Epidemiology of extra pulmonary tuberculosis in Eastern Sudan

Objective: To investigate the epidemiological factors associated with extra pulmonary tuberculosis (EPTB) in Kassala, Eastern Sudan. Methods: Patients infected with TB (pulmonary and extra-pulmonary) documented at the hospital were interviewed with a structured questionnaire used to gather sociodemographic information. The diagnosis of EPTB cases was based on presence of tuberculous granulomas in the histological samples, positive PCR to DNA of mycobacterium tuberculosis, radiological findings and fluid analysis suggestive of EPTB and clinical diagnosis with adequate response to anti-tuberculous therapy. Results: A total of 985 patients with TB were enrolled in the study, including 761 (77.3%) with PTB and 224 (22.7%) with EPTB. The mean age (SD) of patients with PTB and EPTB was 33.2 (15.4) and 34.7 (14.6) years respectively. The prevalence of EPTB was at (22.7%), with TB lymphadenitis 79 (35.3%), marking the frequent form of EPTB followed by peritoneal TB 27 (12.05%). While residence and occupation were not associated with EPTB, those with lower level of education (OR = 0.3; confidence intervals (CI) = 0.2-0.5; P < 0.001), female (OR = 8.7, CI = 4.9-15.1, P < 0.001), non vaccination (OR = 70.3, CI = 34.2-144.3, P < 0.001), and non smoker (OR = 0.1; CI = 0.06-0.20; P < 0.001), were associated with high prevalence of EPTB. Conclusions: Around one quarter of patients with TB in this study were more likely to have EPTB. Therefore, effective strategic plans regarding diagnostic procedures and control measures are needed to reduce the burden of the disease in Sudan.

Analysis of urine cytology at a community hospital

To review the pattern of urine cytology in our setting of a community hospital with age and gender distribution. Also to discuss the importance of this safe and inexpensive tool for diagnosing and screening urothelial cancers. We desire to encourage more wider and confident use of urine cytology in the routine practice. Method: We reviewed all the consecutive urine cytology specimens received at our institution during time frame of one year. The cytological diagnosis were grouped in four categories; 1: negative, benign or reactive cases; 2: cases showing acute inflammatory changes; 3: inconclusive cases and 4: malignant cases. Only the positive malignant cases were followed histologically to determine the accuracy and efficiency of urine cytological examination for positive cases. A total of 1957 consecutive urine cytology specimens were reviewed. Majority of the cases were negative for tumour [67.19%]. The most common diagnostic category was acute inflammatory case [17.3%] while inconclusive cases constituted 11.39% of total. There were 23 [1.18%] positive cases that were diagnosed malignant on urine cytology. These 23 malignant cases were followed histologically and 22 [95.6%] cases turned out to be malignant. Urine cytological examination is an efficient tool that has a good diagnostic yield in detecting malignant urothelial lesions. It should be used routinely for diagnosing, screening and for follow-up of all malignant urothelial lesions

Tips on searching the internet for medical information

Searching for references is part of everyday life in medicine. Since the arrival of the Internet, it has provided great promise for clinicians because of its ready provision of access to large amounts of knowledge and information. But because of the overload of information, searching for particular information has now become a tedious time-consuming and frustrating task. This article describes effective ways, tips, tools, detailed search techniques and strategies for searching for medical information. It also lists some useful resource and database sites that can help in the search for accurate information

Histopathological and Immunohistochemical Characteristics of Primary Renal Primitive neuroectodermal Tumor

We report a 32-year-old male who presented with huge [17x10.5x5 cm] right kidney with metastasis in the liver and retroperitoneal lymph nodes. Histological, detailed immunohistochemical studies and electron microscopic examinations were performed. Microscopy revealed small to intermediate sized cells with hyperchromatic nuclei, scanty cytoplasm, abundant mitosis with no pseudorossete formation. Immunohistochemical study revealed positive staining of the tumor cells for S100, neurofilaments, neuron specific enolase, vimentin and myoglobin. Primitive neuroectodermal tumors are rare malignant round cell tumors of the kidney. A correct diagnosis can be made on light microscopic features, and by immunohistochemically positive staining for more than one neural marker. This neoplasm should be differentiated from other renal neoplasms composed of small round cells

value of fine needle aspiration cytology in the diagnosis of male breast lesions

The aim of this retrospective case series is to explore and highlight the subject of male breast diseases in Jeddah, Saudi Arabia and to assess the value of fine needle aspiration in diagnosing these lesions. Material and Data on male breast biopsies and fine needle aspiration cytology [FNAC] done between 1984 and 1999 were retrieved from the laboratory records. The same pathologist blindly examined all the cytology and histology slides. Histopathology diagnoses were classified into benign and malignant. FNAC diagnoses w e re categorized as positive, negative, inconclusive or unsatisfactory. Cytohistologic correlation was done with data from histopathology records. Sensitivity, specificity, and predictive values of FNAC were calculated using standard statistical methods. Our results were also compared with a similar large study. Sixty-three [6.0%] of 1044 patients undergoing breast surgical biopsies were males. Benign lesions comprised 55 cases [87.3%], but eight cases [12.7%] were malignant lesions [six ductal carcinomas and two metastatic adenocarcinoma]. Gynecomastia is the most common male breast lesion, constituting 54% [mean age 31.23 years]. Amajority [54%] of these patients presented near puberty. Twelve patients had cytohistological records for correlation, giving a sensitivity of 100%, specificity of 83.33%, positive predictive value of 85.71%, negative predictive value of 100%, false positive fraction of 8.3% and a false negative fraction of 0%. Male breast lesions constituted 6% of all breast lesions and male breast carcinomas constituted 2.59% of all breast carcinomas. This study also shows that FNAC is an accurate tool for diagnosing male breast lesions. It is highly sensitive and specific. FNAC should, therefore, be used confidently and be included as an integral part of primary assessment of breast lumps in males

Analysis of false positive and false negative cytological diagnosis of breast lesions

To study the reasons for interpretive errors in false negative and false positive diagnosis of breast carcinoma on fine needle aspiration cytology material. We reviewed only those cases in which cytohistological discrepancies were found, where the cytologic material was abnormal and to some extent misinterpreted or both. There was only one false negative case [false negative fraction 0.32%] proved histologically as ductal carcinoma and four false positive cases [false positive fraction 1.2%]; 2 fibroadenoma; 1 fibrocystic disease; and 1 stromal fibrosis. Smears of the two false positive fibroadenoma cases showed very high cellularity, overcrowded clusters and frequent stripped nuclei. The fibrocystic case showed tight clusters of apocrine cells and sheets of loosely aggregated macrophages that were over interpreted. Smears of the false negative ductal carcinoma was hypocellular overall, and the cells showed minimal nuclear pleomorphism. Overcrowded clusters and hypercellular smears should be carefully assessed for uniformity of cells and detailed nuclear and cytomorphological features. If the full-blown malignant cytomorphological changes are not visible, a diagnosis of suspicious or inconclusive should be made and frozen section recommended before surgery. Hypocellularity and relatively nuclear monomorphism are the reasons for failure to diagnose malignant breast lesions. Careful attention should be paid to extreme nuclear monomorphism and absence of naked bipolar cells. A cytologically atypical or suspicious diagnosis together with positive radiological and clinical findings should suggest a diagnosis of malignancy

Gallbaldder pathologies and cholelithiasis

Cholecystectomy, mostly due to cholelithiasis is one of the most common surgical procedures utilizing a significant amount of healthcare resources. As there are a huge number of cases, for example approximately 300 cases per year in our region, outlines this commonly encountered lesion should be recorded. Also, in an attempt to delineate the outline of the pattern, age and sex distribution of gallbladder diseases in the whole Kingdom, a comparative analysis is also included in this study with 7 other studies published from different parts of the Kingdom. Our study consisted of 740 consecutive gallbladder cholecyctectomies mostly for cholelithiasis received in a time frame of 3.5 years [for example between January 1997 through to May 2000] by the Department of Histopathology retrieved from the records of the laboratory. The outline of main gallbladder pathologies was tabulated. The number of gallbladders received with stones was also calculated. Age and sex distribution for gallbladder pathology and gallstones was also tabulated. There were 131 males [18%] and 609 [82%] females, with a female ratio male 4.6:1. Benign lesions comprised 99% [mean age 36], mostly chronic cholecyctitis [97%] and acute cholecystitis which constituted 15 cases only [2%], malignant lesions comprised only 7 cases for example 1% of all lesions [mean age 65]. Gallbladder pathologies are very common and similar results have been obtained from other studies by comparative analysis. The mean cholecystectomy rates in the Kingdom totalled approximately 10%, mean age for all cholecystectomy diseases in both sexes equalled 37.05. The mean age for males was 42.26, females 37.25 and their ratio was 44.5:1

Morphological profile of testicular biopsies associated with infertility

Based on testicular biopsies examined at King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia, the goal of this retrospective study is identification and systemization of the histopathological patterns of testicular biopsies received especially for investigating male infertility and further more to compare the findings of our study with similar studies in the literature. Our study group consisted of 164 testicular biopsies, which were examined in the Department of Histopathology at King Abdulaziz University Hospital in Jeddah, over a period of 10 years. The data was retrieved and analyzed and the available histopathological results were grouped into 8 different morphological categories. The findings of the biopsies associated with infertility were complied as follows: 45 [27%] showed normal spermatogenesis of which 15% showed active spermatogenesis associated with duct obstruction, 41 [25%] with hypospermatogenesis, 39 [24%] showed end stage tubular sclerosis with interstitial fibrosis, 27 [16.5%] with germ cell aplasia [with or without focal spermatogenesis], 11 [7%] biopsies showed maturation arrest and only on biopsy were associated with karyotpic abnormalities. A higher percentage of hypospermatogenesis and end stage tubular sclerosis with interstitial fibrosis was noticed in this study when compared with the other studies reported from Saudi Arabia. A high percentage [27%] of the biopsies show normal spermatogenesis with or without duct obstruction

Evidence-based medicine

Evidence-based medicine is one of the recently born explosively growing important issues, whose philosophical origins extend back to mid-19th century and remains a hot topic for clinicians, public health practioners, purchasers, planners, and the public. Evidence-based health care has extended the application of the prinicples of evidence-based medicine to all professions associated with health care, including purchasing and management. So it is important for the up and coming young doctors and clinicians, and even other health care professions, to gain knowledge of critical appraisal and experience in the practice of evidence-based health care. This article gives a brief description of what evidence-based medicine is and how to practice evidence-based medicine and enlists some useful Internet sites that can provide assistance in understanding the subject in even greater detail