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Baweja K, Rashid M, Hanson M, Jackson R, Nair V, Duke L, Almufleh A. A Case of Incidental Giant Cell Myocarditis Presenting After COVID-19 mRNA Vaccination. CJC Open 2024; 6:544-547. [PMID: 38559339 PMCID: PMC10980915 DOI: 10.1016/j.cjco.2023.11.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 11/19/2023] [Indexed: 04/04/2024] Open
Affiliation(s)
- Kirun Baweja
- Department of Medicine, Queen’s University, Kingston, Ontario, Canada
| | - Mohammed Rashid
- Division of Cardiology, Queen’s University, Kingston, Ontario, Canada
| | - Matthew Hanson
- Division of Cardiology, Queen’s University, Kingston, Ontario, Canada
| | - Robyn Jackson
- Division of Cardiology, Queen’s University, Kingston, Ontario, Canada
| | - Vidya Nair
- Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Linnea Duke
- Department of Pathology, Health Sciences Centre, Winnipeg, Manitoba, Canada
| | - Aws Almufleh
- Division of Cardiology, Queen’s University, Kingston, Ontario, Canada
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Baweja K, Shuster S, Awad S. The Use of Ovarian Vein Sampling to Lateralize a Virilizing Leydig Cell Ovarian Tumor. AACE Clin Case Rep 2023; 9:182-185. [PMID: 38045790 PMCID: PMC10690409 DOI: 10.1016/j.aace.2023.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 07/10/2023] [Accepted: 07/17/2023] [Indexed: 12/05/2023] Open
Abstract
Background/Objective Leydig cell tumors are a rare androgen-secreting ovarian tumor. We present a patient with virilization symptoms secondary to a Leydig cell tumor, with nonrevealing imaging studies, that was localized using ovarian vein sampling (OVS). Case Report A 56-year-old postmenopausal woman was referred by her gynecologist to the endocrinology clinic for voice-deepening, clitoral enlargement, scalp hair loss, and excessive body hair growth. Her total testosterone was 11.5 (0.3-1.3 nmol/L), bioavailable testosterone was 7.19 (0.1-0.6 nmol/L), and dehydroepiandrosterone sulfate was 4.0 (0.8-4.9 μmol/L). Transvaginal ultrasound and abdominal magnetic resonance imaging showed no adrenal or ovarian masses bilaterally. On adrenal vein sampling (AVS) and OVS, total testosterone from the left gonadal vein was 780.0 (0.3-1.3 nmol/L) and right gonadal vein was 18.6 (0.3-1.3 nmol/L), with a left-to-right ovarian testosterone ratio of 41.94. A bilateral salpingo-oophorectomy was performed, and a 1.0 cm Leydig cell tumor in the left ovary was noted on histopathology. One month after surgery, her total and bioavailable testosterone were <0.4 (0.3-1.3 nmol/L and 0.1-0.6 nmol/L, respectively). At 6 months, she had normalization of her voice to baseline, decreased clitoral size, decreased hair growth on her back, and improvement in her male-pattern baldness. Discussion OVS and AVS are useful diagnostic investigation tools in cases of virilization, in which imaging is nonrevealing. Our case supports previously suggested left-to-right ovarian vein testosterone ratio of ≥15 being associated with a left-sided tumor. Conclusion Few cases have been published on the interpretation of AVS and OVS in the setting of virilization. Previously suggested ratios for lateralization were valid for this patient.
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Affiliation(s)
- Kirun Baweja
- Department of Medicine, Queen’s University, Kingston, Ontario, Canada
| | - Shirley Shuster
- Division of Endocrinology and Metabolism, University of Toronto, Toronto, Ontario, Canada
| | - Sara Awad
- Division of Endocrinology and Metabolism, Queen’s University, Kingston, Ontario, Canada
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Loan JJM, Tominey S, Baweja K, Woodfield J, Chambers TJG, Haley M, Kundu SS, Tang HYJ, Wiggins AN, Poon MTC, Brennan PM. Prospective, multicentre study of screening, investigation and management of hyponatraemia after subarachnoid haemorrhage in the UK and Ireland. Stroke Vasc Neurol 2023; 8:207-216. [PMID: 36150732 PMCID: PMC10359796 DOI: 10.1136/svn-2022-001583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 09/13/2022] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Hyponatraemia often occurs after subarachnoid haemorrhage (SAH). However, its clinical significance and optimal management are uncertain. We audited the screening, investigation and management of hyponatraemia after SAH. METHODS We prospectively identified consecutive patients with spontaneous SAH admitted to neurosurgical units in the United Kingdom or Ireland. We reviewed medical records daily from admission to discharge, 21 days or death and extracted all measurements of serum sodium to identify hyponatraemia (<135 mmol/L). Main outcomes were death/dependency at discharge or 21 days and admission duration >10 days. Associations of hyponatraemia with outcome were assessed using logistic regression with adjustment for predictors of outcome after SAH and admission duration. We assessed hyponatraemia-free survival using multivariable Cox regression. RESULTS 175/407 (43%) patients admitted to 24 neurosurgical units developed hyponatraemia. 5976 serum sodium measurements were made. Serum osmolality, urine osmolality and urine sodium were measured in 30/166 (18%) hyponatraemic patients with complete data. The most frequently target daily fluid intake was >3 L and this did not differ during hyponatraemic or non-hyponatraemic episodes. 26% (n/N=42/164) patients with hyponatraemia received sodium supplementation. 133 (35%) patients were dead or dependent within the study period and 240 (68%) patients had hospital admission for over 10 days. In the multivariable analyses, hyponatraemia was associated with less dependency (adjusted OR (aOR)=0.35 (95% CI 0.17 to 0.69)) but longer admissions (aOR=3.2 (1.8 to 5.7)). World Federation of Neurosurgical Societies grade I-III, modified Fisher 2-4 and posterior circulation aneurysms were associated with greater hazards of hyponatraemia. CONCLUSIONS In this comprehensive multicentre prospective-adjusted analysis of patients with SAH, hyponatraemia was investigated inconsistently and, for most patients, was not associated with changes in management or clinical outcome. This work establishes a basis for the development of evidence-based SAH-specific guidance for targeted screening, investigation and management of high-risk patients to minimise the impact of hyponatraemia on admission duration and to improve consistency of patient care.
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Affiliation(s)
- James J M Loan
- Translational Neurosurgery, The University of Edinburgh Centre for Clinical Brain Sciences, Edinburgh, UK
- Neurosurgery, NHS Lothian, Edinburgh, UK
| | - Steven Tominey
- Neurosurgery, Institute of Neurological Sciences, Glasgow, UK
- Department of Medicine, School of Medicine, Dentisty and Nuring, University of Glasgow, Glasgow, UK
| | - Kirun Baweja
- Internal Medicine, Queen's University, Kingston, Ontario, Canada
| | - Julie Woodfield
- Translational Neurosurgery, The University of Edinburgh Centre for Clinical Brain Sciences, Edinburgh, UK
- Neurosurgery, NHS Lothian, Edinburgh, UK
| | - Thomas J G Chambers
- Centre for Discovery Brain Sciences, University of Edinburgh, Edinburgh, UK
- Edinburgh Centre for Diabetes and Endocrinology, NHS Lothian, Edinburgh, UK
| | - Mark Haley
- Radiology, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Simran S Kundu
- Department of Medicine, Cork University Hospital, University College Cork, Cork, Ireland
| | - H Y Josephine Tang
- Department of Medicine, School of Medicine, Dentisty and Nuring, University of Glasgow, Glasgow, UK
| | | | - Michael T C Poon
- Translational Neurosurgery, The University of Edinburgh Centre for Clinical Brain Sciences, Edinburgh, UK
- Neurosurgery, NHS Lothian, Edinburgh, UK
| | - Paul M Brennan
- Translational Neurosurgery, The University of Edinburgh Centre for Clinical Brain Sciences, Edinburgh, UK
- Neurosurgery, NHS Lothian, Edinburgh, UK
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Tominey S, Baweja K, Woodfield J, Chambers TJG, Poon MTC, Wiggins AN, Brennan PM, Loan JJM. Investigation and management of serum sodium after subarachnoid haemorrhage (SaSH): a survey of practice in the United Kingdom and Republic of Ireland. Br J Neurosurg 2022; 36:192-195. [PMID: 33470851 DOI: 10.1080/02688697.2020.1859460] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 11/21/2020] [Accepted: 11/30/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Hyponatraemia is a common complication of aneurysmal subarachnoid haemorrhage (SAH). We aimed to determine current neurosurgical practice for the identification, investigation and management of hyponatraemia after SAH. METHODS An online questionnaire was completed by UK and Irish neurosurgical trainees and consultant collaborators in the Sodium after Subarachnoid Haemorrhage (SaSH) audit. RESULTS Between August 2019 and June 2020, 43 responses were received from 31 of 32 UK and Ireland adult neurosurgical units (NSUs). All units reported routine measurement of serum sodium either daily or every other day. Most NSUs reported routine investigation of hyponatraemia after SAH with paired serum and urinary osmolalities (94%), urinary sodium (84%), daily fluid balance (84%), but few measured glucose (19%), morning cortisol (13%), or performed a short Synacthen test (3%). Management of hyponatraemia was variable, with units reporting use of oral sodium supplementation (77%), fluid restriction (58%), hypertonic saline (55%), and fludrocortisone (19%). CONCLUSIONS Reported assessment of serum sodium after SAH was consistent between units, whereas management of hyponatraemia varied. This may reflect the lack of a specific evidence-base to inform practice.
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Affiliation(s)
- Steven Tominey
- Department of General Medicine, Queen Elizabeth University Hospital, Glasgow, UK
| | - Kirun Baweja
- Department of Surgery, Glasgow Royal Infirmary, Glasgow, UK
| | - Julie Woodfield
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Department of Clinical Neurosciences, NHS Lothian, Edinburgh, UK
| | - Thomas J G Chambers
- Centre for Discovery Brain Sciences, University of Edinburgh, Edinburgh, UK
- Edinburgh Centre for Diabetes and Endocrinology, NHS Lothian, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Michael T C Poon
- Department of Clinical Neurosciences, NHS Lothian, Edinburgh, UK
- Usher Institute, University of Edinburgh, Edinburgh, Edinburgh, UK
| | | | - Paul M Brennan
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Department of Clinical Neurosciences, NHS Lothian, Edinburgh, UK
| | - James J M Loan
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Department of Clinical Neurosciences, NHS Lothian, Edinburgh, UK
- Centre for Discovery Brain Sciences, University of Edinburgh, Edinburgh, UK
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