook University Hospital (JCUH) and the University Hospital of North Tees (UHNT) between March 2012 and May 2013. All patients who had a solitary thyroid nodule or a dominant nodule within a multinodular goitre at ultrasound scanning (USS) were included. Patients with multinodular goitre and multiple/incidental asymptomatic nodules or thyroiditis on USS were excluded. The following data for each thyroid USS report was collected from the electronic reporting system:

Iatrogenic Cushing's syndrome secondary to combined oral contraceptive pill in a patient with congenital adrenal hyperplasia

M ID H 51 98 References 1. Speiser PW, Azziz R, Baskin LS, et al. Congenital adrenal hyperplasia due to steroid 21-hydroxylase deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2010; 95:4133. 2. Merke DP, Bornstein SR. Congenital adrenal hyperplasia. Lancet 2005; 365:2125 3. Pang S, Clark A. Congenital adrenal hyperplasia due to 21-hydroxylase deficiency: Newborn screening and its relationship to the diagnosis and treatment of the disorder. Screening 1993; 2:105. 4. Therrell BL. Newborn screening for congenital adrenal hyperplasia. Endocrinol Metab Clin North Am 2001; 30:15. 5. Valin N, De Castro N, Garrait V, Bergeron A, Bouche C, Molina JM. Iatrogenic Cushing’s syndrome in HIV-infected patients receiving ritonavir and inhaled fluticasone: description of 4 new cases and review of the literature. J Int Assoc Physicians AIDS Care (Chic). 2009;8(2):113-21. 6. Slayter KL, Ludwig EA, Lew KH, Middleton E, Jr, Ferry JJ, Jusko WJ. Oral contraceptive effects on methylprednisolone pharmacokinetics and pharmacodynamics. Clin Pharmacol Ther 1996; 59: 312±321. 7. Sanna P, Kari TK, Pasi T, Pekka M, Pertti JN, Kari L. Effect of an oral contraceptive preparation containing ethinylestradiol and gestodene on CYP3A4 activity as measured by midazolam 1’-hydroxylation. J Clin Pharmacol, 50, 333-337. 8. John E. Plager, Kurt G. Schmidt, William J. Staubitz. Increased Unbound Cortisol in the Plasma of Estrogen-treated Subjects. J Clin Invest. 1964;43(6):1066-1072 Systolic blood pressure: