To report and review a case of prolactin-producing pituitary tumor presenting with mass effects, hormonal deficiency, and neurogenic diabetes insipidus in a nulliparous woman of Afro-Caribbean descent. The patient presented with dull-aching headaches associated with worsening vision, nausea, and vomiting. The patient also complained of polyuria, nocturia, thirst, polydipsia, and weight gain. Physical examination showed bilateral visual field defects, while investigations revealed hypernatremia and elevated plasma osmolality but decreased urine sodium concentration, osmolality, and specific gravity. Results of the hormonal profile showed high plasma prolactin levels, a low plasma concentration of the antidiuretic hormone, and decreased levels of other anterior pituitary hormones. Imaging revealed a large, uncalcified, cystic pituitary mass extending into adjacent structures and compressing the optic chiasm and internal carotid artery. The outcome of the water deprivation and desmopressin administration tests were consistent with neurogenic diabetes insipidus, and a diagnosis of prolactin-producing pituitary macroadenoma with mass effects, hormonal deficiencies, and neurogenic diabetes insipidus was made. The patient was commenced on medical treatment and referred for histopathological diagnosis and definitive treatment. This report highlights the coexistence of neurogenic diabetes insipidus with a prolactin-producing pituitary macroadenoma presenting with mass effects.

Calciphylaxis, also known as calcific uremic arteriolopathy (CUA), affects small arteries of the skin in patients with end-stage renal failure, dialysis patients, and patients with hypercalcemia. The condition is characterized by the calcification of small blood vessels leading to skin necrosis without inflammation. It is frequently complicated by superimposed infection and bleeding and has a high mortality rate. The rare condition is yet to be documented on the islands of Saint Vincent and the Grenadines. The authors have, therefore, made efforts to document, educate, and discuss this rare presentation in a 65-year-old local Vincentian male with 30 years history of poorly controlled diabetes mellitus and hypertension who commenced hemodialysis two years prior to the presentation for end-stage chronic renal failure. With the increasing incidence and prevalence of diabetes mellitus, hypertension, and complications of chronic kidney disease, and renal failure, this article is written as a case study with a concise literature review on calciphylaxis to provide continuing medical education and increase the level of awareness among medical students and index of suspicion among healthcare providers.

Breast cancer is a leading cause of cancer related death among women worldwide and it is a complex disease characterized by its heterogeneity. The heterogenous characteristic of the breast cancer is responsible for its aggressiveness and treatment resistance. Breast cancer stem cells (BCSCs) are population of heterogenous cells with increased propensity for proliferation, differentiation, migration, invasion and mammosphere formation with increased resistance to treatment. They have ability to initiate and propagate cancer cells population and share similarity with the normal stem cells in relation to their expressions of cell surface markers; Cluster of Differentiation 44 positive (CD44+), Cluster of Differentiation 24 negative/low (CD24-/low) and Alkaline dehydrogenase 1 (ALDH1). MicroRNAs (miRNAs) are responsible for the RNA silencing and post-transcriptional regulation of the gene expression. MicroRNAs (miRNAs) control gene expression by acting as oncogenes or tumor suppressor genes. The epigenetic mechanisms are used for the regulation of miRNAs expression in the breast cancer, and this can be targeted to reverse the cancer progression. This review aims to provide an overview of the pathogenic mechanism of the microRNA’s expressions on the breast cancer stem cells in controlling the prognosis and aggressiveness of breast cancer disease. This is done by highlighting the regulatory mechanism of miRNA expressions on the BCSCs. Dysregulation of the MicroRNAs expression in the breast cancer stem cells and upregulated miRNAs expression were identified in the breast cancer stem cells (BCSCs), including miR-10b, miR-21, miR-155, miR-181, miR-183, miR-210 and miR-221/222, and the downregulated miRNAs expression in BCSCs include Let-7, miR-22, miR-30e, miR-31, miR-103/107, miR-200, miR-205, miR-335, miR-449a, miR-519c, miR-600, miR-708, miR-760. Studies showed association between the miRNA expression and breast cancer metastasis and aggressiveness. MicroRNAs were noticed to have a regulatory effect on neovascularization, drug resistance, and cancer metastasis. They can be used as predictive indicators in determining prognosis of breast cancer following cancer treatment and miRNAs expression can be used to determine the metastatic BCSCs for an efficient targeting mechanism and identification of the metastatic cancer cells. The systematic literature review aims at providing insight into the potential roles of microRNA in oncology especially breast cancers. The data for this study review were obtained from the Medline on OvidSP, includes PubMed of the US National Library of Medicine and the search was done through the University of Bristol Library services. This is to provide an overview of the pathogenic mechanism of microRNAs regulatory effect on the breast cancer stem cells in controlling the prognosis and aggressiveness of breast cancer disease. The review will be providing highlight of the dysregulation of oncogenic and tumor suppressor microRNAs in the breast cancer stem cells and highlighting the roles of miRNAs regulated BCSCs in the pathogenesis, prognosis, and aggressiveness of the breast cancer. We further discuss the biogenesis of miRNAs, regulatory roles of miRNAs on BCSCs, and then summarize the mechanism of miRNAs regulated BCSCs.

Background: Systemic Lupus Erythematous (SLE) is a rare, severe and lasting autoimmune disease that can vary in severity from mild to possibly life-threatening with a multi-system manifestation characterized by symptoms relating to joint, skin or mucosal inflammation, or with a varying degree of haematological abnormality or constitutional features, with women affected predominantly with peak onset (15-44) years of age. Aim: This study was aimed at estimating the incidence and mortality of Systemic Lupus Erythematous lupus in Milton Cato Memorial Hospital Saint Vincent and the Grenadines, including temporal trends and variations in age and sex from 2014 to 2018 by using routinely collected administrative health data/patient records. Methods: From 2014 to 2018, individuals with SLE were identified from the hospital records of Milton Cato Memorial Hospital, which records information on all patient coming in for healthcare services. A structured data extraction tool was employed to extract the data from the hospital record using the open data kit (ODK). Data was analysed using Statistical Package for Social Sciences (SPSS) version 23 and R Studio statistical software for analysis. The Chi-square test was used to test for association. All statistical tests were two-tailed and Level of Confidence was set at 95%, and P=<0.05 was considered to be statistically significant. Results: The mean age of patient with SLE was 28.52 ± 13.03 years old and the median age was 30 years old, almost all 25(92.6%) were females. Every year, women showed a significantly increase in incidence of Systemic Lupus Erythematous (SLE), there was an annual decrease in the incidence from 2014 to 2018, with a peak incidence in 2016 (0.11/1000 person-years). The lowest incidence was noted in 2018 (0.02/1000 person-years). Among sex, there was an annual decrease in the incidence from 2014 to 2018, with a peak incidence in 2015 and 2016 for male (0.02/1000 person-years) and in 2016 for females (0.21/1000 person-years) respectively. The lowest incidence was noted in 2018 (0.00/1000 person-years) and (0.04/1000 person-years) for both male and female respectively. Case fatality from SLE shows that 2017 had the highest case fatality of 33% compared to the other years, 2014 (25%), 2015(25%) and 2016 (9%) with 2018 having no case fatality at all. Conclusions: This study showed that the incidence of SLE in Saint Vincent have decreased in the last decade, whereas the mortality rates of SLE have increased. Age and sex were found to be risk factors for SLE. This discovery of increased mortality of SLE suggests that this disease is no longer rare and will have implications for future healthcare planning and health service utilizations.

Dermatomyositis is a chronic progressive autoimmune disease of unknown etiology and rare occurrence worldwide. It is an immunologically mediated idiopathic inflammatory disease in which damage to small blood vessels contributes to injury and inflammation of muscle and skin. Dermatomyositis belongs to a heterogeneous group of three autoimmune rheumatological diseases termed idiopathic inflammatory non-suppurative myopathies, with polymyositis and inclusion body myositis as other component diseases. Dermatomyositis and polymyositis typically show characteristic clinical features of autoimmune inflammatory diseases and association with autoantibodies, HLA-DR genotype, and other autoimmune diseases. While it is known that inflammation plays a significant role in the pathogenesis of these diseases, its role in inclusion body myositis remains unclear. Overlapping forms of inflammatory myopathies that are poorly differentiated and defy a precise classification have also been identified. However, the clinical response to steroids and other immunosuppressive agents may help distinguish the subtypes of inflammatory myopathies from one another. Dermatomyositis is further described as a multisystemic rheumatologic disease presenting with muscular and cutaneous symptoms. It is associated with malignancy in 20 – 25% of patients. Dermatomyositis occurs in children and adults, with a higher incidence observed in women. Diagnosis is usually made from clinical manifestations, elevated blood enzymes, autoantibody testing, electromyography (EMG), and muscle biopsy. The diagnosis, however, remains challenging in third-world countries. There is no known cure for dermatomyositis. However, corticosteroids and other immunosuppressive agents, and intravenous immunoglobins are routinely used for treatment. The index patient in this review is a 22-year-old Afro-Caribbean woman whose presentation met the probable-to-definite criteria for diagnosis based on the Bohan and Peter Classification Criteria. This article is a case report and a detailed review of the autoimmune inflammatory disease known as dermatomyositis that can be used to teach about the disease condition.