Mycetoma at a tertiary care hospital in Saudi Arabia: Correlation of histopathological and clinical findings

Objective: To present the histopathological and clinical correlation of mycetoma among patients attending King Abdulaziz University Hospital between 1998-2013. Methods: The data of all histopathologically diagnosed mycetomas in the period between January 1998 and January 2013 were collected through a computerized database search of the anatomic pathology archives at King Abdulaziz University Hospital. The collected data were analysed. Identification of species were performed for five patients using 16S ribosomal DNA and internal transcribed spacer 2. Results: There were 19 patients with mycetoma with an average age of 44.26 years and male: female ratio of 4:1. Actinomycetoma were 63.15% and eumycetoma were 36.84%. All patients presented with the classic lesions; presenting as painless subcutaneous mass, sinuses and discharge containing grains. The swellings were of slow evolution, with preferential foot localization. Species specification performed for samples from five patients with active lesions revealed species of Actinomyces israelii and Madurella mycetomatis in respective cases. Conclusions: Actinomycetoma is more common than eumycetoma in this region. The fact that one of the patients with eumycetoma was a Saudi national raises the possibility of an indigenous species similar to Maduraella mycetomatis to be further explored for characteristics and pathogenesis. The disease has to be prioritized again and more robust and quick molecular diagnostic tools should be made available in order to save patients form disfiguring amputations.

Frequency of overactive urinary bladder in females and assessment of gynaecological and obstetrical risk factors for its worsening

To estimate frequency of overactive urinary bladder in females and to assess gynaecological and obstetrical risk factors worsening the overactive bladder compromising quality of life. Cross- sectional survey. Liaquat National Hospital and Medical College Karachi, from August to November 2009. Females visiting different outpatient departments for medical and non-medical reasons were interviewed after informed verbal consent. They filled-up pre-designed questionnaire V-8 validated by ICS for primary screening of overactive bladder [OAB] in population. Any related obstetrical and gynaecological condition were also recorded. Five hundred and ten women were interviewed. The estimated frequency of OAB was 23.28% [n=144]. Age related changes were significant as high scores of OAB found in multiparous women and with advancing age. It was also related to history of vaginal prolapse, sexual activity and obesity. Overactive bladder adversely affected quality of life, but very few women sought treatment for it. A quarter of women interviewed reported OAB which affected their daily routines but no treatment was taken

Pattern of cutaneous melanoma at King AbdulAziz university hospital, Jeddah, Saudi Arabia

This study was performed to determine the pattern of CM [cutaneous melanoma] among Saudi patients at King AbdulAziz University Hospital, Jeddah, Saudi Arabia. The analysis included 139 skin cancers histological diagnosed among Saudi patients between Jan 1995 and Jan 2011. Pattern of CM by age, sex and anatomic location was examined along with the possible risk factors implicated. Among the 139 cases of skin cancer in Saudis there were 16[11.5%] cases of CM. CM ranked as the fourth skin cancer in the order of frequency with a mean age of 52 years and equal gender distribution. The predominant pattern of distribution was acral 68.7%. Risk factors involved mainly were exposure to pesticides and history of high solar exposure in childhood. Incidence of CM continues to be remain relatively stable over a period of past two decades across different regions of the Kingdom which is contrary to the incidence and pattern of CM in the West. Risk factors other than UV radiation, such as occupational exposure to pesticides, variable UV radiation susceptibility, genetic predisposition could be involved among the Saudis

Frequency of urinary incontinence and the associated obstetric and gynaecological risk factors

To find out the frequency and associated obstetrical and gynaecological risk factors of urinary incontinence in women Cross-sectional study.Department of Obstetrics and Gynaecology Liaquat National Hospital Karachi, from August to November 2009. Women from various out-patient departments and waiting areas of the hospital were interviewed after taking an informed consent. The questionnaire covered demographic data, physical characteristics, gynaecological and obstetrical risk factors associated with symptoms of urinary incontinence. To find out the frequency and associated obstetrical and gynaecological risk factors of urinary incontinence in women. A total of 510 women [mean age of 35.4 year and parity 2.6] were studied. Out of the total women interviewed 234[45.9%] reported episodes of urinary incontinence. Urinary incontinence was found related to traumatic and operative vaginal births, pelvic organ prolapse, abdominal mass, smoking, obesity, old age and menopause. Urinary incontinence was the common complaint of women attending hospital out- patient clinics and those accompanying the patients. It was under-reported by the women although it affected their daily life. Only small proportion of women sought medical advice.

Mixed germ cell tumors: Experience of a single institution over past 15 Years

Malignant mixed germ cell tumors [MMGCT] are rare ,biologically diversified and diagnostically challenging tumors. They arise in the gonads more frequently than at extragonadal sites and their individual constituents are the same in both gonads .In the testis they account for 40-45% of all primary testicular tumors .In the ovary an incidence between 12% to 28% is reported in literature. Extragonadal GCT [germ cell tumors] constitute nearly 3% of pediatric brain tumors and Germinomas alone account for approximately two thirds, of all GCT . Aim: The purpose of this retrospective study was to present the clinicopathological profile of these rare, less well studied and intriguing malignant mixed germ cell tumors [MMGCTs] in both genders and inclusive of gonadal and extra gonadal locations. All primitive germ cell tumors inclusive of both genders and all sites were retrieved from the archives of the Anatomical Pathology Department at King AbdulAziz University Hospital,Jeddah between 1995-2010 through a computerized search. A total of 28 primitive GCTs were retrieved in both genders and in all locations. Nineteen [67.85%] of the tumors were pure germ cell type. MMGCTs were 9 [32.14%] of all primitive GCTs with a mean age of 21.22 years. Of the 9 MMGCTs in both genders that were studied further 7[25%] were gonadal and 2[7.14%] were extra-gonadal [intracranial] in location . Five [17.85%] were testicular MMGCTs with a mean age of 23.6 years. Two [7.14%] were ovarian MMGCTs with a mean age of 27 years. Two [7.14%] cases were extragonadal [intracranial] in location and both the patients were pediatric males with a mean age of 9.5 years. Clinical, radiological, demographic origin, pathological characteristics and immunohistochemical profile of all MMGCTs are presented along with review of literature. Malignant germ cell tumors are rare and our findings suggest that MMGCTs in general have a favourable prognosis regardless of histological constituents or location and despite a higher clinical stage

Wilms tumor: the experience of the anatomic pathology department at king abdul aziz university hospital, Jeddah, Saudi Arabia

The aim of this study was to compare clinico-pathological features of Wilms tumor with those reported in literature and explore the possibility of any significant correlations not documented earlier. We retrospectively reviewed 10 cases of Wilms tumor. Surgical material was obtained by nephrectomy specimens that were grossly described and adequately sampled. Diagnosis was made on routine paraffin sections using hematoxylin and eosin stain and examining under light microscope. The tumors were sub -classified according to NWTS classification protocol. WT accounted for 90.9% of pediatric primary renal malignant tumors. All patients were male and the median age was 1.5 years. The most common clinical presentation was abdominal mass in all cases with variable additional features of abdominal pain, weight loss, vomiting hematuria and fever. Histologically. Classic triphasic pattern was found in all cases. The commonly found heterologous structures were skeletal muscles. All the cases revealed favorable histology. The frequently found features were younger age at presentation, abdominal mass and favorable histology which is suggestive of a correlation between the presenting age of less than 2 years, favorable histology and better prognosis

Effect of various degrees of maternal hyperglycemia on fetal outcome

To find out the effect of various degrees of maternal hyperglycemia on fetal outcome. Comparative study. Obstetrics and Gynecology Department, Liaquat National Hospital Karachi, from August 2007 to August 2009. The preponderance of maternal obesity, increasing maternal age and multiparity had strong association with the development of diabetes. In cases of unplanned pregnancies, the prepregnancy blood sugar levels are usually not known, therefore type II diabetes mellitus [DM] some times 1st diagnosed during pregnancy. GCT, Maternal hyperglycemia, Fetal outcome. Healthy pregnant women with no co-morbids attending antenatal clinic were subjected to glucose challenge test [GCT] with 50 gm load of glucose in their 2nd trimester of pregnancy regardless of previous meal. Patients with established type II diabetes mellitus and pregnancies with medical disorders were excluded from study. Patient data was collected on predesigned performa and analyzed on SPSS 15 version. A total of 228 antenatal women enrolled in the study. Higher rate of cesarean section were noted among women with gestational diabetes mellitus [GDM-68%] as compared to 45.2% and 46.8% [p 0.009] with mild gestational hyperglycemia [MGH] and control groups. Normal babies in GDM were 44% [p<0.001] while neonatal intensive care unit [NICU] admissions were significantly higher in GDM babies [54.7% p<0.001], as compared to other two groups. Rate of premature births in GDM mothers was higher than MGH and control. Gestational age of babies at birth for GDM was 36.4 +/- 2.1 weeks as compared to MGH [38.1 +/- 1.2 weeks] and control groups [37.8 +/- 1.9 weeks]. The preponderance of maternal obesity, increasing maternal age and multiparity had strong association with the development of diabetes. In cases of unplanned pregnancies, the prepregnancy blood sugar levels are usually not known, therefore type II diabetes mellitus [DM] some times 1st diagnosed during pregnancy

Histiocytoid breast carcinoma: a diagnostic delimma, case report and literature review

Histiocytoid carcinoma of the breast is a very rare neoplasm and has not been categorically classified so far. Reported cases support either a apocrine, ductal or lobular origin.In this case report; we are presenting a rare case of histiocytoid carcinoma in a 48 year old Saudi Arabian woman who presented to our hospital with a gradually enlarging, tender and erythematous left breast mass Immunohistochemical profile, supportive of ductal origin is presented along with review of literature

Basidiobolomycosis: a case report

Basidiobolomycosis is a rare disease caused by the fungus Basidiobolus ranarum. Patients with Basidiobolus ranarum infection may present with subcutaneous, gastrointestinal, or systemic lesions. Recently, its etiologic role in gastrointestinal infections has been increasingly recognized. We report this case of gastrointestinal and retroperitoneal basidobolomycosis because of its rarity and also to emphasize the need to consider gastrointestinal and retroperitoneal basidiobolomycosis in the differential diagnosis of inflammatory bowel diseases, tuberculosis and malignancy