Congenital Hypothyroidism: An Unusual Combination of Biochemical Abnormalities

A forty-five-day-old female infant presented with prolonged jaundice with clinical features suggestive of congenital hypothyroidism (CHT). On investigations, the infant was noted to have indirect hyperbilirubinemia (13.8 mg/dl) with increased levels of AST (298 IU/dl) and ALT (174 IU/dl) in the serum. The child had low levels of free T3 (500 microIU/ml) in the serum. The combination of indirect hyperbilirubinemia and raised levels of hepatic transaminases has not been reported in babies with CHT. Following institution of oral thyroxin therapy, the serum bilirubin levels ameliorated (2.9 mg/dl) considerably by 15 days of therapy and the serum levels of AST (40 IU/dl) and ALT (20 IU/dl) got normalized. The case demonstrates that raised levels of hepatic transaminases can occur in infants with CHT and these can resolve just with thyroxin therapy, obviating the need for extensive investigative laboratory work-up.

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Dilated Cardiomyopathy Induced by Chronic Starvation and Selenium Deficiency

Protein energy malnutrition (PEM) has been rarely documented as a cause of cardiovascular abnormalities, including dilated cardiomyopathy. Selenium is responsible for antioxidant defense mechanisms in cardiomyocytes, and its deficiency in the setting of PEM and disease related malnutrition (DRM) may lead to exacerbation of the dilated cardiomyopathy. We report a rare case of a fourteen-year-old boy who presented with symptoms of congestive heart failure due to DRM and PEM (secondary to chronic starvation) along with severe selenium deficiency. An initial echocardiogram showed severely depressed systolic function consistent with dilated cardiomyopathy. Aggressive nutritional support and replacement of selenium and congestive heart failure medications that included diuretics and ACE inhibitors with the addition of carvedilol led to normalization of the cardiac function within four weeks. He continues to have significant weight gain and is currently completely asymptomatic from a cardiovascular standpoint.

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Validation of questionnaire on the Spiritual Needs Assessment for Patients (SNAP) questionnaire in Brazilian Portuguese

Diego de Araujo Toloi, Deise Uema, Felipe Matsushita, Paulo Antonio da Silva Andrade, Tiago Pugliese Branco, Fabiana Tomie Becker de Carvalho Chino, Raquel Bezerra Guerra, Túlio Eduardo Flesch Pfiffer, Toshio Chiba, Rodrigo Santa Cruz Guindalini, Daniel P Sulmasy and Rachel P Riechelmann

from Cancer via ola Kala on Inoreader http://ift.tt/2fZfSjE
via IFTTT

Hepatic metastasis of thymoma: case report and immunohistochemical study

Daniela Speisky, María Teresa García de Davila, Felix Vigovich, Julian Mendez, Rafael Maurette, Marcos García Ejarque, Juan Carlos Spina, Alejandro Iotti and Pablo Dezanzo

from Cancer via ola Kala on Inoreader http://ift.tt/2fOb6b1
via IFTTT

Validation of questionnaire on the Spiritual Needs Assessment for Patients (SNAP) questionnaire in Brazilian Portuguese

Diego de Araujo Toloi, Deise Uema, Felipe Matsushita, Paulo Antonio da Silva Andrade, Tiago Pugliese Branco, Fabiana Tomie Becker de Carvalho Chino, Raquel Bezerra Guerra, Túlio Eduardo Flesch Pfiffer, Toshio Chiba, Rodrigo Santa Cruz Guindalini, Daniel P Sulmasy and Rachel P Riechelmann

http://ift.tt/2fZfSjE

Hepatic metastasis of thymoma: case report and immunohistochemical study

Daniela Speisky, María Teresa García de Davila, Felix Vigovich, Julian Mendez, Rafael Maurette, Marcos García Ejarque, Juan Carlos Spina, Alejandro Iotti and Pablo Dezanzo

http://ift.tt/2fOb6b1

Estimating Long-Term Survival of Adults with Philadelphia Chromosome-Negative Relapsed/Refractory B-Precursor Acute Lymphoblastic Leukemia Treated with Blinatumomab Using Historical Data

Abstract

Introduction

Blinatumomab is a bispecific T cell-engaging antibody construct indicated for adult patients with relapsed/refractory (R/R) Ph(−) B-precursor acute lymphoblastic leukemia (ALL), an aggressive disease with poor prognosis. A phase 2 single-arm clinical study showed that 43% of patients achieved CR/CRh within two cycles and approximately 20% of patients receiving blinatumomab were still alive after 2 years.

Methods

The objective of the current analysis was to estimate long-term survival of patients receiving blinatumomab beyond the observed time period in the clinical study using a large historical observational dataset. Conditional survival probabilities of blinatumomab-treated patients beyond month 60 were assumed to be the same as the US general population.

Results

At month 60, the estimated proportion of blinatumomab-treated patients alive was more than double that of historical patients (12.6% vs 5.4%). The mean overall survival was 76.1 months for blinatumomab patients and 39.8 months for historical patients. Sensitivity analyses including additional follow-up data from the clinical study showed consistent results.

Conclusions

These findings suggest that blinatumomab provides substantial overall survival benefit to patients with (R/R) Ph(−) B-precursor ALL compared with salvage chemotherapy.

Funding

Amgen.

Trial Registration

ClinicalTrials.gov identifier NCT01466179 and NCT02003612.

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