A rare and unusual presentation of Epstein–Barr virus-associated diffuse large B-cell lymphoma involving colon as the primary site

Lymphoproliferative malignancies can involve both nodal- and extra-nodal tissues. The most common extranodal site involved is the gastrointestinal (GI) tract, and it is secondary to the widespread primary nodal disease. However, about 33% of non-Hodgkin's lymphoma primarily arise from tissues other than lymph nodes, spleen, or bone marrow, for example, GI tract, skin, or the central nervous system and are called primary extranodal lymphomas. The most common site of GI localization is stomach (50%–60%) followed by small bowel. Primary colonic lymphoma is seen only in 6% of GI lymphomas and up to 0.5%–1% of all colon malignancies. Hence, primary GI lymphoma is extremely rare, and primary colonic lymphoma is an even rarer occurrence. There is clearly a paucity of cases reported in literature resulting in unclear treatment protocol. Here, we report a case of a 51-year-old man who presented with abdominal pain, weight loss, and bright red blood per rectum. A colonoscopy revealed diffuse bleeding ulcers involving the entire colon. Pathology was consistent with primary diffuse large B-cell lymphoma arising from the colon. The patient was started on treatment with rituximab, cyclophosphamide, adriamycin, vincristine, and prednisone

Exploring the relationship between demographic factors; performance and fortitude in a group of diverse 1st-year medical students

Background. The majority of 1st-year students are ill-equipped for university life. This heightens stress levels; which are accentuated by a lack of resilience and impact negatively on academic performance and personal wellbeing.Objectives. To explore; within the paradigm of positive psychology; the relationship between the self; family and support constructs of fortitude; and academic performance of 1st-year medical students.Method. First-year medical students completed a fortitude questionnaire and their academic performances in two academic modules were collated. Mann-Whitney and Kruskal-Wallis tests were employed for statistical analysis of the variables. Pearson correlation coefficients were calculated to assess the relationship between academic performance and fortitude subscales; as well as the fortitude composite score.Results. The student population was multicultural; multilingual and had different educational and residential backgrounds. The fortitude instrument was found to be reliable and correlated significantly with student academic performance. Male students had significantly higher fortitude scores than female students. Students who had attended state/government schools had significantly lower fortitude than those who had attended private and ex-Model C schools. Students with prior degrees had higher fortitude than matriculants.Conclusion. The significant; albeit moderate; positive correlation between fortitude and academic performance highlights the need for further exploration of wellbeing and holistic development of medical students. Support programmes are recommended to bridge the gap related to gender and educational background. Low and fair levels of fortitude indicate a need for corrective measures. These could include consulting relevant support networks such as student counsellors; mentors and academic development personnel

Motivated strategies for learning and their association with academic performance of a diverse group of 1st-year medical students

Background. Most instruments; including the well-known Motivated Strategies for Learning Questionnaire (MSLQ); have been designed in western homogeneous settings. Use of the MSLQ in health professions education is limited. Objective. To assess the MSLQ and its association with the academic performance of a heterogeneous group of 1st-year medical students.Methods. Eighty-three percent of 1st-year medical students consented to participate in this quantitative study. The MSLQ consisted of a motivation strategies component with six subscales; while the learning strategies component had nine subscales. Demographic and academic achievement information of the students was also collected. Stata version 13 (StataCorp LP; USA) was used for the statistical analyses of all data.Results. Female students displayed significantly higher motivational scores. Students with prior educational experience and those who attended peer-mentoring sessions had significantly higher learning strategy scores. Significant but moderate relationships were found between academic performance and the motivation strategies subsumed within the categories 'task value' and 'self-efficacy for learning performance'. In terms of the 'learning strategy component'; 'critical thinking'; and 'time and study environment'; the composite score was significantly but poorly correlated to academic performance. Conclusion. Overall; limited correlations were found between the MSLQ scores and academic performance. Further investigation of the use of the MSLQ and its association with academic achievement is recommended; with greater focus on specific learning events than on course outcomes. This study highlights the importance of evaluating an instrument in a specific context before accepting the findings of others with regard to the use of the instrument and its correlation with academic performance

A rare case of an appendiceal mass masquerading as a pelvic tumour and causing bilateral hydronephrosis

Diagnosing acute appendicitis in children can be difficult due to atypical presenting symptoms. While there are reported cases of acute appendicitis or appendiceal masses causing unilateral hydronephrosis, bilateral hydronephrosis as a complication of appendiceal mass is very rare. We report a case of a child who presented with cardinal symptomatology associated with the urogenital tract. Ultrasound (US) investigation showed a pelvic mass causing bilateral hydronephrosis. An initial diagnosis of a pelvic teratoma was made based on the US and computed tomography (CT) scan findings. The final diagnosis of an appendiceal mass causing bilateral hydronephrosis was established intraoperatively.

Evaluation of quality characteristics for three types of local produced Yoghurt [Zabady]

To evaluate quality of three types of Yoghurt [A,B,C], chemical, organoleptic microbiological tests were conducted, after 24 hours, a week and 2 weeks of the production and during storage at 5°C +/- 2°C. The results showed that the quality characteristics of the three types of Yoghurt were confirmed to the Yemeni standards [No: 66 for Yoghurt] in the total titrable acidity, total solids, fat, solids not fat,flavour, taste texture and total coliform bacteria, during the period of storage. The [C] type was significantly better [P<0.05] in flavour than the other two types [A,B] after 24 hours from the production and storage at 5°C +/- 2°C. The [C] type was mathematically better in most of the quality characteristics under investigation

Analysis of Disability Adjusted Life Years (DALYs) among arsenic victims: a cross-sectional study on health economics perspective.

Arsenic contamination of ground water is a major public health problem in Bangladesh. It is estimated that more than 20 million people are potentially exposed to arsenic poisoning. This cross-sectional study was carried out in Haziganj Upazila under Chandpur district between September to December, 2001 with the objectives to assess the socioeconomic consequences and disease burden in terms of Disability Adjusted Life Years (DALYs). A total of 168 subjects suffering from arsenicosis were studied. Both age and disability weights were considered to calculate DALYs. Agricultural labour and housewives suffered more from the disease. A strong relationship (p<0.005) was found between duration of suffering and occupation of the subjects. Also, there was a strong relationship between age of onset and education of the study subjects (p<0.006). No deaths directly from arsenicosis were reported. It may be noticed that 47% of the patients would be living with disability for more than 51 years. A strong relationship exists (p<0.002) between educational level and Years Lived with Disability (YLDs). A total of 7930 YLDs were lost due to arsenicosis, which accounts for 1908 DALYs.

Changes in temperature of newborn babies bathed immediately after birth.

In the tropics, bathing full-term newborn babies are routinely done immediately after birth, although it is usually not recommended until 2 – 6 hours of age. Yet, there is no study in Indonesia about hypothermia in newborns bathed immediately after birth. The aim of this study is to determine the influence of bathing the newborn immediately after birth to the body temperature and hypothermia. One hundred and twenty five healthy full-term newborn babies delivered on March 1999 were included and separated into two groups, 59 newborns were bathed immediately after birth and 66 newborns were bathed later. There was no statistical difference between both groups in the mean of birth weight, gestational age, room temperatures, gender, delivery method, and risk of infection. Mean body temperature between both groups were not statistically different on the 0 and the 30th minute after birth. On the other hand, on the 15th minute after birth, the mean body temperature of the immediately bathed group was statistically lower than not immediately bathed group [36.84 (SD 0.25) °C vs 37.02 (SD 0.27) °C, p=0.0001]. On the 15th minute after birth, there were four (6.8%) hypothermic babies (rectal temperature < 36.5°C) in the immediately bathed group and one (1.5%) hypothermic baby in the not immediately bathed group (p=0.134). Conclusion, bathing healthy full-term newborn babies immediately after birth will decrease the body temperature, but hypothermia occurred only in very small numbers which are not statistically significant.

Comparison of liver histology in chronic active hepatitis C and chronic active hepatitis B.

OBJECTIVE: To study the histological features of chronic active hepatitis C (CAH-C) and to compare these with those of chronic active hepatitis B (CAH-B). METHODS: Thirty-two liver biopsy specimens from patients with chronic active hepatitis and presence of antibodies to hepatitis C on second generation enzyme immunoassay were studied and compared with those in 34 patients with CAH-B. Seventeen of the 32 CAH-C patients had fully developed or developing cirrhosis of liver whereas the remainder had only chronic active hepatitis. RESULTS: Among 32 patients with CAH-C, fatty change (20), Kupffer cell hyperplasia (30), sinusoidal lymphocytosis (27) lymphoid follicles aggregates in portal tracts (26) and bridging necrosis (16) were regular features. Focal necrosis, bile duct necrosis, cholestasis and ground glass cells were however seen much less often. On the other hand, in patients with CAH-B, fatty change (no patient), sinusoidal lymphocytosis (one patient) and lymphoid follicles/aggregates in portal tracts (one patient) were rare. Also, Kupffer cell hyperplasia (22 patients) was seen less commonly in patients with CAH-B as compared to CAH-C. Focal necrosis (34 patients), bile ductular proliferation (9 patients), cholestasis (17 patients) and ground glass cells (15 patients) were more prominent in CAH-B. CONCLUSION: Presence of certain histological features can help in distinguishing between CAH-C and CAH-B.

Familial alkaptonuria with neurological complications

A family of Alkaptonuric patients with autosomal dominant inheritance is recorded from the province of Azarbijan in IRAN. As yet undescribed, nerve deafness and autonomic neuropathy in this disorder is documented. Infantile hemiplegia with epileptic seizures n a juvenile member of this family in the absence of a detectable aetiology, might well be the result of this very metabolic dysfunction, which might have been in a benign form as intermittent phase in early childhood. Detailed survey of the case belonging to this disorder is suggested for detection of multiple enzyme defects in a single patient family