Extensive Resection for Treatment of Locally Advanced Primary Mucinous Adenocarcinoma Arising From Fistula-in-Ano

We report a case of a 66-year-old male who presented with a locally advanced primary mucinous adenocarcinoma arising from a fistula-in-ano. The presentation was typical for perianal sepsis and fistula-in-ano with anal pain and chronic discharge. Initial treatments with fistula debridement and seton were performed. Subsequent review of histology revealed underlying adenocarcinoma, while magnetic resonance imaging (MRI) showed local invasion into the prostate. The patient received neoadjuvant chemoradiotherapy followed by pelvic exenteration to maximize the chance of achieving cure. Features of this case are discussed together with its implications, including treatment guidelines and typical MRI findings.

Extensive Resection for Treatment of Locally Advanced Primary Mucinous Adenocarcinoma Arising From Fistula-in-Ano

We report a case of a 66-year-old male who presented with a locally advanced primary mucinous adenocarcinoma arising from a fistula-in-ano. The presentation was typical for perianal sepsis and fistula-in-ano with anal pain and chronic discharge. Initial treatments with fistula debridement and seton were performed. Subsequent review of histology revealed underlying adenocarcinoma, while magnetic resonance imaging (MRI) showed local invasion into the prostate. The patient received neoadjuvant chemoradiotherapy followed by pelvic exenteration to maximize the chance of achieving cure. Features of this case are discussed together with its implications, including treatment guidelines and typical MRI findings.

Flunarizine: a review of its role in migraine prophylaxis

Flunarizine, a potent calcium channel blocker has been used for more than three decades for the prophylactic management of migraine. Theories suggest that flunarizine may act through multiple mechanisms such as inhibition of cortical spreading depression, neurogenic inflammation and channelopathy. Flunarizine is efficacious in the management of various types of migraines such as common, classical, vestibular, abdominal, hemiplegic and pediatric migraine. It has a manageable safety profile with weight gain and drowsiness being commonly reported.

The burden of acute coronary syndrome, heart failure, and stroke among emergency department admissions in Tanzania: A retrospective observational study

Introduction The prevalence of cardiovascular disease in sub-Saharan Africa is substantial and growing. Much remains to be learned about the relative burden of acute coronary syndrome (ACS), heart failure, and stroke on emergency departments and hospital admissions.Methods A retrospective chart review of admissions from September 2017 through March 2018 was conducted at the emergency department of a tertiary care center in northern Tanzania. Stroke admission volume was compared to previously published data from the same hospital and adjusted for population growth. Results Of 2418 adult admissions, heart failure and stroke were the two most common admission diagnoses, accounting for 294 (12.2%) and 204 (8.4%) admissions, respectively.ACS was uncommon, accounting for 9 (0.3%) admissions. Of patients admitted for heart failure, uncontrolled hypertension was the most commonly identified etiology of heart failure, cited in 124 (42.2%) cases. Ischemic heart disease was cited as the etiology in only 1 (0.3%) case. Adjusting for population growth, the annual volume of stroke admissions increased 70-fold in 43 years, from 2.9 admissions per 100,000 population in 1974 to 202.2 admissions per 100,000 in 2017.Conclusions :The burden of heart failure and stroke on hospital admissions in Tanzania is substantial, and the volume of stroke admissions is rising precipitously. ACS is a rare diagnosis, and the distribution of cardiovascular disease phenotypes in Tanzania differs from what has been observed outside of Africa. Further research is needed to ascertain the reasons for these differences

Relationship between muscle strength and motor function in Duchenne muscular dystrophy / Relação entre força muscular e função motora na distrofia muscular de Duchenne

ABSTRACT Measuring muscle strength and motor function is part of Duchenne muscular dystrophy (DMD) assessment. However, the relationship between these variables is controversial. Objective To investigate the relationship between muscle strength and motor function and between these variables and age. Method Muscle strength was measured by Medical Research Council (MRC) scale and motor function, by Motor Function Measure (MFM), in 40 non-ambulatory patients. Spearman tests investigated the relationships between muscle strength, motor function and age. Results Total MRC and MFM scores were strongly related to each other (r = 0.94; p < 0.001), but not to age (r = -0.19, r = -0.31, respectively; p > 0.05). Strong and moderate relationships between partial muscle strength and motor function scores were found. Higher correlation coefficients were found between total scores and Dimensions 2 (axial/ proximal control) and 3 (distal control) of MFM. Conclusion Muscle strength and motor function are strongly correlated and seem to decrease proportionally in DMD.

RESUMO Mensurar força muscular e função motora é parte da avaliação em distrofia muscular de Duchenne (DMD). A relação entre essas variáveis é controversa. Objetivo Investigar a relação entre força muscular, função motora e idade. Método Força muscular foi medida pela Medical Research Council (MRC), e função motora pela escala Medida da Função Motora (MFM), em 40 pacientes cadeirantes. Teste de Spearman investigou as relações entre força muscular, função motora e idade. Resultados O escore total da escala MRC e da MFM foram fortemente relacionados entre si (r = 0,94; p < 0,001), mas não com a idade (r = -0,19; r = -0,31, respectivamente; p > 0,05). Foram encontradas correlações fortes e moderadas entre os escores parciais de força muscular e função motora. As relações mais fortes ocorreram entre os escores totais, Dimensão 2 (controle axial/proximal) e 3 (controle distal) da escala MFM. Conclusão Força muscular e função motora estão fortemente correlacionadas e parecem diminuir proporcionalmente na DMD.

Transarterial 188 rhenium-HDD-lipiodol conjugate in the treatment of inoperable hepatocellular carcinoma

This is a descriptive study to assess the safety and efficacy of 188 Rhenium-HDD-Lipiodol conjugate in treating patients with unresectable hepatocellular carcinoma. Eight patients with inoperable hepatocellular carcinoma with liver lesions ranging from 1.8 x 2.0 cm to 12.7 x 70 cm participated in the study. 188 Rhenium-HDD-Lipiodol conjugate was administered to the patients via femoral catheter based on the radioactivity that was eluted from the generator. Corresponding whole body scintigraphic images, which showed significant tracer uptake in the liver lesions, were obtained at 24, 48 and 72 hours after 188 Rhenium-HDD-lipiodol administration. Follow-up CT scans in six patients showed progressive disease in three patients and stable disease in three patients. Two patients had re-treatment due to progression of liver lesions. Follow-up scintigraphy after re-treatment showed decrease in tracer uptake in liver lesions on one patient, while the other showed diffuse tracer uptake. Post-ttherapy symptoms were minimal: mild to moderate epigastric pain in two, nausea and vomiting in one, while the rest are asymptomatic. Karnofsky performance status of patients three months after the therapy ranged from 20-90%. Two of the eight patients are still living at the time this paper was written. Radionuclide therapy aided in the prolongation of life and improvement of its quality for some patients. 188 Rhenium-HDD-Lipiodol radio conjugate provides promising results in treating inoperable hepatocellular carcinoma.

Injury surveillance in Trinidad: an accident and emergency based injury surveillance system at the San Fernando General Hospital / Vigilancia de las lesiones en Trinidad: un sistema de vigilancia de lesiones basado en emergencias y accidentes en el Hospital General San Fernando

OBJETIVE: Injuries are a significant cause of morbidity and mortality worldwide. Injuries disproportionately affect people living in low and middle income countries, including the Caribbean; however, little is known about the epidemiology of injuries in these areas. An Accident and Emergency (A&E) Department injury surveillance system was established at the San Fernando General Hospital, Trinidad and Tobago, to address this important data gap. METHODS: A detailed overview of the objectives, data collection methods, and inherent strengths and limitations of this surveillance system are presented, along with results of an analysis of data collected during the first three years of operations (from 2002 to 2004). RESULTS: Trained hospital staff collect a variety of injury/poisoning, demographic and clinical data on nearly 20 000 patients presenting each year with injury to the A&E Department. The total number of injuries in men was almost twice that in women. The majority of injuries were seen in those 25-44-years of age. Falls, other blunt force, stab/cut, traffic injury and poisoning represented the leading causes of injury. Nearly half of all the injuries occurred in the home, with the street/highway and work environments also accounting for an appreciable number of injuries. The majority of injuries were reported as unintentional. CONCLUSION: Injuries represent an important population health and health services issue in South Trinidad. Data from the A&E Department injury surveillance system represent an important resource to inform evidence-based health policy decisions on injury prevention and public health resource allocation.

OBJETIVO: Las lesiones son una causa significativa de morbilidad y mortalidad a nivel mundial. Las lesiones afectan de manera desproporcionada a la gente que vive en países de ingresos bajos y medios, incluyendo el Caribe. Sin embargo, poco se sabe acerca de la epidemiología de las lesiones en estas áreas. Con el propósito de cubrir esta laguna de importantes datos epidemiológicos, se estableció un sistema de vigilancia de lesiones en forma de Departamento de Accidentes y Emergencias (A&E), en el Hospital General San Fernando, en Trinidad y Tobago. MÉTODOS: Se presenta un resumen detallado de los objetivos, métodos de recopilación de datos, así como las fortalezas y limitaciones inherentes de este sistema de vigilancia, junto con los resultados de un análisis de los datos recogidos durante los primeros tres años de operaciones (desde 2002 al 2004). RESULTADOS: Personal entrenado del hospital recogió una variedad de datos de lesiones/ envenenamientos, así como datos demográficos y clínicos de casi 20000 pacientes que acudían con lesiones cada año al Departamento de A&E. El número total de lesiones en los hombres fue casi el doble que en las mujeres. La mayoría de las lesiones se veían en personas de 25 a 44 años de edad. Caídas, golpes contundentes, cortadas/cuchilladas, lesiones por accidentes de tráfico y envenenamiento, representan las principales causas de lesión. Casi la mitad de todas las lesiones ocurrieron en los hogares, seguidas de las producidas en la calle/autopista y los ambientes laborales, también responsables de un número apreciable de lesiones. La mayor parte de las lesiones fueron reportadas como no intencionales. CONCLUSIÓN: Las lesiones representan un asunto importante para los servicios de salud y la salud de la población del sur de Trinidad. Los datos del sistema de vigilancia de lesiones del Departamento de A&E, representan un importante recurso informativo para las decisiones sobre políticas de salud basadas en evidencias a la hora de asignar recursos para la salud pública y la prevención de lesiones.

Secondary syphilis in a 55 year-old homosexual male

We report a case of a 55-year old sexually active homosexual male who presented with one month duration of erythematous, non-pruritic papules on the forehead, nape, scalp, chest, back, extremities and genitals and the presence of coppery-red, slightly scaling macules on the palms and soles. RPR (>1:16 dilution) and TPPA were reactive. A 4-mm skin punch biopsy revealed hyperplasia of the epidermis, focal areas of erythrocytic exocytosis with mild spongiosis and vacuolar degeneration of the basal cell layer, and many superficial and deep moderately dense perivascular granulomous inflammatory infilitrates consisting of histiocytes, lymphocytes, many plasma cells, some neutrophils, nuclear dusts and few eosinophils. The patient was given a single dose of 2.4M units of benzathine penicillin G, divided into each buttock. A repeat quantitative RPR was scheduled after 6 and 12 months to monitor the patient's titer.

A procura da justiça transicional e os valores tradicionais africanos: um choque de civilizações - o caso de Uganda / La búsqueda de justicia transicional y los valores tradicionales africanos: un choque de civilizaciones - el caso de Uganda / The pursuit of transitional justice and African traditional values: a clash of civilizations - the case of Uganda

Este artigo analisa o papel que a anistia e as práticas tradicionais assumem na promoção da justiça e da reconciliação no norte de Uganda.

This article examines the role that amnesty and traditional practices play in fostering justice and reconciliation in northern Uganda.

Este artículo analiza el papel que desempeñan la amnistía y las prácticas tradicionales en la promoción de la justicia y la reconciliación en el norte de Uganda.

Differentially displayed expressed sequence tags in Melipona scutellaris (Hymenoptera, Apidae, Meliponini) development

Nesse estudo nós usamos a técnica de Differential Display Reverse Transcriptase - Polymerase Chain Reaction (DDRT-PCR) para comparamos o perfil de mRNA em Melipona scutellaris durante o desenvolvimento ontogenético pós-embrionário e em operárias adultas, rainha natural e induzida pelo Hormônio Juvenil III. Fragmentos diferencialmente expressos foram detectados usando as seguintes combinações de primers: HT11G-AP05; HT11C-AP05; HT11G-OPF12; HT11G-OPA16. Dos 9 ESTs descrito nesse trabalho, 6 tiveram expressão diferencial nas fases de larva L1 e L2, sugerindo serem mecanismos chave no regulação do desenvolvimento larval em Melipona. A combinação HT11G-AP05 revelou em L1 e L2 um produto com similaridade à proteína tioredoxina redutase de Clostridium sporogenes, uma proteína importante durante os processos de oxidoredução. Esse estudo representa as primeiras evidências moleculares do perfil de expressão durante o desenvolvimento ontogenético em abelhas do gênero Melipona.

Presentación de Francis M. Deng: representante del Secretariado General de las Naciones Unidas para los Desplazados Internos sobre Atención al desplazamiento forzado / Francis M. Deng presentation, United Nations General Secretariate Representative to intern displaced persons on Forced Displacement Care

La finalización del conflicto en Colombia es esencial para detener la tendencia al crecimiento en el número de personas desplazadas y obtener una solución durable para el enorme número de personas que perdieron sus raíces. Hasta ese entonces, exhorto al Gobierno de Colombia a que, con la ayuda de la comunidad internacional y las organizaciones no gubernamentales, aumente sus esfuerzos para proveer a los ciudadanos colombianos protección frente a desplazamientos arbitrarios, asistencia durante el desplazamiento, y soluciones efectivas para el retorno o la reintegración. Paralelamente, es crítico que se continuen los esfuerzos hacia la paz. En particular, doy la bienvenida al reconocimiento del Presidente Pastrana que el problema del desplazamiento debe ser un factor clave en el proceso de paz. Los desplazados internos han hecho avances impresionantes en organizarse y es importante que sus voces se hagan oir y sean escuchadas en el proceso de paz

A pilot study of alcohol and drug-related traffic accidents and death in two Jamaican parishes, 1991

This study is a preliminary effort to document the role of drugs in motor vehicle accidents as it examines the presence of alcohol, marijuana and cocaine in blood samples of thirty-one motor vehicle fatalities. The study identified that males (90.3 percent) and pedestrians (41.9 percent) were killed most often. Evidence of alcohol intake was found in 77.5 percent of the fatalities and 35.5 percent had alcohol levels above the legal acceptable limits. Traces of marijuana were found in 22.5 percent and a combination of alcohol and marijuana in 22.5 percent of the victims

community study of hypertension in the Seychelles

The ministry of health and social services in the Seychelles recently set up a health service audit unit. One of its first projects was to look at the management of high blood pressure. Questionnaires about hypertension to patients and doctors in Seychelles showed wide discrepancies between the belief of each group. Some of the important misconceptions which interfered with clinical management are described. There was also a gap between the management that doctors would like to employ and the records of their actual performance. The results were presented to health workers for consideration, and following this discussion of discrepancies, changes were proposed. This paper describes the practical arrangements proposed and suggests means of avoiding difficulty in implementation