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Key wordsC'n~~ii)/ic.citioiis; hypoglycaemic encephalopathy. S~i r g c q~; p haeoch ro niocy t oina reinova I.Many coinplications that follow surgery on phaeochromocytoma have been reported and mainly concern bleeding. haemodynamic disturbances. cardiac dysrhythmias and fluid balance problems. Phaeochromocytoma is also associated with a diabetic syndrome that presents with hyperglycaemia both pre-and postoperatively.However, some patients may develop hypoglycaemia d uring surgery and immediately postoperatively, due to a rebound insulin storm as ;I result of inhibition of catecholaminc secretion following removal of the timiour. Here we describe a case of hypoglycaemic eneephalopathy that resulted from hypoglycaemia o f nearly 4 hours' duration. which subsequently resolved without sequelae. Case historyAn 18-year-old Saudi male presented with intermittent attacks of severe headache, dizziness, palpitations and sweating that occurred over a period or 12 months. Blood pressure measurement during one such episode revealed severe hypertension and he was referred to King Khalid Hospital with a provisional diagnosis of phacochroniocytoma.On examination he was a healthy young man o f normal intelligence and behaviour. General and systematic examination revcaled n o abnormality. He remained normotensive apart from ~w o brief elevations of arterial blood prcssurc to 170.'90 mniHg.A series of 24-hour urine samples showed elevation of vanillyl mandclic acid to thrcc times the normal level. Ultrasonography and CT scan revealed a k n i inass in the right adrenal gland. The left adrenal was normal in size and shape. A diagnosis of phaeochromoeytoma of the right adrenal gland was made and he was prepared for surgery with a 4-day course of phcnoxy-

Objectives Malnutrition is a significant health problem among children in low- and middle-income countries. In 2017, 35% of children in South Asia were reported to be stunted. In Pakistan, 4 in every 10 children under 5 years are reported to be stunted. The aim of this study was to identify the factors associated with stunting amongst children 24 months of age, living in Pakistan, an LMIC. Methods This is a secondary analysis of the AMANHI prospective cohort study. Newborns of mothers who were enrolled in the AMANHI-cohort were followed up to 24 months of life. Information on antenatal history, gestational age, sociodemographic and education, household hunger scale and food consumption status at 12 and 24 months was assessed. Anthropometry was done to evaluate length/height and weight using standardized methods. Logistic regression analysis was run using STATA (v.17.0) and odds ratios with 95% confidence interval were calculated. Results In this prospective cohort study, 923 children were included with a gender distribution of 48.8% males and 51.2% females. The results of univariate analysis showed that the factors associated with stunting amongst children 24 months of age were: low birth weight (OR 2.23; 95% CI 1.61 to 3.10; P < 0.0001), small for gestational age (OR 2.07; 95% CI 1.54 to 2.78; p = 0), wealth falling in poorest quintile (OR 2.02; 95% CI 1.32 to 3.07; p = 0.001) or poor quintile (OR 1.62; 95% CI 1.07 to 2.45; p = 0.023), children who are Muslims (OR 1.87; 95% CI 1.15 to 3.07; p = 0.012), no maternal education (OR 3.22; 95% CI 1.53 to 6.77; p = 0.002), underweight mothers (OR 1.55; 95% CI 1.1 to 2.18; p = 0.013), and daily wage earning fathers (OR 1.4; 95% CI 1.03 to 1.9; p = 0.033). The consumption of dairy (OR 2.1; 95% CI 1.51 to 2.92; P < 0.0001) and sugar sweetened items (OR 1.79; 95% CI 1.32 to 2.44; P < 0.0001) were also found to be positively associated with stunting. However, there was no difference in odds of being stunted amongst children with poor/borderline or acceptable food consumption status at 12 and 24 months. Conclusions The results of this study report the multitude of factors associated with stunting amongst children 24 months of age, residing in Pakistan. It also helps identify the different levels at which interventions can be targeted to reduce prevalence of stunting in this country. Funding Sources None.

Background With the high frequency of acute respiratory infections in children worldwide, particularly so in low-resource countries, the development of effective diagnostic support is crucial. While pulse oximetry has been found to be an acceptable method of hypoxemia detection, improving clinical decision making and efficient referral, many healthcare set ups in low- and middle-income countries have not been able to implement pulse oximetry into their practice. Main body A review of past pulse oximetry implementation attempts in low- and middle-income countries proposes the barriers and potential solutions for complete integration in the healthcare systems. The addition of pulse oximetry into WHO health guidelines would prove to improve detection of respiratory distress and ensuing therapeutic measures. Incorporation is limited by the cost and unavailability of pulse oximeters, and subsequent oxygen accessibility. This restriction is compounded by the lack of trained personnel, and healthcare provider misconceptions. These hurdles can be combated by focus on low-cost devices, and cooperation at national levels for development in healthcare infrastructure, resource transport, and oxygen delivery systems. Conclusion The implementation of pulse oximetry shows promise to improve child morbidity and mortality from pneumonia in low- and middle-income countries. Steady measures taken to improve access to pulse oximeters and oxygen supplies, along with enhanced medical provider training are encouraging steps to thorough pulse oximetry integration.