ABSTRACT
Objective: To determine the genetic diversity, natural selection and mutations in Plasmodium (P.) knowlesi drug resistant molecular markers Kelch 13 and dhps gene in clinical samples of Malaysia. Methods: P. knowlesi full-length gene sequences Kelch 13 gene (PkK13) from 40 samples and dhps gene from 30 samples originating from Malaysian Borneo were retrieved from public databases. Genetic diversity, natural selection, and phylogenetic analysis of gene sequences were analysed using DNAsp v5.10 and MEGA v5.2. Results: Seventy-two single nucleotide polymorphic sites (SNPs) across the full-length PkK13 gene (63 synonymous substitutions and 9 non-synonymous substitutions) with nucleotide diversity of π~0.005 was observed. Analysis of the full-length Pkdhps gene revealed 73 SNPs and π~0.006 (44 synonymous substitutions and 29 non-synonymous substitutions). A high number of haplotypes (PkK13; H=37 and Pkdhps; H=29) with haplotype diversity of Hd ~0.99 were found in both genes, indicating population expansion. Nine mutant alleles were identified in PkK13 amino acid alignment of which, 7 (Asp 3 Glu, Lys 50 Gln, Lys 53 Glu, Ser 123 Thr, Ser 127 Pro, Ser 149 Thr and Ala 169 Thr) were within the Plasmodium specific domain, 2 (VaI 372 Ile and Lys 424 Asn) were in the BTB/POZ domain and no mutation was observed within the kelch propeller domain. The 29 non-synonymous mutations in the Pkdhps gene were novel and only presented in exon 1 and 2. Conclusions: Monitoring the mutations from clinical samples collected from all states of Malaysia along with clinical efficacy studies will be necessary to determine the drug resistance in P. knowlesi.
ABSTRACT
Background: Mycetoma is widespread in Yemen; however, there are only a few documented reports on the entity from this geographical area. Methods: A prospective study of 184 cases of mycetoma (male 145 and female 39) from different regions of north-western Yemen was conducted between July 2000 and May 2014. Clinical profile was recorded in a standardized protocol. The diagnosis was based on clinical features, X-ray studies, examination of grains, and histopathology. Results: Eumycetoma was diagnosed in 129, caused by Madurella mycetomatis in 124, Leptosphaeria senegalensis in one and pale grain fungus in four, whereas actinomycetoma occurred in 55, caused by Streptomyces somaliensis in 29, Actinomadura madurai in nine, Actinomadura pelletieri in one, and Nocardia in sixteen. Eumycetoma cases were treated with prolonged course of antifungal drugs, mostly ketoconazole, with itraconazole being used in four patients, along with excision or debulking. Results were better when antifungal drugs were given two to three months before surgery and in those who received itraconazole. Actinomycetoma cases were initially treated with co-trimoxazole monotherapy; later streptomycin was added in 30 cases. Six patients who did not show adequate improvement and two others from the start were treated with modified Welsh regimen and with good results. Limitations: Identification of different causative agents was done by histopathology and could not be reconfirmed by culture. Conclusion: Mycetoma is widespread in north-western Yemen with a higher incidence of eumycetoma and a majority of the cases were caused by Madurella mycetomatis. Modified Welsh regimen in actinomycetoma and itraconazole with excision in eumycetoma showed the best results.
ABSTRACT
Background: Urinary Bladder cancer is the second most common neoplasm of the urinary tract worldwide. It accounts for 6-8 % of malignancy in men and 2-3% in women with the highest incidence rates in North American and Europe as well as areas with endemic schistosomiasias in Africa and the middle east
Purpose: To show the staging accuracy of Dynamic MRI in urinary bladder carcinoma
Patients and Methods: This is a Prospective randomized clinical study, study setting: Radiology and Urology Departments, Faculty of Medicine, Ain Shams University, study period: 6 months from August 2017 till February 2018
Results: This study conducted on 20 patients [17 male and 3 females] with age ranged from 42 - 78 years and with mean+/-SD of 55.95+/-9.01 years. 4/20 patients [20.0%] were presented to TURT procedure while 16/20 patients [80.0%] were presented to radical cystectomy
Conclusion: In this study, despite small differences between the results of the MRI and pathology, Dynamic MRI was found to be an accurate modality for assessment of tumor staging, and its routine use in bladder cancer staging can lead to significant improvement of diagnostic accuracy of the staging and treatment planning and hence improvement of the prognosis of the patients and their survival rates. Furthermore, the use of Dynamic MRI systems with higher magnetic field and imaging techniques standardized with higher resolution could further enhance the accuracy of the method. Further studies with larger sample size may also help to validate the results of this study