SYNOPSIS: Male hypogonadi sm i s an impor tant and treatable cause of osteoporosis. Severe osteoporosis leading to multiple osteoporotic fractures from idiopathic hypogonadotrophic hypogonadism (IHH) is rare. The present case illustrates the significance of timely and thorough evaluation of young adult males presenting with a seemingly ordinary complaint of "bone pains."
THE CASE: I report a case of a 45 year-old male presenting with a 6-year history of progressive bone pains. Most prominent laboratory findings include low total serum tes tos terone (4.6 nmol/L) in the background of an inappropriately normal serum FSH, LH and sex hormonebinding globulin (SHBG). There is associated elevated urinary N- telopeptide (4x). Sperm analysis showed oligospermia. Scrotal ultrasound revealed normal-sized descended testis with no solid masses. Skeletal survey showed generalized decrease in bone density. Dual energy x-ray absortiometry (DXA) showed severe osteoporosis. Cranial CT scan with contrast did not show a sellar-suprasellar mass.
TREATMENT AND OUTCOME: The patient was diagnosed with severe osteoporosis secondary to IHH. The patient received zoledronic acid (Aclasta) 5mg IV infusion. Two months after discharge, the patient reports a significant decrease in bone pains leading to more mobility. He is scheduled for his first dose of a GnRH agonist (Leuprodin acetate 3.75mg IM) to induce testosterone production.
DISCUSSIONS: The incidence of osteoporosis among males is indirectly correlated to the reduction in circulating testosterone. First - line t reatment of os teoporosis in hypogonadal men is with bisphosphonates. Bisphosphanate therapy increase BMD, reduces vertebral fracture risk and is currently considered the standard of care for osteoporotic care for men.
CONCLUSION: Osteoporosis is fast becoming a common condition among males. Osteoporotic fractures are associated with substantial morbidity and mortality. The present case emphasizes the importance of thorough and timely evaluation among men with low BMD or low-trauma fractures, which should include laboratory assessment to exclude secondary causes such as hypogonadism.

Human ; Male ; Middle Aged ; Osteoporosis ; Hypogonadism ; Hypoparathyroidism ; Acetates ; Bone Density ; Diphosphonates ; Globulins ; Gonadotropin-releasing Hormone ; Hypogonadism ; Imidazoles ; Oligospermia ; Osteoporosis ; Osteoporotic Fractures ; Spermatozoa ; Testosterone

Clinical recognition of cerebral amyloid angiopathy is important since aggressive antiplatelet or anticoagulation use may result in intracranial hemorrhage. Following case illustrates sequential evolving sensory disturbance involving perioral and ipsilateral finger (cheiro-oral syndrome) as a manifestation of underlying cerebral amyloid angiopathy.

There has been increasing emphasis on maintaining the patients' quality of life while on antihypertensive therapy (e. g., regular physical activity as a lifestyle modification) . However, no information is available on the effects of regular swimming exercise on mental health despite the popularity and potential benefits of this life-style modification. To determine the efficacy of swim training on mood states, 19 obese subjects with stages 1 to 2 essential hypertension were randomly assigned to either a swim training (n=12) or control group (n=7) . Subjects were assessed before and after a 10 week supervised swim exercise program with the Profile of Mood State (POMS) questionnaire. The swim training group completed an average of 94% of the scheduled exercise sessions, and were able to gradually and significantly (p<0.05) increase daily swim distance. Additionally, resting heart rate was significantly reduced (p<0.05) . Swim training resulted in significantly higher (p<0.05) vigor-activity scores. In addition, anger and fatigue scores were 34 and 28% lower after the swim training period. No significant changes were observed in any of the POMS scores in the control group. The improved mood state observed after swim training may have a clinically important influence on the quality of life in these subjects with essential hypertension.

Simultaneous endopthalmitis and ipsilateral cerebral abscesses are uncommon. This is the case report of a 68 years old man with left peritonsillar squamous cell carcinoma, who had coils placed in the external carotid artery to induce arterial thrombosis and slow tumor growth. The patient subsequently developed left sided endopthalmitis and left brain abscess. This shows that the coils are able to serve as a nidus of infection resulting in secondary endopthalmitis and brain abscess in an immunocompromised host.
Carcinoma, Squamous Cell

Psoriasis is an inflammatory skin disease characterized by hyperproliferation and incomplete differentiation of keratinocytes. Mounting scientific evidence suggests that this epidermal alteration occurs as a response to an immunologic injury, giving rise to the concept that psoriasis is a skin-specific autoimmune disease. Indeed, many effective therapeutic agents for psoriasis are immunosuppressive in nature, lending further support to this view. The well known ability of calcipotriene and 1,25(OH)2D3 to inhibit keratinocyte proliferation and to induce its differentiation is certainly compatible with their antipsoriatic actions. In addition, topical calcipotriene has been shown to correct, at least in part, the local cytokine imbalance observed in psoriatic lesions. Interleukin (IL)-8 is a proinflammatory cytokine that is chemotactic for polymorphonuclear cells and T lymphocytes. It also promotes proliferation of keratinocytes and endothelial cells. In lesional psoriatic skin, IL-8 and its receptor levels are markedly elevated. IL-10 is an immunosuppressive cytokine, which as a type2 (T2) cytokine antagonizes cell-mediated immunity. Indeed, IL-10 administration has been shown to improve psoriasis. Topical calcipotriene markedly reduces elevated levels of IL-8 while simultaneously increasing IL-10 levels in lesional skin of psoriasis. These changes occur very early, within the first three days of therapy, prior to significant clinical improvement of psoriasis, indicating that the cytokine alterations are not simply secondary to resolution of psoriatic plaques. Therefore, elaboration of the immunosuppressive cytokine IL-10 and a concomitant reduction in the proinflammatory cytokine IL-8 may mediate the immunopharmacological improvementin psoriasis by calcipotriene.
Autoimmune Diseases ; Cholecalciferol ; Cytokines ; Endothelial Cells ; Immunity, Cellular ; Immunosuppression ; Interleukin-10 ; Interleukin-8 ; Interleukins ; Keratinocytes ; Psoriasis ; Skin Diseases ; Skin* ; T-Lymphocytes ; Vitamin D* ; Vitamins*

We established the Western Pacific Surveillance and Response Journal (WPSAR) in 2010 to increase the dissemination of data from surveillance systems in the Asia Pacific region as part of the Asia Pacific Strategy for Emerging Diseases.¹ WPSAR was to provide a platform for people working in surveillance and response in the Western Pacific Region to share scientific and operational findings and publish a broad range of articles not limited to conventional research articles.

In mid-2014, four years after the first issue of WPSAR, an online survey of WPSAR subscribers was conducted to assess the impact, network and visibility of WPSAR in the region to determine if these objectives had been met. Based on a similar survey undertaken by Eurosurveillance in 2011,² we sought to understand the WPSAR audience more comprehensively, how the journal is used and readers’ expectations. The WPSAR readership survey link was e-mailed to the 514 registered subscribers, and 25% responded.

Agouti Signaling Protein ; Animals ; Central Nervous System ; abnormalities ; metabolism ; pathology ; Energy Metabolism ; Hair Color ; genetics ; physiology ; Humans ; Intercellular Signaling Peptides and Proteins ; metabolism ; Membrane Proteins ; genetics ; metabolism ; physiology ; Mutation ; Obesity ; genetics ; metabolism

Medicine, Kampo ; Recent ; Therapeutic procedure

The prevalence of atrial fibrillation (AF) is high in both community- and hospital-based studies in the Far East and South East Asia. Hypertension is the most common risk factor, but coronary heart disease and diabetes mellitus are other important co-morbidities in these countries. Anticoagulant therapy use was low, being 0.5%–28% in Malaysia, Singapore, and China. The reported rate of stroke related to AF was 13.0%–15.4% based on community studies in those countries and was 3.1%–24.2% of stroke rate in hospital-based cohorts. Better assessment of thromboembolic and bleeding risks is important. International guidelines now recommend the use of the CHA2DS2-VASc score to identify the ‘‘truly low-risk’’ AF patients, who do not need antithrombotic therapy, whilst those with ≥ 1 stroke risk factors can be offered oral anticoagulation. Aspirin is ineffective and may not be any safer than oral anticoagulants, especially in the elderly. It is anticipated that the availability of the new oral anticoagulant drugs would improve our efforts for stroke prevention in the Far East and South East Asia, especially where anticoagulation monitoring for warfarin is suboptimal.

Kimura’s disease is a rare chronic inflammatory disease of unknown etiology, commonly presenting with painless lymphadenopathy and subcutaneous masses in the head and neck regions.1 However, presentations with inguinal lymphadenopathy are rare and mimics other differentials, may pose a diagnostic challenge. We present a case of a 50-year-old male, with right inguinal swelling for one month duration that was finally diagnosed with Kimura’s Disease after a multitude of investigations to rule out differentials of lymphadenopathy, delaying conclusive treatment. Specialized test had been done resonated with the histopathological findings only. We report this case to increase awareness of Kimura’s Disease.