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Primary hypoparathyroidism can occur due to an activating mutation of calcium sensing receptor (CaSR). Most patients remain asymptomatic and therefore not diagnosed until adulthood. We present a 38-year-old lady who had a history of muscle cramps since 8 years. She presented with vomiting, abdomen pain and body ache, showed clinical evidence of hypovolemia, severe hypocalcemia, hypokalemia, hypomagnesemia, hyperphosphatemia and metabolic alkalosis. Her 24 h urinary phosphorus was low and 24 h urinary excretion of sodium, potassium and chloride were high. Her intact parathormone was on the lower side of the normal range. She improved once we had corrected her biochemical abnormalities. By excluding acquired causes of hypoparathyroidism, we are able to conclude that this may be a case of primary hypoparathyroidism due to activating mutation of CaSR.

Actinomycosis of esophagus is uncommon. Herpes simplex virus, cytomegalovirus, candidiasis, tuberculosis, and other fungal infections are the commonly reported infections in both immunocompromised and immunocompetent patients. We report a case of esophageal actinomycosis in an end-stage renal disease patient. A 28-year-old lady, known case of systemic lupus erythematosus, hepatitis B virus infection with end-stage renal disease on regular maintenance hemodialysis since 5 years presented with history of epigastric pain and odynophagia for 1 week. Her upper gastrointestinal endoscopic examination revealed extensive necrotic areas with membrane in the esophagus. Histopathology revealed actinomycotic colonies and bacterial clumps. She was treated with intravenous penicillin followed by oral ampicillin for 6 months. She showed marked clinical improvement, and repeat endoscopy showed healing of ulceration and no evidence of actinomycosis.

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Objective:High daily salt consumption amongst adolescents is one of the most relevant etiological factors for future risk of hypertension and other lifestyle diseases. The aim of this study is to evaluate and compare the amount and pattern of sodium (Na) consumption in urban and rural school-going adolescents and identify high risk groups for conducting awareness and intervention programs.Design and method:Subjects aged 12 - 15 years from 3 schools in and around Mumbai were given a questionnaire detailing their demographic, anthropometric data and eating habits. A self-administered semi-quantitative Food Frequency Questionnaire was used to record consumption pattern of 22 high salt containing food items, divided into 5 categories (bakery, fried, packed, preserved and fast foods). Each participant`s sodium consumption from these food items was calculated. Additional sodium consumption from regular meals was excluded.Data analysed with MS Excel.Results:1141 (urban- 565; rural- 576; Males-612,Females -524) participated. 13 % subjects added table salt while 62 % ate frozen foods < twice a month .Median Sodium consumption of the study population was 473 mg/day (~ 1 g salt) (Q1-Q3: 254 - 851 mg/day). Daily Median Na consumption was significantly higher (p < 0.05) in urban students (724 mg/day) as compared to rural (292 mg/day). Bakery and fried foods comprised 51% of sodium consumption amongst rural, whereas all five food categories had equal representation in the urban population. An alarming 54 % subjects’ BMI (34 % urban, 20 % rural) was above the normal range. Higher BMI values correlated significantly with higher daily Na consumption (p = 0.001, Mann-whitney test).Conclusions:The salt intake over and above the usual dietary salt consumption was high (~ 2 g per day for urban and ~1 g/day for rural adolescents). More than half the study population was found to be either overweight or obese .This double whammy has a singular potential for producing future hypertensives .Thus targeted awareness, counselling and intervention programs for salt reduction in adolescents is the urgent need of the hour.