Primary Sjogren's syndrome with central nervous system involvement

To describe the clinical, laboratory, and radiological features of Primary Sjogren's syndrome [PSS] with central nervous system [CNS] involvement. A retrospective case series of 12 female patients with PSS and CNS involvement at King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia from 1991-2009. The diagnosis of PSS is defined by the American-European Diagnostic Criteria. We analyzed the clinical, radiological, and immunological features. The mean age was 40 years [range 16-58 years]; all patient were females and presented with active neurological symptoms. The neurological involvement preceded the classic sicca symptoms [33%]. Eight patients [66%] presented with myelopathy, 9 patients [75%] had optic neuritis, and the rest had variable neurological signs. Immunological tests [anti-Sjogren's syndrome A and anti-Sjogren's syndrome B] were high in 7 patients [58%]. Minor salivary gland biopsy revealed inflammatory cell infiltrate in 11 patients [92%]. Brain MRI showed scattered white matter changes in 7 patients [58%]. Spine MRI showed multiple foci of hyperintensity in T2-weighted image in 6 patients [50%], and long segment of hyperintensity at the cervical spinal cord in 2 patients [16%]. Our findings demonstrate that CNS involvements in PSS have great clinical variability and could precede the classic sicca symptoms by years. Primary Sjogren's syndrome can mimic multiple sclerosis [primary progressive multiple sclerosis or relapsing remitting multiple sclerosis], therefore a screening test for PSS should be considered in suspected cases. A well-defined management protocol awaits studies with larger case numbers

Pure red cell aplasia-a single centre experience

To determine the frequency of Pure Red Cell Aplasia [PRCA] in patients referred to Haematology Department of Holy Family Hospital, Rawalpindi for bone marrow examination. Single center descriptive study. The study was conducted at the Haematology Department of Holy Family Hospital Rawalpindi from 1st January 1999 to 31[st] September 2004. All patients referred to this department for bone marrow were included in this study. They comprised both male and female subjects of all ages. After taking a detailed history and conducting a complete physical examination blood samples were taken for complete blood picture. Bone marrow aspiration was done on all patients and trephine biopsies were taken only where indicated. Total of 1724 bone marrow aspirations biopsies were performed during this period, of which. 13 [0.75%] were diagnosed as Pure Red Cell Aplasia. 08/13 [61.5%] were males and 05/13 [38.4%] were females. The age range was from 1-52 years. Maximum number of patients belonged to 15-30 years age group. 01/13 [7.7%] was diagnosed as Diamond Blackfan Anaemia CDBA[2], 03/13 [23%] were associated with viral hepatitis. 04/13 [30.7%] cases had developed after some viral infection other than viral hepatitis. 01/13 [7.7%] had immune mediated PRCA, developing during the course of DAT positive hemolytic anaemia. 04/13 [30.7%] were idiopathic in origin. DBA patients initially responded well to corticosteroids but later developed resistance to steroids and became transfusion dependent. 02/13 [15.4%] patients also showed a good initial response to corticosteroid therapy and thus were labelled as Acute PRCA. 02/13 [15.4%] recovered spontaneously after diagnosis. Both these cases were children and thus diagnosed as cases of Transient Erythroblastopenia of Childhood [TEC]. PRCA is a rare disorder with a frequency of 0.75%. It is most commonly encountered in young adults secondary to a viral infection. Hepatitis is a major health hazard in our society and may play a significant role in the etiology of PRCA our patients

effect of severe cystic hydatidosis on the liver of a Najdi sheep with special reference to the cyst histology and histochemistry

A single case of severe hydatidosis in a liver of a Najdi sheep was studied. The estimated age of the animal was 1.5 years and the liver was infected with 29 cysts and their diameters ranged from 4.0 mm to 5.1 cm. Cysts with a diameter less than 10 mm were immature and those of more than 1.5 cm were fertile and developed protroscoleces. Harvested protroscoleces measured 120 x 60 to 140 x 80 um. Comparative histochemical studies by hematoxylin and eosin, periodic acid Schiff [PAS] and Masson's trichrome stains revealed that the cystic wall consisted of three layers [germinal, laminated and fibrous, respectively]. The thickness varied with each stain. The glycogen and mucopolysaccharide content increased in the infected sheep. Histopathological changes were the formation of fibrotic capsules around biliary tracts and portal vein and also leaky liver was marked in all the sections examined. Meanwhile, pre-malignant changes were seen in the different foci, particularly around the biliary tracts and portal veins. The histochemical structure of the hydatid cyst wall may pave the way for an effective therapeutic treatment

El desarrollo de recursos humanos / The development of health human resources

The purposes, objectives and strategies of WHO for the development of human resources are described and commented. The implication of this programme were emphasized in relation to the strategy of primary health care. The mediate and longterm plans are analyzed, underlining the fellowship activities and the training of academic personnel

Time constant of lung emptying

The force vital capacity [FVC] - time curves from 20 healthy volunteers and 20 patients with COPD were analysed semilogarithmically [log volume remaining in lungs against time by reading the curves at 0.1s intervals]. Important observations from this study are: [i] Volume-time curve for a forced expiration is biexponential in healthy subjects and in patients with moderate obstruction. [ii] A single exponential FVC-time curve is a typical finding in patients with severe obstruction. [iii] The intersection of the two exponentials occurs at a remaining volume that may correspond to the point of dynamic airway compression and it shifts towards lower lung volume in obstruction determining the degree of air trapping. [iv] Both regions of the bronchial tree corresponding to FEF25 and FEF25-75% have a single time constant of 0.46s in healthy volunteers. There are two time constants [0.96 and 1.66 seconds] of peripheral regions of the bronchial tree corresponding to FEF25-75in patients with moderate obstruction. [v] The plot of time constant against the FEV1/FVC ratio shows a hyperbolic curve for the fast component [tau1] and a non-hyperbolic for the slow component [tau2]. [vi] the time constant [tau1] of The fast component seems to be independent from the lung volume, age, height and sex in contrast to tau2. Mean transit-time [MTT] seems to correspond more to the second time constant