Diabetes insipidus during pregnancy

Purpose of review Benign epithelial gastric polyps, although typically asymptomatic, are identified incidentally on upper endoscopy in up to 23% of patients. These include fundic gland, hyperplastic, and adenomatous polyps. Their appropriate characterization is critical as some have malignant potential, may be indicative of a gastric mucosal field defect, or may be related to an underlying polyposis syndrome. This review will discuss the current management of benign epithelial gastric polyps. Recent findings Association of gastric polyps with proton pump inhibitor use, Helicobacter pylori infection, risk of malignant transformation, and association with polyposis syndromes have been the focus of recent literature. Summary All symptomatic polyps, polyps larger than 1 cm in size, and polyps later found to contain dysplasia or cancer should be completely removed. Additionally, random biopsies from the intervening non-polypoid mucosa should be obtained. Finally, identification of multiple polyps of fundic gland type and/or concomitant dysplasia should raise suspicion for an underlying polyposis syndrome and prompt appropriate workup. Surveillance is generally only indicated if there is confirmed dysplasia and/or carcinoma within the polyp itself or if preneoplastic changes are identified in the non-polypoid gastric mucosa.

Current Management of Benign Epithelial Gastric Polyps.

Empty sella syndrome is a damaged pituitary gland. Either the gland has shrunk or has been crushed and flattened making it look like an empty sella on MRI scan. The reported prevalence of primary empty sella in general population is 8–35 %. The incidence is more in females, the ratio being 5:1. It is generally found in middle aged women who are obese and hypertensive.

Partial Empty Sella Syndrome: A Case Report and Review

Sheehan's syndrome refers to the occurrence of hypopituitarism after delivery, usually preceded by postpartum hemorrhage. The condition still continues to be a common cause of hypopituitarism in developing countries like India. The disorder usually presents with anterior pituitary failure with preservation of posterior pituitary functions. Posterior pituitary dysfunction in the form of central diabetes insipidus is rare in patients with Sheehan's syndrome. We describe the clinical course of a young lady who after her sixth childbirth developed severe postpartum hemorrhage followed by development of panhypopituitarism which was confirmed by hormonal investigation and demonstration of empty sella on imaging. In addition, she developed Polyuria. The water deprivation test and response to vasopressin test results indicated central diabetes insipidus. She needed oral desmopressin on a continuous basis to control polyuria.

https://www.aem-sbem.com/wp-content/uploads/articles_xml/0004-2730-abem-S0004-27302011000200010/0004-2730-abem-S0004-27302011000200010.pdf

Sheehan's syndrome with central diabetes insipidus

Hyperplastic gastric polyps are incidentally diagnosed during upper gastrointestinal endoscopy. They are known to cause gastric outlet obstruction and chronic blood loss leading to iron deficiency anemia. However, hyperplastic gastric polyp presenting as acute severe upper gastrointestinal bleeding is very rare. To the best of our knowledge, there have been two cases of hyperplastic gastric polyps presenting as acute gastrointestinal bleeding in the medical literature. We present a case of a 56-year-old African American woman who was admitted to our hospital with symptomatic anemia and sepsis. The patient developed acute upper gastrointestinal bleeding during her hospital stay. She underwent emergent endoscopy, but bleeding could not be controlled. She underwent emergent laparotomy and wedge resection to control the bleeding. Biopsy of surgical specimen was reported as hyperplastic gastric polyp. We recommend that physicians should be aware of this rare serious complication of hyperplastic gastric polyps as endoscopic polypectomy has diagnostic and therapeutic benefits in preventing future complications including bleeding.

/pdf/a-rare-complication-of-hyperplastic-gastric-polyp-2c641lmgdj.pdf

A rare complication of hyperplastic gastric polyp.

The main factor in fractures among seniors and women post-menopausal is osteoporosis, which decreases the density of bones. Finding a low-cost diagnostic technology to identify osteoporosis in its initial stages is imperative considering the substantial expenses of diagnosis and therapy. The simplest and most widely used imaging method for detecting bone diseases is X-ray radiography, however, it is problematic to manually examine X-rays for osteoporosis as well as to identify the essential components and choose elevated classifiers. To categorize x-ray pictures of knee joints into normal, osteopenia, and osteoporosis condition categories, authors present a process in this investigation that uses three convolutional neural networks (CNN) architectures, i.e., Inception v3, Xception, and ResNet 18, to create an ensemble-based classifier model. The suggested ensemble approach employs a fuzzy rank-based unification of classifiers by taking into account two distinct parameters on the decision scores produced by the aforementioned base classifiers. Contrary to the straightforward fusion strategies that have been mentioned in the literature, the suggested ensemble methodology finalizes predictions on the test specimens by considering the confidence in the recommendations of the base learners. A 5-fold cross-validation approach has been employed to assess the developed framework using a benchmark dataset that has been made accessible to the general population. The suggested model yields an accuracy rate of 93.5% with a loss of 0.082. Further, the AUC is observed to be 98.1, 97.9 and 97.3 for normal, osteopenia and osteoporosis, respectively. The results demonstrate the model’s usefulness by outperforming various state-of-the-art approaches. Keywords—Convolutional Neural Network; diagnosis; knee; osteoporosis; transfer learning models; X-rays

/pdf/fuzzy-rank-based-ensemble-model-for-accurate-diagnosis-of-ejcxw2tn.pdf

Fuzzy Rank-Based Ensemble Model for Accurate Diagnosis of Osteoporosis in Knee Radiographs

Giant gastric hyperplastic polyps constitute of around 76% of all gastric polyps found. They are often found incidentally on upper GI endoscopy. They often present with occult GI bleeding causing iron deficiency anemia or partial gastric outlet obstruction. Although mostly benign, they do have potential for malignant transformation and hence must be excised endoscopically or surgically, whichever may be feasible. We hereby present a couple of cases of gastric hyperplastic polyps in an attempt to add to the current literature on this rather rare entity.

Giant gastric hyperplastic polyp: not always a benign lesion.

Fetal valproate syndrome (FVS) results from valproate intake during pregnancy. Children with FVS may have various ocular abnormalities such as refractive error, amblyopia, and strabismus. Congenital pediatric cataract has been reported earlier in two cases. We describe a case of FVS, who presented to us with a bilateral total white cataract. The child underwent bilateral lens aspiration + posterior capsulorhexis + anterior vitrectomy + intraocular lens (IOL) implantation under general anesthesia followed by refraction.

Bilateral congenital cataract in a child with fetal valproate syndrome

Purpose
To identify the facial anthropometric parameters that predict the difficulty during femtosecond (FS) laser.


Methods: This was a
single-center observational study was conducted on participants between the ages 18 and 30 years who were planned for FS-LASIK (femtosecond laser-assisted laser in situ keratomileusis) or SMILE (small incision lenticule extraction) at Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India. The front and side-facing images of the participants were analyzed using Image J software to measure different anthropometric parameters. The nasal bridge index, facial convexity, and other parameters were measured. The difficulty faced by the surgeon during docking was recorded for each subject. The data were analyzed on Stata 14.


Results
A total of 97 subjects were included. The mean age was 24 (±7) years. Twenty-three (23.71%) subjects were females while the rest were males. Difficulty in docking was seen in 1 (4.34%) female and 14 (19%) males. The mean nasal bridge index was 92.58 (±4.01) in subjects with deep-set eyes and 89.72 (±4.30) in normal subjects. The mean total facial convexity was 129.28 (±4.24) in deep-set eyes, and 140.23 (±4.74) in normal subjects.


Conclusion
Total facial convexity appeared as the most important feature, with the value being less than 133° in most subjects with unfavorable facial anthropometry.

Anthropometry of deep-set eyes with respect to difficulty in docking during femtosecond laser procedures.

Sheehan Syndrome Presenting as Central Diabetes Insipidus: A Rare Presentation of an Uncommon Disorder

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