Effects of Solanum lycopersicum L. (tomato) against isoniazid and rifampicin induced hepatotoxicity in wistar albino rats

Abstract Anti-tuberculosis drugs are reported to cause hepatotoxicity, which varies from asymptomatic rise of the hepatic enzymes. Hepatoprotective plants plays important role to protect liver. This study investigated the hepatoprotective potential of the Solanum lycopersicum in rats intoxicated with Isoniazid and Rifampicin (INH+RIF) to induce hepatotoxicity. Thirty wistar albino rats were divided into five groups of six animals each. Group 1 rats were kept control while groups II, III, IV and V were administered with INH+RIF (75+150 mg/kg) orally, for seven consecutive days. For treatment, rats in group III received silymarin while animals in group IV and V were provided with 40 mg/kg and 80 mg/kg of Solanum lycopersicum extract, respectively. On day 0 and 8th blood samples were collected for the analysis of hepatic biomarkers. The data were subjected to one-way ANOVA and Bonferronis post hoc test for statistical analysis. Hepatotoxicity induced by INH+RIF resulted in significant elevation of serum hepatic enzymes including Aspartate aminotransferase (AST), Alanine aminotransferase (ALT), Alkaline phosphatase (ALP), and total bilirubin while decreased the albumin level. The Solanum lycopersicum at dose of 80 mg/kg significantly reduced the hepatic enzymes AST, ALT, ALP and bilirubin while the albumin level was significantly increased. The treatment had non-significant effect on body and liver weight. Drug induced hepatotoxicity can be effectively treated with Solanum lycopersicum at 80 mg/kg dose.

Resumo As drogas antituberculose são relatadas como causadoras de hepatotoxicidade, ocasionando o aumento assintomático das enzimas hepáticas. As plantas hepatoprotetoras desempenham um papel importante na proteção do fígado. Este estudo investigou o potencial hepatoprotetor de Solanum lycopersicum em ratos que foram intoxicados com isoniazida e rifampicina (INH + RIF) para induzir hepatotoxicidade. Trinta ratos wistar albinos foram divididos em cinco grupos de seis animais cada. Os ratos do grupo 1 representaram o grupo controle, enquanto os ratos dos grupos II, III, IV e V receberam INH + RIF (75 + 150 mg/kg) por via oral, por sete dias consecutivos. Para o tratamento, os ratos do grupo III receberam silimarina, enquanto os animais do grupo IV e V receberam 40 mg/kg e 80 mg/kg de extrato de S. lycopersicum, respectivamente. Nos dias 0 e 8, foram coletadas amostras de sangue para análise de biomarcadores hepáticos. Os dados foram submetidos a teste unilateral (ANOVA) e post hoc de Bonferroni para análise estatística. A hepatotoxicidade induzida por INH + RIF resultou em elevação significativa das enzimas hepáticas séricas, incluindo aspartato aminotransferase (AST), alanina aminotransferase (ALT), fosfatase alcalina (ALP) e bilirrubina total, enquanto houve a diminuição do nível de albumina. O S. lycopersicum, na dose de 80 mg / kg, reduziu significativamente as enzimas hepáticas AST, ALT, ALP e bilirrubina, enquanto o nível de albumina aumentou de forma significativa. O tratamento não teve efeito significativo no peso corporal e hepático. A hepatotoxicidade induzida por drogas pode ser tratada de forma eficaz com S. lycopersicum na dose de 80 mg/kg.

Effects of Solanum lycopersicum L. (tomato) against isoniazid and rifampicin induced hepatotoxicity in wistar albino rats / Efeitos de Solanum lycopersicum L. (tomate) contra hepatotoxicidade induzida por isoniazida e rifampicina em ratos albinos wistar

Anti-tuberculosis drugs are reported to cause hepatotoxicity, which varies from asymptomatic rise of the hepatic enzymes. Hepatoprotective plants plays important role to protect liver. This study investigated the hepatoprotective potential of the Solanum lycopersicum in rats intoxicated with Isoniazid and Rifampicin (INH+RIF) to induce hepatotoxicity. Thirty wistar albino rats were divided into five groups of six animals each. Group 1 rats were kept control while groups II, III, IV and V were administered with INH+RIF (75+150 mg/kg) orally, for seven consecutive days. For treatment, rats in group III received silymarin while animals in group IV and V were provided with 40 mg/kg and 80 mg/kg of Solanum lycopersicum extract, respectively. On day 0 and 8th blood samples were collected for the analysis of hepatic biomarkers. The data were subjected to one-way ANOVA and Bonferroni's post hoc test for statistical analysis. Hepatotoxicity induced by INH+RIF resulted in significant elevation of serum hepatic enzymes including Aspartate aminotransferase (AST), Alanine aminotransferase (ALT), Alkaline phosphatase (ALP), and total bilirubin while decreased the albumin level. The Solanum lycopersicum at dose of 80 mg/kg significantly reduced the hepatic enzymes AST, ALT, ALP and bilirubin while the albumin level was significantly increased. The treatment had non-significant effect on body and liver weight. Drug induced hepatotoxicity can be effectively treated with Solanum lycopersicum at 80 mg/kg dose.

As drogas antituberculose são relatadas como causadoras de hepatotoxicidade, ocasionando o aumento assintomático das enzimas hepáticas. As plantas hepatoprotetoras desempenham um papel importante na proteção do fígado. Este estudo investigou o potencial hepatoprotetor de Solanum lycopersicum em ratos que foram intoxicados com isoniazida e rifampicina (INH + RIF) para induzir hepatotoxicidade. Trinta ratos wistar albinos foram divididos em cinco grupos de seis animais cada. Os ratos do grupo 1 representaram o grupo controle, enquanto os ratos dos grupos II, III, IV e V receberam INH + RIF (75 + 150 mg/kg) por via oral, por sete dias consecutivos. Para o tratamento, os ratos do grupo III receberam silimarina, enquanto os animais do grupo IV e V receberam 40 mg/kg e 80 mg/kg de extrato de S. lycopersicum, respectivamente. Nos dias 0 e 8, foram coletadas amostras de sangue para análise de biomarcadores hepáticos. Os dados foram submetidos a teste unilateral (ANOVA) e post hoc de Bonferroni para análise estatística. A hepatotoxicidade induzida por INH + RIF resultou em elevação significativa das enzimas hepáticas séricas, incluindo aspartato aminotransferase (AST), alanina aminotransferase (ALT), fosfatase alcalina (ALP) e bilirrubina total, enquanto houve a diminuição do nível de albumina. O S. lycopersicum, na dose de 80 mg / kg, reduziu significativamente as enzimas hepáticas AST, ALT, ALP e bilirrubina, enquanto o nível de albumina aumentou de forma significativa. O tratamento não teve efeito significativo no peso corporal e hepático. A hepatotoxicidade induzida por drogas pode ser tratada de forma eficaz com S. lycopersicum na dose de 80 mg/kg.

Study of Mineral Nutrient Accumulation in Different Cultivars of Guava Fruits

Guava, is one of the most promising fruit crops of India and is considered to be one of the exquisite nutritionally valuable and remunerative crops. We are unaware of any report describing macro and micronutrient dynamics in fruit at different growth stages of guava. Micronutrients play an important role in production and their deficiency lead in lowering the productivity. For conducting this experiment fruit of variety Allahabad Safeda, L-49, Lalit, Shweta, Arka Kiran, Salithong, Kimchu were collected at different stages like Marble, Stone hardening & Harvest stage for estimation of primary nutrient (N, P, K), secondary nutrient (Ca, Mg) & micronutrient (Fe, Mn, Zn, Cu). The nutrient content particularly N, K, Mg, and Mn are highest in variety of Allahabad Safeda, whereas, P and Ca are highest in variety Lalit. Micronutrient Fe recorded highest in Salithong while Zn and Cu were accumulated maximum in Arka Kiran and Kimchu respectively. Recommendation of fertilizer at various growth stages is paramount for precise nutritional management for which the requirement of different nutrition is essential.

case of severe autoimmune hepatitis associated with Graves' disease

Graves' disease is a common condition and is known to have a wide range of effects on a variety of organs. Hepatic dysfunction ranging from mild to severe due to direct effect of high circulating thyroid hormones as well as a deleterious effect of antithyroid medications [methimazole and propylthiouracil] has been well - documented in literature. However, severe autoimmune hepatitis [AIH] associated with Graves' disease is rare and limited to few case reports only. A 38?year?old woman presented with abdominal pain and yellowish discolouration of conjunctivae. On investigation, she was found to have Graves' disease and AIH. The liver histopathology showed typical features of AIH. She responded excellently to glucocorticoid therapy with normalisation of thyroid function and liver histology. The case is discussed with relevant literature review

Together we stand, divided we fall: Interprofessional collaborative practice competencies from Malaysian medical professionals' perspectives

Objective: As the demands on the health care system are increasing, there are more calls to embed interprofessional education [IPE] into health professionals' curriculum. However, the outcomes for the curriculum are still being defined, and there is limited information about IPE in medical contexts to guide educators. This study aims to explore medical professionalism from the perspective of Malaysian medical professionals and specifically the interprofessional collaborative practice [ICP] competencies that are expected from physicians in Malaysian medical contexts

Methods: We conducted focus-group discussions with medical doctors in Malaysia to capture the participants' experiences and views on medical professionalism and ICP. We then conducted a thematic analysis of the transcripts. The data were managed by Atlas.Ti software

Results: As many as 22 academician and nonacademician medical doctors participated in this study. From the focus-group discussions, eight themes emerged to describe medical professionalism in Malaysia. These themes can be categorized into common, complementary and collaborative competencies. We found that collaborative competencies in Malaysia include 'leadership and interprofessional skills' and 'patient primacy

Conclusion: This study provided a preliminary description of medical professionalism and collaborative competencies expected in Malaysia. The findings of this study provide a skeleton for further studies about effective teaching strategies and assessment tools that are used to impart IPE

Social support and self-care activities among the elderly patients with diabetes in Kelantan

Introduction: Diabetes is common among the elderly and can significantly affect their lives including the issues related with social support and diabetic self-care activities. Objectives: The objective of this study was to examine the social support and self-care activities among the elderly patients with diabetes. Methods: A survey involving 200 patients was conducted from March 2013 to May 2013 in three hospitals in Kelantan. Data were obtained through self-administered questionnaires and clinical characteristics were acquired from the patients’ records. Results: The scores for social support (mean = 19.26; SD = 2.63) and self-care activities (mean = 14.83; SD = 4.92) were moderate. Higher social support was associated with high levels of glycated haemoglobin (HbA1c), fasting blood sugar (FBS) level, the duration of diabetes and a decrease in body mass index (BMI) (p<0.05). It was observed that the patients with low educational, Hb1Ac and FBS level, with other chronic diseases and who have had diabetes for some time had low self-care activities (p<0.05). There was a significant negative relationship between an increase in social support and decrease in self-care activity (p<0.05). Conclusion: Healthcare providers, family and friends have to strengthen their relationship with the elderly patients with diabetes to provide more social support and promote the compliance with diabetic self-care activities to improve clinical outcomes.

[Incidence of Thyroid Dysfunction among chronic hepatitis C Egyptian patients treated with Interferon/Ribavirin therapy]

Background/Aim: The use of pegylated interferon-alpha [IFN-alpha] and ribavirin is still an integral part of the standard of care treatment of chronic hepatitis C [CHC] in Egypt until the present time, even after introducing the new era of direct acting antiviral drugs. Such regimens are accompanied by the production of autoantibodies that carries the risk of development of thyroid dysfunction [TD]. The study tries to describe the incidence, long-term outcome, and predictors of TD among Egyptian patients with CHC receiving IFN-based treatment

Patients and Methods: Between January 2013 and August 2014, a prospective study design was conducted to include naive CHC patients [virologically and histopathologically proved] enrolled for INFbased therapy with normal thyroid function profile

Results: A total of 400 patients [mean age was 37.4+9.6 years, 18% were females] were included. At the end of the study period, 12.3% of patients [n=49] developed biochemical TD [TSH<0.3 or >5.0 mIU/L]. At the 12th week after the end of antiviral therapy, 67.3% of them [n=33] were spontaneously normalized. At the 24[th] week, 14.3% of the remaining [n=7] had spontaneously normalized. Female gender was significantly associated with the development of TD

Conclusions: The incidence of TD among the Egyptian patients treated by INF-based antiviral therapy for CHC is not low and more predominant in females. Spontaneous recovery after the end of treatment was common however, it entails a strict follow up

Design, synthesis, molecular docking of new thiopyrimidine-5- carbonitrile derivatives and their cytotoxic activity against HepG2 cell line.

A series of new thiopyrimidine derivatives were synthesized via the reaction of ethyl cyanoacetate with thiourea and the appropriate aldehydes namely, 3-methoxy-benzaldehyde, 2, 5-dimethoxy-benzaldehyde and 3,5- dimethoxy-benzaldehyde to give the corresponding pyridine thiones 1a-c. Compounds 1a-c were then chlorinated to give the corresponding chloro compounds 2a-c, which then underwent variant cyclocondensation reactions to afford different cyclized compounds 3-10. On the other hand, 1a-c were condensed with monochloroacetic acid and different aldehydes to give 11-14. Some of the new derivatives were selected for cytotoxicity evaluation against HepG2 cell line in comparison to 5-FU as a reference drug. Among all tested compounds, compound 4a was the most potent with IC50 value of 13.18 μM. Furthermore, a docking study of the most active compounds was carried out with thymidylate synthase enzyme. Structures of all new compounds were elucidated by their correct elemental analysis and spectral data.

Platelet count, mean platelet volume and aggregation as markers of disease activity in rheumatoid arthritis

Rheumatoid arthritis [RA] is a chronic inflammatory disorder that affects small joints of hands and feet. Different forms of hematological disorders are associated with RA as anemia, neutropenia, thrombocytosis, thrombocytopenia, eosinophilia, and hematological malignancies. To correlate the value of mean platelet volume [MPV], platelet count and platelet hyperactivity with Disease Activity Score [DAS 28 score] and their reflection on cardiovascular system in RA. 50 newly diagnosed RA patients were attending the Clinical Rheumatology Unit during the year 2012 with twenty five control helthy subjects randomly selected. For all, CBC, including platelet count, MPV, platelet aggregation using ADP, echocardiography in addition to ECG, ESR, and CRP were done. MPV, Platelet count, CRP and ESR were, significantly higher in RA patients than controls, while Platelet aggregation, hemoglobin level, mean diastolic function and ejection fraction[EF] were significantly lower in RA patients than control group. Significant positive correlations were detected between DAS 28 score and both MPV and platelet count, while significant negative correlations were found with both hemoglobin and EF. Significant increase of the platelet aggregation in sero-negative compared to sero-positive rheumatoid arthritis patients was detected. Platelet count and MPV are inexpensive tests, may be useful for a rapid assessment of disease activity in patients with RA

Hodgkin's lymphoma an immunohistochemical profile in northern Iraq

To evaluate the expression of several immunohistochemical markers in Hodgkin's lymphoma [HL], and to determine the relative frequency of HL subtypes. From January 2010 through January 2013, 42 HL cases were included in this case series study. Cases were collected from Al-Jumhori Teaching Hospital and private laboratories in Nineveh province, Iraq. The tumors were subtyped according to the World Health Organization classification system. Several markers including CD30, CD15, CD20, CD79a, CD3, and CD43 were evaluated immunohistochemically. The patients' ages ranged from 5-81 years [mean: 32]. A bimodal age distribution was discerned, with most cases in the third decade [26.2%]. Male to female ratio was 1.6:1. Histopathological subtyping revealed that 33 cases [78.6%] were nodular sclerosis HL, 8 cases [19%] were mixed cellularity HL, and one case [2.4%] was nodular lymphocyte-predominant HL. The CD30 marker was expressed in all classical HL cases [100%]; while, CD15 was detected in 51.8% of cases. The nodular lymphocyte-predominant HL was CD30 and CD15 negative, but CD20 and epithelial membrane antigen [EMA] were positive. There was no significant relation between CD15 expression, and both patients' age and HL subtypes. The CD30 marker was expressed in 100% of cases of classical HL, while CD15 was positive in 51.8% only. Nodular sclerosis HL was the most common subtype of HL [78.6%], followed by mixed cellularity HL

High C reactive protein associated with increased pulse wave velocity among urban men with metabolic syndrome in Malaysia

To determine the association between carotid femoral pulse wave velocity [PWV[CF]]; augmentation index [AI]; and high-sensitivity C reactive protein [hs-CRP] with metabolic syndrome [MetS], and to determine the influence of ethnicity on PWV[CF] and AI, and the association between high hs-CRP and increased PWV, and AI in MetS. A cross-sectional study was conducted at Universiti Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia from September 2009 to September 2011. Three hundred and eighty men [Chinese and Malays] were recruited from the study. The PWV[CF] and AI were measured by Vicorder [SMT Medical, Wuerzburg, Germany]. The hs-CRP level was also determined. We defined MetS using the International Diabetes Federation [IDF] and harmonized criteria. Malays had higher AI compared to the Malaysian Chinese. Patients with MetS had higher PWV[CF] [IDF criteria: 8.5 [8.3-8.7] versus 8.2 [8.0-8.4] m/s, p=0.03; harmonized criteria: 8.5 [8.4-8.7] versus 8.2 [8.0-8.4] m/s, p=0.007] and hs-CRP [IDF criteria: 0.9 +/- 2.0 versus 0.4 +/- 1.1 mg/L, p=0.0007; harmonized criteria: 0.8 +/- 1.9 versus 0.4 +/- 1.1 mg/L, p=0.002] compared to non-MetS. In subjects with MetS, those with high hs-CRP [>3mg/L] had higher PWV[CF]. Augmentation index values were significantly higher in Malays compared with Malaysian Chinese. Metabolic syndrome was associated with increased PWV[CF] and hs-CRP. Patients with MetS and high hs-CRP were associated with higher PWV[CF]. The measurement of hs-CRP reflects the degree of subclinical vascular damage in MetS

An occurrence of Synthesiomyia nudiseta (Wulp) (Diptera: Muscidae) from a human corpse in a high-rise building in Malaysia: A case report

Abstract. This is the first report of Synthesiomyia nudiseta (Wulp) (Diptera: Muscidae) on a human corpse discovered in a high-rise building in Malaysia. On 5 March 2008, a decomposing body of an adult female was found on the top floor of a thirteen-story building in Kuala Lumpur, Malaysia. Her body was colonized by S. nudiseta larvae, which were normally associated with corpses found indoors at ground level. The post-mortem interval (PMI) was estimated at approximately 5 to 9 days. This case is significant as it demonstrates that this species can locate a dead body even in a high-rise building. Further findings of fly distribution especially in high-rise buildings should be reported to assist entomologists in PMI analysis.

Cervical lymphadenopathy in children: a diagnostic approach

To determine the common causes of persistent cervical lymphadenopathy in children and to test a diagnostic approach. This study was conducted at King Hussein Medical Center/pediatric clinic over one year period to look for all children between ages of 6 months and 14 years with persistent lymph node enlargement. Persistent enlargement is defined as a lymph node > 1 cm in diameter, and > 2 weeks duration. A management algorithm was proposed and followed in the management. One hundred and thirty children presented to infectious diseases clinic with persistent lymph nodes enlargement. In 70 children [53%] the nodes regressed in 2 weeks time, in another 30 children [23%] they regressed in 4 weeks time. Fifteen children [12%] had tuberculous lymphadenitis; 10 children [8%] had lymph node abscess; 3 children [2%] had Epstein Barr virus infection and 2 children [1.5%] had Hodgkin's lymphoma on initial presentation. Reactive lymphadenitis is the commonest cause of cervical lymph node enlargement in children. Majority of lymph nodes regress in 4 weeks time. Persisting lymph nodes more than 4 weeks warrant histological examination. Tuberculosis is a common cause of cervical lymphadenopathy among Jordanian children

Insulin resistance, steatosis, and fibrosis in Egyptian patients with chronic hepatitis C virus infection

Both nonalcoholic fatty liver disease [NAFLD] and chronic hepatitis C virus [HCV] infection are common in Egypt, and their coexistence is expected. There is controversy regarding the influence of NAFLD on chronic HCV disease progression. This study evaluates the effect of NAFLD on the severity of chronic hepatitis C [CHC] [necroinflammation and fibrosis] and assesses the relative contribution of insulin resistance syndrome to the occurrence of NAFLD in patients with chronic HCV infection. Untreated consecutive adults with chronic HCV infection admitted for liver biopsy were included in this study. Before liver biopsy, a questionnaire for risk factors was completed prospectively, and a blood sample was obtained for laboratory analysis. Our study included 92 male patients. Their mean +/- SD age and aspartate aminotransferase [AST] level were 42 +/- 7.7 years [range 20-56] and 68 +/- 41.7 U/L [range 16-214], respectively. The mean insulin level and insulin resistance index were 15.6 +/- 18.3 mlU/mL [range 5.1-137.4] and 5.9 +/- 15.2 [range 0.9-136.2], respectively. Fifty four percent of patients had steatosis and 65% had fibrosis. In multivariate analyses, steatosis was associated with insulin resistance and fibrosis was associated with high AST level, age >40 years, and steatosis. Steatosis is a histopathologic feature in >50% of patients with chronic HCV infection. Insulin resistance has an important role in the pathogenesis of steatosis, which represents a significant determinant of fibrosis together with high serum AST level and older age

Risk factors of hepatocellular carcinoma: are they the same among cirrhotic and noncirrhotic patients in Upper Egypt?

Hepatocellular carcinoma [HCC] is the commonest primary cancer of liver. Epidcmiologic research exploring risk factors of HCC is important because of increasing frequency of the disease in Egypt with remarkable rise in noncirrhotic patients. Identifying risk factors of HCC may help in decreasing its incidence.This study was carried out to identify risk factors of HCC among both cirrhotic and noncirrhotic patients in Upper Egypt. A case control study of 104 cases with HCC against 104 controls without HCC were recruited from Tropical Medicine and Gastroenterology Department, Assiut University Hospital; patients were from the governorates of Assiut, Sohag, Qena, and Aswan. Patients were divided into two groups, cirrhotics and noncirrhotics. For all participants, the following was conducted: clinical evaluation, abdominal ultrasonography examination, and laboratory investigations. Risk factors of HCC were identified using univariate then multivariate analysis. Cirrhotic patients constituted 60.6% of the total sample while noncirrhotic patients constituted 39.4%. Among cirrhotic patients, higher risk of HCC was observed with underground water use [OR 15.825, 95% CI 4.462-56.128], tobacco smoking [OR 7.755, 95% CI 2.790-21.558], and metabolic syndrome [OR 5.595, 95% CI 1.565-20.009], While risk factors of HCC in noncirrhotic patients were found to be positive HBsAg [OR 15.223, 95% CI 2.009-115.352], tobacco smoking [OR 8.349, 95% CI 2.113-32.982], metabolic syndrome [OR 7.374, 95% CI 1.635-33.266], and manual agricultural job [OR 7.001, 95% CI 1.604- 30.648]. Distinct patterns of HCC risk factors exist among cirrhotic and noncirrhotic patients, with a common ground. The risk factor of HCC in cirrhotic patients was underground water use while chronic HBV infection and manual agricultural job were risk factors in noncirrhotic patients. For both cirrhotic and noncirrhotic patients, tobacco smoking and metabolic syndrome were common risk factors of HCC

Aneurysmal bone cyst concomitant with fibrous dysplasia in the frontal bone

Secondary aneurysmal bone cyst in fibrous dysplasia is exceedingly rare, especially in the skull and particularly in the frontal bone. We present a case of aneurysmal bone cyst concomitant with fibrous dysplasia in the frontal bone in a 15-year-old male patient presenting with headache and euphoria with an uncharacteristic imaging appearance and treated successfully by total resection

Bacille calmette-guerin lymphadenitis: a single center experience

To describe the clinical presentation, course and management of lymphadenitis post Bacille Calmette-Guerin vaccine. This descriptive study was conducted on 17 cases who were referred to the infectious disease clinic at King Hussein Medical Center with regional lymphadenitis post Bacille Calmette-Guerin vaccine. All cases were infants between two and 12 months of age. The results of lymph node aspirate and biopsy were shown as well. Different treatment protocols used were included. The study was conducted from September 2006 to September 2007. Seventeen patients, 9 males [52%] and 8 females [48%], were studied. Constitutional symptoms were found only in one infant. All infants received the same type of vaccine used by our Ministry of Health which is the Danish strain. Unilateral axillary lymph node enlargement was seen most commonly [47%]. Cervical lymph nodes were involved in four cases [24%] followed by supraclavicular lymphadenopathy in three cases [18%], and one case had cervical and supraclavicular lymphadenopathy. Sinus formation was seen in three [18%] cases. Five cases [30%] had fluctuating lymph nodes. Only one infant had disseminated infection. The majority [65%] of cases had their symptoms starting within the first two months post vaccine. Eight [47%] infants had conservative observational management. Anti-tuberculosis medications were used in five [30%]. Surgical approach was used in four [23%] cases. All infants had complete healing by the end of the study period. Since the introduction of the new vaccine more complications are seen. This stresses the importance of early recognition and implementation of appropriate treatment protocols. Complete healing of suppurative lymphadenitis post Bacille Calmette-Guerin vaccine can be achieved using different treatment protocols

Ewing sarcoma of the left big toe with trans-articular skip lesion: A case report.

We report the case of the patient who had Ewing Sarcoma in whom radiological and hystopathological appearances revealed a tumor mass in the left big toe along with trans-artikular skip lesion on the left diaphysis of tibia. In Cipto Mangunkusomo Hospital since 1995 until 2004 we have found 20 Ewing sarcoma cases, but only one skip lesion Ewing sarcoma was found. The diagnosis of transarticular skip lesion in association of Ewing sarcoma was confirmed in clinicopathological conferrence. The initial evaluation of all patients included the recording of the medical history, physical examination, and hematological studies. Radiographs of the chest and the site of the primary tumor were made routinely. Systemic staging was performed with use of total-body bone scan. Ray amputation of left big toe and open biopsy from mass of mid-shaft of tibia had been done to confirm the diagnosis. The patient underwent induction chemotherapy and above knee amputation. Ten months after diagnosis, he died because of advanced-distant metastasis.