Prevalence and correlation of human papilloma virus and its types with prognostic markers in patients with invasive ductal carcinoma of the breast in Kuwait

This study aimed to document the association of human papilloma virus [HPV] and its types in breast carcinoma tissues in Kuwaiti women, and correlate this with known prognostic markers. The clinicopathological data of archived tissue from 144 cases of invasive ductal breast carcinoma were studied [age, histological grade, size of tumour, lymph node metastases, oestrogen/progesterone receptors and human epidermal growth factor receptor 2 status]. HPV frequency was documented using immunohistochemistry [IHC] and chromogenic in-situ hybridisation [CISH]. HPV types were documented by CISH using HPV probes. CISH and IHC techniques were compared and HPV correlated with prognostic parameters. The HPV prevalence as determined by CISH and IHC was 51 [35.4%] and 24 [16.7%] cases, respectively. The sensitivity of HPV by IHC was 37.3% and specificity was 94.6%. The sensitivity and specificity of HPV-CISH compared to HPVIHC was statistically significant [P <0.001]. HPV-CISH was seen in 51 cases. A combination of HPV 6 and 11, and 16 and 18 was seen in 2 [3.9%] cases, and a combination of HPV 6, 11, 31 and 33 was seen in 7 [13.7%] cases. All three HPV probes: 6 and 11, 16 and 18, as well as 31 and 33 were present in 2 [3.9%] cases. The prevalence of HPVCISH in the Kuwaiti and non-Kuwaiti populations was 27 [52.9%] and 19 [37.2%], respectively. No correlation was observed with the prognostic parameters. The frequency of HPV in breast carcinoma cases in Kuwait was 35.4% [CISH]. Of those, 52.9% were Kuwaitis in whom both low- and high-risk HPV types were detected

Primary mediastinal pleomorphic rhabdomyosarcoma: a case report

To report a rare case of pleomorphic rhabdomyosarcoma which occurred in the mediastinum of a 34-year-old man. A young male labourer presented with dyspnoea on exertion. A large mediastinal mass was detected on chest CT scan. The chest surgeons advised against open biopsy. His alpha-fetoprotein was 22,000 IU/l; based on this the diagnosis of a germ cell tumour was made and the patient was treated with a bleomycin/etoposide/cisplatin regimen. He left for his native country where an open biopsy from the mediastinum was taken and reported as pleomorphic rhabdomyosarcoma. He was given five courses of chemotherapy with doxorubicin, etoposide, and ifosfamide with mesna protection without much relief. The inoperable disease occupied the whole of the right chest and mediastinum. The enormous size of the radiation field made radiotherapy prohibitive. Finally, the patient opted for symptomatic treatment and left for his native place. This case is presented because of its difficulty in management and rarity

Programa de atención musculoesquelética (PAME) en atención primaria: propuesta y diseño / Program of musculoskeletal attention in primare care: proposal and design

Las enfermedades musculoesqueléticas (EME), constituyen un grupo importante de patologías de alta prevalencia en nuestro país, capaces de afectar la calidad de vida, produciendo dolor y limitación funcional en las actividades de la vida diaria, principalmente en mujeres y adultos mayores. Su sintomatología asociada, se caracteriza por su cronicidad y su capacidad de generar demanda asistencial. La gran mayoría de los problemas musculoesqueléticos que hoy no tienen acceso a la atención especializada, reflejada en largas listas de espera al nivel secundario, corresponden a patología degenerativa de manejo generalmente conservador. Hoy en día no existe un programa estructurado desde el nivel central que de cuenta del acceso a este problema de salud. Durante los años 2005-2006, en el Servicio de Salud Metropolitano Sur, se desarrolló un piloto de atención musculoesquelética (llamado PAME), basado en estrategias de articulación de la red asistencial y de aumento de la resolutividad de la Atención Primaria. Se crearon flujogramas de manejo y derivación médica de las principales patologías involucradas, y se implementó una sala de manejo kinésico, en un consultorio de Atención Primaria. El presente artículo pretender dar cuenta del diseño, áreas e indicadores de evaluación, propuestos para el piloto mencionado. El PAME, espera constituirse en una estrategia válida para cumplir con el objetivo sanitario señalado para la década 2000-2010, del ítem osteomuscular, respondiendo además a las GES 2006-2007 (garantías explícitas de salud de artrosis de rodilla, cadera, hernia del núcleo pulposo y ayudas técnicas). La inserción del PAME preferentemente en Atención Primaria, permitirá desarrollar los ámbitos preventivos y promocionales de las EME.

Changing spectrum of squamous cell abnormalities observed on papanicolaou smears in Mubarak Al-Kabeer Hospital, Kuwait, over a 13-year period

The aim of this study was to determine the incidence of squamous cell abnormalities in cervical cytology in Mubarak Al-Kabeer Hospital, Kuwait, and to document any change in the pattern of these lesions. Over a 13-year period [1992-2004], 86,434 cervical smears were studied in Mubarak Al-Kabeer Hospital, Kuwait. Conventional Pap smears were first examined by cytotechnicians and finally reported by cytopathologists. The smears were classified according to the modified Bethesda system. The age of presentation of squamous cell abnormalities in Kuwaiti women was analyzed. Smears from 83,052 [96.09%] patients were found satisfactory for reporting while the remaining 3.9% was unsatisfactory. Atypical squamous cells of undetermined significance [ASCUS] were seen in 1,790 [2.2%] cases, atypical glandular cells of undetermined significance [AGUS] in 630 [0.8%] cases, low grade squamous intraepithelial lesion including human papillomavirus changes [LSIL] in 824 [1.0%] cases, high grade squamous intraepithelial lesion [HSIL] in 189 [0.2%] cases, and carcinoma in 79 [0.1%] cases of which 44 [0.05%] were squamous cell carcinoma. A comparison of average cases/annum during the study period revealed a significant increase in ASCUS from 1.13 to 2.83% [p < 0.001] and AGUS from 0.33 to 1.08% [p < 0.001]. However, the percentage of LSIL, HSIL and carcinoma detected in Pap smears remained the same. A significant linear trend [p < 0.001] was observed in satisfactory smears, ASCUS and AGUS over the years. However, no significant change was found in the detection of LSIL, HSIL and carcinoma. A reduction in the age of LSIL/HSIL and an increasing trend in the number of Kuwaiti women over the years was also observed which makes screening of young women essential in Kuwait

Role of fine needle aspiration, intraoperative imprint cytology and frozen section the diagnosis of breast lumps and thyroid lesions

Background and Lesions of the thyroid and breast represent the two commonest sources of frozen section in Kuwait. This study investigates the value of intraoperative cytology [IC], preoperative fine needle aspiration cytology [FNAC] and intraoperative frozen section [FS], in improving the diagnostic accuracy of such lesions. Material: Thirty-one breast masses and 45 thyroid lesions were included. In each case, diagnosis was established by [1] preoperative FNAC, [2] intraoperative IC and [3] FS. Their accuracy was compared to paraffin section diagnosis. Sensitivity of FNAC, IC and FS for breast malignancy was 82.6, 95.8 and 91.7%, respectively, while for thyroid malignancy sensitivity was 68.4, 85.0 and 65%, respectively. All three had 100% specificity and 0% false-positive rates. A 100% diagnostic accuracy was achieved by combined FNAC and IC in breast, and 93.3% with combined IC and FS in thyroid lesions. Intraoperative IC improves the diagnostic accuracy of FNAC and FS in breast and thyroid lesions

Static image telepathology in routine surgical pathology diagnosis: a report on the first experience in the arab word from Kuwait

Telepathology [TP] diagnosis is currently practiced in several countries. The present study presents the first documented experiment of static-image TP in Kuwait and the Arab world. Materials and Paraffin or frozen tissue sections of 100 cases of routine surgical pathology consisting of 40 malignancies, 10 benign neoplasms and 50 nonneoplastic conditions were studied. Diagnostic microscopic images captured by a microscope-attached digital camera were selected by a pathologist in each case and sent with the clinical history to a second pathologist via E-mail across the Internet. The diagnosis was sent back to the referring pathologist via E-mail. The specificity, sensitivity and diagnostic accuracy of TP was calculated. For malignant versus benign lesions, the diagnostic accuracy was 97% with 3 false-negative and no false-positive results [100% specificity]. Correct diagnosis by exact category was 92%. The deferral rate awaiting special stains was 5%, immunohistochemistry 6%, and extra images 2%. In 2 cases [2%], there was a request for original tissue glass slides. A simple E-mail-based TP system provides a high diagnostic accuracy for routine surgical pathology diagnosis. It can be utilized either as a primary or a secondary diagnostic tool

Parasite infestation of the vermiform appendix: the experience in Kuwait

A histology-based retrospective study was carried out in Kuwait to determine the frequency and type of helminthic infestation of the appendix in this predominantly desert environment. In 1,674 consecutive appendectomies, 109 parasites [5.6%] of five species were detected: Schistosoma sp. 70 [4.1%], Enterobius vermicularis 36 [2.1%], and a single case each of Ascaris lumbricoides, Taenia sp. and Trichuris trichiura. Schistosomiasis was seen exclusively in immigrants of whom 12 had evidence of coexistent extra-appendiceal infestation of the urinary system. Suppuration in this group was common [79%] in addition to fibrosis [74%] and granulomata [43%]. Enterobiasis seen in both natives and immigrants predominantly affected children. Suppuration in this group was uncommon [22%] but a fecalith or thick lumen contents containing the parasites were frequently seen [72%]. It was concluded that parasite infestation of the appendix is important to report even in countries such as Kuwait which is nonendemic for many intestinal parasites. Such data contribute to further understanding of epidemiology, enable the diagnosis of easily treatable disease such as enterobiasis, or provokes a search for more significant extra-appendiceal infection as in schistosomiasis. Enterobiasis should be suspected in children and young adults with normal histology of the appendix. Examination of the lumen contents may improve the chances of detecting intraluminal parasites

C-peptide and insulin in liver cirrhosis: the relative role of hypersecretion and defective degradation

This study was performed on 60 subjects, 45 patients with liver cirrhosis or fibrosis and 15 controls. All patients and controls were subjected to estimation of their total serum proteins, serum albumin, total bilirubin, transaminases, alkaline phosphatase, prothrombin time and concentration, hepatitis B surface antigen, glucose tolerance test, fasting and postprandial serum insulin and C-peptide. Only the patients were subjected to upper GIT endoscopy abdominal ultrasonography and liver biopsy

Bone formation in abdominal surgical scars

Four cases of heterotopic bone formation in abdominal scars are presented and possible causative factors discussed with reference to the literature. The awareness of the condition will prevent unnecessary investigations and anxiety. Excision of the bony mass is indicated only when symptomatic, without the need for local irradiation