Pilomatrixoma: A Clinico - Pathological Study

Introduction: Pilomatrixoma (calcifying epithelioma ofMalherbe) is a benign skin tumor with differentiation towardshair follicles. Pilomatrixoma may be mistaken for many otherconditions like epidermoid cyst, dermoid cyst, calcified lymphnode or a hemiangioma. The aim of this study was to describethe clinical and histopathological characteristics of patientspresenting with pilomatrixoma.Material and Methods: The present study was conductedin the Post Graduate department of pathology, govt. medicalcollege Srinagar. 51 cases of pilomatrixoma were included inthe study. The final diagnosis was arrived by histopathologicalexamination of the specimens. The clinical features andphysical examination including age, sex, site of lesion andsize were noted and analyzed.Results: 51 cases of pilomatrixoma, comprising about 37%cases of all skin adnexal tumors were considered. The mostcommon age group involved was 11-20 years comprising of33.34% of all cases. 23 (45.10%) were males and 28 (54.90%)were females. There was a slight female predominance. Themost common anatomical location for the tumor was foundto be head and neck followed by trunk, upper limbs and lowerlimbs. The histopathological findings observed were: a benignwell demarcated lesion surrounded by a capsule in almost allof the cases. The lesions were found to be composed of islandsof epithelial cells embedded in a stroma. Two types of cellswere identified in these epithelial islands basaloid cells andshadow cells.Conclusions: Pilomatrixoma should be considered in thedifferential diagnosis of nodules, especially those on the headand neck. Careful clinical examination and familiarity withthe condition may lead to accurate diagnosis and appropriatetreatment.

Rifampicin-monoresistant Mycobacterium tuberculosis among the patients visiting chest clinic, state specialist hospital, Akure, Nigeria.

Background: Tuberculosis (TB), one of the most important contagious diseases, is a leading cause of death due to a single pathogen worldwide. Co-infection of people living with HIV with M. tuberculosis has been shown to increase the mortality rate in sub-Saharan Africa. Methods: This present study was carried out to establish the rifampicin resistant profiles among the patients attending chest clinic, state specialist hospital, Akure. We enrolled clinical samples submitted between January 2013 and December 2013 for this study. The sputum samples were analyzed using GeneXpert. Results: Of the 135 sputum processed by GeneXpert, 48 (35.6%) contained Mycobacteria tuberculosis (MTB) and 9 (18.8%) were rifampicin resistant Mycobacteria tuberculosis. Patients within the age group of 24-32 years showed the highest resistant to RIF 6 (12.5%). Conclusion: This study has helped to establish that there is presence of rifampicin resistant Mycobacterium tuberculosis in Akure, Ondo state, Nigeria and most of them were observed among patients who default treatment. This is considered as a threat to TB control programme in Akure, Nigeria and it is recommended that strategies should be put in place in order to ensure patients’ compliance and monitoring of patients’ response to TB treatment.

Cefepime-resistance in Clinical Isolates of Pseudomonas aeruginosa and Klebsiella spp in Ogbomoso.

Aims: Our goal was to identify resistance rate of Cefepime-resistant Pseudomonas aeruginosa and Klebsiella spp infections in the hospital setting within Ogbomoso. Study Design: The study includes clinical isolates of Klebsiella spp and Pseudomonas aeruginosa obtained by screening samples of blood (for blood culture), urine, aspirate, wound, throat, sputum etc. Place and Duration of Study: Clinical isolates were obtained from Medical Microbiology and Parasitology Laboratory of the Ladoke Akintola University of Technology Teaching Hospital, Ogbomoso, between March and August 2013. Methodology: Sixty-six clinical isolates of Pseudomonas aeruginosa and Klebsiella spp obtained from different clinical sites were analyzed using standard bacteriological methods. The sensitivity of clinical isolates of Pseudomonas aeruginosa and Klebsiella spp to Cefepime (30μg) was determined using disk diffusion method. The isolates were divided into three groups sensitive, intermediate and resistance. Results: The results shows that Pseudomonas aeruginosa had 34.38% sensitivity, 6.25% intermediate and 59.37% resistance while Klebsiella spp had 41.18% sensitivity, 5.88% intermediate and 52.94% resistance. Overall susceptibility pattern of the clinical isolates to Cefepime is 37.87% sensitivity, 6.06% intermediate and 56.06% resistance. Conclusion: There was a great Cefepime–resistance among the clinical isolates analyzed. The resistance pattern of Pseudomonas aeruginosa and Klebsiella spp calls for continuous surveillance for Cefepime resistance control.

A comparative evaluation of in vivo antiplasmodial activity of aqueous leaf exracts of Carica papaya, Azadirachta indica, Magnifera indica and the combination thereof using plasmodium infected BALB/c mice.

Combination of herbal plants may produce synergistic, additive or antagonistic effects. A concoction prepared from the aqueous leaf extracts of Azadirachta indica (ALEAI), Magnifera indica (ALEMI), Carica papaya (ALECP) has been used in the treatment of malaria in some parts of Ghana. In the present study, ALEAI, ALEMI, ALECP and their combination (AMC) were evaluated in vivo for antiplasmodial activities using Plasmodium berghei infected BALB/c mice. Freeze-dried extracts of the combined therapy as well as those of the individual plants were tested in vivo on Plasmodium berghei infected BALB/c mice at 50 mg/kg and 100 mg/kg dosages. Coartem at 20 mg/kg and water were used as positive and negative controls respectively. Cryptolepsis sanquinolata was also used as a positive control. The extracts showed varying antiplasmodial activities using Four day suppressive and Seven day repository tests. The antiplasmodial activities of the extracts were significant compared with the negative control (P<0.05). Exceptions were ALECP at 50 mg/kg (3.98%) and the combined therapy (AMC) at 100 mg/kg (4.36%) which were only significant in the repository test. Although the combined therapy at 50 mg/kg showed the highest chemo-suppression (54.07%) when compared with the individual test extracts (ALECP = 19.13%; ALEMI = 51.81% and ALEAI = 48.95%) at similar dose, the activity was neither a demonstration of synergistic nor additive effect. These results suggest that the active components in the various single plant extracts may overlap in their modes of action. At dose 100 mg/kg, the AMC showed the least chemo-suppression suggesting an increased amount of a possible antagonistic component. Phytochemical screening of the various aqueous extracts revealed the presence of bioactive compounds with reported antiplasmodial properties. The LD50 recorded for the various extracts was greater than 5000 mg/kg. In conclusion, ALEAI, ALEMI, ALECP and their combination (AMC) possess antiplasmodial properties and this supports their use in folkloric medical setting in treating malaria.

Prevalence of Congenital Malaria in Minna; North Central Nigeria

The study was designed to determine the true prevalence of congenital; cord; and placental malaria in General Hospital Minna; North Central Nigeria. Peripheral blood smears of near-term pregnant women; as well as the placental; cord; and peripheral blood smears of their newborn babies; were examined for malaria parasites; using the Giemsa staining technique. Out of 152 pregnant women screened; 21 (13.82) of them were infected with malaria parasites. Of the 152 new born babies; 4 (2.63) showed positive peripheral parasitaemia. Placental parasitaemia was 7/152 (4.61); while cord blood parasitaemia was 9/152 (5.92). There were strong associations between peripheral and cord malaria parasitaemia and congenital malaria (P 0.05). Plasmodium falciparum occurred in all; and none had mixed infection. The average birth weights of the babies delivered of nonmalarious pregnant women were higher than those delivered by malarious pregnant women; though not significant (P 0.05). Malaria parasitaemia occurred more frequently in primigravidae than multigravidae

IL-10 Implications in Psoriasis

Interleukin [IL]-10 is a pluripotent cytokine with effects on numerous cell populations, in particular circulating and resident immune cells as well as epithelial cells. With its potent immunoregulatory capacities, its main biological function seems to be the limitation and termination of inflammatory responses. Hence, its low level expression found in psoriasis may have pathophysiological relevance to this immune disease. Remarkably, the induction of IL-10 expression was found by conventional antipsoriatic therapies, supporting the hypothesis that it may be a key cytokine in psoriasis. Furthermore, the first use in clinical trials in patients with established psoriasis showed that it had moderate antipsoriatic effects and was well tolerated. Moreover, long-term application in psoriatic patients in remission showed that it decreases the incidence of relapse and prolongs the disease free interval. The IL-10 antipsoriatic activity is suggested to be due to the effects on different cell populations, including antigen presenting cells and T-cells [type 1/type 2 balance shift], but not through direct effects on keratinocytes. In conclusion, IL-10 seems to have major clinical and therapeutic implications in psoriasis. Further multicenter, placebo-controlled, double blind trials are required to be an established antipsoriatic therapy. We can come to the conclusion that IL-10 genetic polymorphism and expression is potentially a key immune marker in psoriasis

Extracorporeal shock wave lithotripsy versus lasertripsy for the treatment of upper ureteric calculi

Objectives: To compare the efficacy, cost effectiveness and safety of both ESWL and Holmium:YAG laser lithotripsy for the management of upper ureteric stones.Patients and Methods: One hundred and eight patients of various age groups and of both sexes who had primary or recurrent unilateral or bilateral upper ureteric stones underwent 108 primary procedures and 19 ancillary procedures (total: 127) including in-situ ESWL (60 patients) using the Dornier MPL 9000 machine and ureteroscopy combined with Holmium:YAG laser lithotripsy (46 patients). Results: The overall stone-free rate was (93.75%) for cases subjected to uretero-scopy in combination with laser lithotripsy and (91.7%) for cases subjected to ESWL. For stones < 1 cm, the success rate was 100% in the laser and 95.65% in the ESWL group. For stones > 1 cm, the success rate was 90% in the laser and 78.6% in the ESWL group. For impacted stones, the success rate was 92.85% in the laser and 72.7% in the ESWL group. The EQ for the laser and ESWL groups was 0.86 and 0.73, respectively. The complication rate was 12.53% in the laser and 11.7% in the ESWL group. The average cost (in Egyptian pounds) was 1618.1 £E for Holmium: YAG laser treatment and 1069.1 £E for ESWL treatment. Conclusion: Apart from impacted stones and stones larger than 1 cm, ESWL is the first line of choice as a treatment modality for upper ureteric stones. However both ESWL and URS combined with holmium: YAG laser lithotripsy may be complementary to each other in treating upper ureteric stones

Diagnosis of unilateral single system ectopic ureter in girls in the era of magnetic resonance urography (MRU)

Objective: The ectopic ureter frequently drains an ectopic dysplastic or hypoplastic kidney. The present study aims at defining the role of MRU in establishing the diagnosis of this anomaly. Patients and Methods: Between February 1996 and March 2000; 11 girls presented or were referred to our department for management of urinary incontinence. Their age at presentation ranged from 4-9 years (mean 6.5 years). Radiological work up included abdominal ultrasound (US); excretory urogram (IVU); voiding cystourethrography (VCUG); 99 m technetium-dimercaptosuccinic acid (99m Tc-DMSA) renal scan; enhanced spiral computed tomography (CT) and magnetic resonance urography (MRU). Results: Ultrasound showed evidence of a solitary kidney with failure to visualize a contralateral kidney in 7/11 patients. In the remaining 4 patients (36.4); US revealed a pelvic kidney in two and a pelvic cystic mass in another two patients. IVU revealed only one functioning renal unit in all cases. None of the patients showed vesicoureteral reflux on VCUG. On 99m Tc-DMSA ; a single kidney was seen in 9/11 patients and ectopic pelvic kidneys with normal contralateral kidneys in 2/11 patients. The 7 patients; in whom US and 99m Tc-DMSA scan had failed to localize the kidney; underwent CT scanning which visualized a pelvic hypoplastic kidney with a normal contralateral kidney in 2/7 patients. The remaining 5 patients underwent MRU that disclosed a normal kidney with a contralateral lumbar hypoplastic kidney in one and a pelvic ectopic kidney in four. The patients were managed by nephrectomy (n=9) and ureteroneocystostomy (n=2). Conclusions: A single system ectopic ureter should be suspected in all girls with continuous urinary dribbling after the age of successful toilet training. With the inclusion of MRU into radiological workup; dysplastic or hypoplastic kidneys can be accurately localized. MRU is indicated for the diagnosis and for therapeutic planning in such cases

Gangrenous cutaneous mucormycosis of the anterior chest wall

Mucormycosis is a rare but serious fungal infection. We report a case of pro g ressive gangrenous cutaneous mucormycosis of the anterior chest wall

Assiut experience in the application of holmium laser in treatment of ureteral calculi in adults

Objective This study was carried out to evaluate the safety and efficacy of holmium:YAG laser in the treatment of ureteral calculi in adults. Patients and Methods Between April 1999 and November 2000; one hundred and seven patients presented to the urology department of Assiut university with symptomatic ureteral stone disease in different locations. The patients were divided into three groups according to the stone location which was determined radiologically. Group I included 38 patients with stones located in the upper third of the ureter; Group II included 19 patients with stones located in the middle third of the ureter and Group III included 50 patients with stones located in the lower third of the ureter. Lithotripsy was done in all patients using the Holmium:YAG laser machine. The stone-free status was checked three months after the procedure. Patients with residual stones were scheduled for another session. Results In Group I; 38 patients with 38 stones underwent 39 procedures for intracorporeal lithotripsy. Eight patients presented with obstructive anuria and elevated blood urea and serum creatinine. Complete stone fragmentation was achieved in 37 cases; while in one case the stone migrated to the kidney and was treated by ESWL. In Group II; 19 patients underwent 20 procedures. Re-treatment after three weeks was necessary in one case due to ureteral wall injury and minimal extravasation. Four patients presented with obstructive anuria; while in 6 patients the stones were impacted. Complete fragmentation could be achieved in all cases. In Group III; 50 patients underwent 51 procedures. A re-treatment session was required in one patient after three months due to a residual stone (5 mm) detected during follow up. In eleven cases the stones were impacted; and one patient had bilateral lower ureteral stones treated in the same session. Out of 50 patients with 55 stones; 54 stones (98.1) were completely fragmented and cleared in a single session. Conclusion Holmium:YAG laser lithotripsy is a safe and effective modality for the treatment of ureteral stones.Key Words Holmium:YAG laser; ureter; lithotripsy

Evaluation of staged fowler-stephens orchiopexy for the high abdominal testis

Objective: To evaluate staged Fowler - Stephens orchiopexy for the high intra-abdominal testis. Patients and Methods: The study included 78 patients with laparoscopically diagnosed high intra-abdominal testes. Their age ranged from 2 -16 years. All cases underwent staged Fowler - Stephens orchiopexy. The first stage was done during diagnostic laparoscopy by clipping the internal spermatic artery and vein 2-3 cm superior to the intra-abdominal testis. Six months later the second stage of the procedure in the form of open (67 cases) or laparoscopic orchiopexy (11 cases) was performed. Only 65 patients were available for follow up at 6 and 18 months following the second stage. At each follow-up visit; the testicular position; size and viability were assessed by Technetium 99 (Tc99m) testicular scintigraphy. Results: Out of 78 cases; 10 had bilateral high intra-abdominal testes. Second stage open orchiopexy was done in 67 cases while the remaining 11 cases were subjected to laporoscopic orchiopexy. No operative or postoperative complications were detected apart from a prolonged ileus after the second stage in 6 patients. On follow up; 49 testes were scrotal and of good size while 6 testes were scrotal and atrophic. In the remaining 10 cases the testes were at the neck of the scrotum and of good size. Tc99m testicular scintigraphy was done in 65 cases. A good perfusion was detected in the majority of them (59 cases) while no radiotracer accumulation was detected in the remaining 6 cases. Conclusion: Laparoscopic clipping of the gonadal vessels is safe in patients with high abdominal testes. The staged approach with preservation of the testicular collateral vascular supply provides an adequate viability of the high abdominal testis with a high success rate. Tc99m testicular scintigraphy allows a proper assessment of the testicular viability as compared to measurement of the testicular size only

Evaluation of diagnostic procedures and outcomes in thyroid surgery: the experience of Al-Amiri hospital

To evaluate the ability of different diagnostic procedures in predicting thyroid malignancy, and to highlight outcomes of thyroid surgery Al-Amiri Hospital, 1990-95 Retrospective review of surgical records. 1.4% of all surgical interventions performed during that period [N=210] were thyroid cases. Surgical indications were solitary cold nodule [58%], multinodular goitre [36%] and hyperthyroidism [5%]. Following surgery, only 10% [n = 21] were histopathologically malignant. Based on postoperative findings, malignancy could have been predicted by thyroid isotopic scanning in no more than 11% of cases, and by ultrasounds [U/S] in 9% of solid lesions. Fine needle aspiration [FNA] accurately predicted 87% of cases. Only 26 patients [13%] developed post-operative complications, of which the most common was voice change [n = 8], mostly transient [6/8]. In this series, most patients [77%] stayed in-hospital for 3-5 days. The predictive value of malignancy in thyroid nodule[s] using fine needle aspiration is by far higher than that of ultrasound or thyroid scans. U/S may be preferred to visualise sub-clinical nodules. At this point in time, FNA is always recommended to diagnose malignancy, and the adjunct use of U/S helps in locating all potentially active nodules. In the presence of U/S. thyroid scans may be of lesser value. Thyroid surgery is generally safe, and should become an outpatient procedure. Hospital stays should be determined by the extent of surgery and/or the appearance of complications

Preliminary results on prevalence of hepatitis C viral infection among patients with surgical biliary diseases

To assess the frequency of hepatitis C virus [HCV] seropositivity among biliary surgical patients. Follow-up of 105 patients tested over 6 months at the Al-Amiri Hospital [1997]. Results: 8.6%, of patients were HCV seropositive. There were no age and sex differences between seropositive and seronegative patients. The risk for seropositivity was higher among Egyptian patients compared to other nationalities. A history of blood transfusion was reported by only one seropositive patient. The prevalence of seropositivity among biliary surgery patients was higher than that reported among blood donors in Kuwait [2.6% in 1997], suggesting that HCV may indeed be a risk factor for biliary problems. The relatively higher proportion of seropositivity among Egyptian patients reflects the endemicity of HCV in their country of origin. This study highlights the importance of adhering to standard surgical precautions. Routine testing is not recommended except for Egyptian patients

Laparoscopic removel of needle embedded in small bowel wall

In this report, we describe a successful laparoscopic removal of foreign body [FB] "Metallic Needle" embedded in the small bowel wall

Atypical case of cystic fibrosis.

A patient of cystic fibrosis is hereby reported. He had no family history and presented with chest symptoms, only. There was no evidence of hepatic or pancreatic involvement. To our knowledge this represents the first case of its kind from this part of country.