Background Multiple endocrine neoplasia type 1 (MEN 1) syndrome is a rare, complex genetic disorder characterized by increased predisposition to tumorigenesis in multiple endocrine and non-endocrine tissues. Diagnosis and management of MEN 1 syndrome is challenging due to its vast heterogeneity in clinical presentation. Case presentation A 23-year-old female, previously diagnosed with Polycystic Ovarian Syndrome (PCOS) and pituitary microprolactinoma presented with drowsiness,confusion and profuse sweating developing over a period of one day. It was preceded by fluctuating, hallucinatory behavior for two weeks duration. There was recent increase in appetite with significant weight gain. There was no fever, seizures or symptoms suggestive of meningism. Her Body mass index(BMI) was 32 kg/m2.She had signs of hyperandrogenism. Multiple cutaneous collagenomas were noted on anterior chest and abdominal wall. Her Glasgow Coma Scale was 9/15. Pupils were sluggishly reactive to light. Tendon reflexes were exaggerated with up going planter reflexes. Moderate hepatomegaly was present. Rest of the clinical examination was normal. Laboratory evaluation confirmed endogenous hyperinsulinaemic hypoglycaemia suggestive of an insulinoma. Hypercalcemia with elevated parathyroid hormone level suggested a parathyroid adenoma. Presence of insulinoma, primary hyperparathyroidism and pituitary microadenoma, in 3rd decade of life with characteristic cutaneous tumours was suggestive of a clinical diagnosis of MEN 1 syndrome. Recurrent, severe hypoglycaemia complicated with hypoglycaemic encephalopathy refractory to continuous, parenteral glucose supplementation and optimal pharmacotherapy complicated the clinical course. Insulinoma was localized with selective arterial calcium stimulation test. Distal pancreatectomy and four gland parathyroidectomy was performed leading to resolution of symptoms. Conclusions Renal calculi or characteristic cutaneous lesions might be the only forewarning clinical manifestations of an undiagnosed MEN 1 syndrome impending a life-threatening presentation. Comprehensive management of MEN 1 syndrome requires multi-disciplinary approach with advanced imaging modalities, advanced surgical procedures and long-term follow up due to its heterogeneous presentation and the varying severity depending on the disease phenotype.

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SARS-CoV-2, the causative agent of COVID-19, was sequenced in early January 2020 and the WHO declared a pandemic in early March 2020.The original virus which caused the first outbreak in Wuhan has mutated significantly, with the delta variant giving rise to a major wave globally with much morbidity and mortality. By the last week of December 2021, nearly 280 million cases were reported with well over 5 million deaths. With the emergence of the new omicron variant which is said to be more transmissible, there is a risk of another major wave with the potential for health facilities around the world being overwhelmed.In such a background, health systems must be better prepared to face the challenge, and that should include refining treatment protocols. Preventing hospitalizations with early use of oral antiviral drugs and optimising treatment of severe COVID-19 are equally important. This review aims to outline a management plan based on the stage and severity of the disease by examining the current clinical evidence that has emerged through a multitude of trials. There is general consensus regarding the use of steroids, immunosuppressive therapy and anticoagulation in COVID-19 although there are slight differences in the respective national guidelines.New research is being carried out with oral antiviral drugs for use in early disease and some of the early results are promising. They could play a decisive role in mitigating the effects of the pandemic in addition to vaccination. As many clinical trials are ongoing it is likely that guidelines will need periodic revision.

The virus SARS-CoV-2 emerged in December 2019 in Wuhan, China and spread rapidly worldwide. As of April 30, 2020, the virus has spread to 213 countries, infecting 3,090,445 and causing death in 217,769 1. The SARS-CoV-2 is a single stranded RNA beta-corona virus, similar to SARS and MERS 2. Therefore, drugs which were effective against SARS and MERS were repositioned for SARS-CoV-2. On behalf of the Ceylon College of Physicians' "Subcommittee for Guidance on Treatment and Prophylaxis against COVID-19", we herein summarize the current evidence as of May 2, 2020 for selected repositioned drugs which have been used in the current COVID-19 pandemic. Antiviral agents Chloroquine and hydroxychloroquine Chloroquine (CQ) has been used effectively against malaria and hydroxychloroquine (HCQ) against systemic lupus erythematous and rheumatoid arthritis for a long time. They appear to block the entry of SARS-CoV-2 virus into cells by inhibiting glycosylation of host receptors, proteolytic processing, and endosomal acidification. They also appear to have immuno-modulatory effects through attenuation of cytokine production 3,4. CQ was shown to be effective against SARS-CoV-2 in vitro with a low half maximal concentration (EC50) 5. HCQ, a less toxic derivative of CQ, has an in vitro activity with a lower EC50 for SARS-CoV-2 compared with CQ 6 and by reducing the production of cytokines, Treatment of COVID-19: A review of emerging treatment This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.