Unusual presentation of seborrheic keratosis: A case report of giant pigmented lesion on the forehead.

INTRODUCTION AND IMPORTANCE: Seborrheic keratosis (SK) is a common benign epidermal tumor usually presenting as small, non-pigmented lesions on the skin. However, giant SK presenting as a pigmented variant is a rare occurrences, with limited documented cases in medical literature. CASE PRESENTATION: Here, we present a case report of a 70 year old female patient with an unusual giant warty cutaneous lesion prompting excisional biopsy. Histopathological examination revealed pigmented proliferative basaloid cell and pseudohorn cysts, characteristic of SK. Notably, the lesion exhibited pigmentation, adding to the rarity of the giant forms of SK case. CLINICAL DISCUSSION: Giant pigmented seborrheic keratosis (GPSK) is an uncommon form that shares clinical and dermatoscopic features, frequently causing misdiagnosis as malignant melanoma. CONCLUSION: Thus this report underscores the importance recognizing such atypical presentations of SK and highlights the need for histological evaluation to diagnose such variants.

Recurrent Intrahepatic Cholestasis of Pregnancy with History of Fetal Demise.

Intrahepatic cholestasis of pregnancy (ICP) is a rare, potentially fatal liver disorder that occurs in late pregnancy. It is characterized by pruritus, jaundice, and elevated liver enzymes, with spontaneous relief of signs and symptoms after birth. Early detection and treatment are required due to the potential risk of fetal complications, including fetal death. A 30-year-old woman with deeply icteric sclera and skin scratch marks presented to a gastroenterology-hepatology referral clinic. Her liver enzymes, bilirubin levels, and serum bile acid levels were all abnormally high. She also disclosed similar symptoms in her previous pregnancy, which resulted in fetal death at the sixth month. With a presumptive diagnosis of recurrent ICP, the patient was started on ursodeoxycholic acid (UDCA) pills, which significantly improved her pruritus and returned her bile acid levels to normalcy after 2 months of treatment. The delivery was uneventful. We believe that a proper diagnosis combined with UDCA treatment and vigilant obstetric follow-up significantly reduced the patient's symptoms and prevented a possible intrauterine death.

A glimpse at locally advanced melanomas in the settings of poverty: pathologist's viewpoint.

Cutaneous melanoma is the most aggressive cancer of the skin arising from pigment-producing cells, known as melanocytes. It is notorious for spreading early to distant locations. Survival of patients with melanoma largely depends on the thickness of the lesion at the primary site thus spotting it early is crucial. Early diagnosis of melanoma, with an improved quality of life and treatment outcomes, is being achieved in some developed nations through screening and health education. On the contrary, as practicing pathologists in a resource-scarce country, we frequently encounter patients with locally advanced melanoma manifesting as ulceration, bleeding, fungation, and bone erosion. Several factors, including low socioeconomic status, medical mistrust, inaccessibility of health facilities, and absent screening and surveillance services can be attributed to the delayed diagnosis. Therefore to alleviate the burden and complications caused by the late presentation of cutaneous melanoma, an urgent massive community mobilization, information campaigning, and the provision of accessible basic primary health care are urgently needed.

A rare presentation of Ludwig's angina with facial nerve palsy, case report.

INTRODUCTION AND IMPORTANCE OF CASE: Ludwig's angina is an inflammation of neck spaces making it immediately life-threatening. The infection spreads to adjacent planes destructing facial planes, aspirations of infective particles, or septic embolism to distant areas. Understanding the rare presentations will help early diagnosis and treatment. PRESENTATION OF CASE: This is about a 40 years-old man who presented with painful anterior neck swelling of 7 days duration. A diagnosis of Ludwig's angina with unilateral facial nerve paralysis and treated with immediate incision and drainage. CLINICAL DISCUSSION: Ludwig's may present clinical with a variety of complications. This complication may be related to ongoing sepsis or mass effects manifesting with airway compromise or nerve palsy. CONCLUSION: Although facial nerve palsy associated with Ludwig's angina is rare, it improves with immediate surgical decompression.

Sub-chronic toxicity of the aqueous leaf extract of Ocimum lamiifolium Hochst. ex Benth on biochemical parameters and histopathology of liver and kidney in rats: in vivo and in- silico toxicity studies.

BACKGROUND: The aerial part of Ocimum lamiifolium is commonly used in Ethiopian traditional medicine. Although this plant is mostly used in traditional medicine, its safety profile has not been documented yet. The aim of this study was to assess the sub-chronic toxicity of O. lamiifolium aqueous extract in rats and to determine the toxicity profile of GC-MS identified bioactive compounds obtained from essential oil of O. lamiifolium using in silico toxicity methods. METHODS: Eighty rats (40 male and 40 female) were randomly assigned to four groups of ten rats per sex/group. For 90 days, Groups I-III received 200, 400, and 600 mg/kg bw of aqueous extract of O. lamiifolium, respectively. Distilled water was given to Group IV (control). Clinical observations, food intake, and rat weight were all recorded during the experiment. In addition, several biochemical parameters, organ weight, and histology of the liver and kidney were all evaluated. For the in-silico toxicity study, GC-MS identified bioactive compounds in O. lamiifolium essential oil were obtained from published articles. The compounds two-dimensional structures were constructed using Chemdraw. The two-dimensional structures were converted into a simplified molecular input line entry system (SMILES) using the Swiss ADMET web tool. Furthermore, the toxicity parameters were predicted using the ProTox II server. RESULTS: The administration of an aqueous extract of O. lamiifolium leaves significantly (p < 0.05) reduced the test animals' food intake and body weight gain. In the high dose (600 mg/kg bw) treated group, the serum alanine aminotransferase, aspartate aminotransferase, and alkaline phosphatase levels were significantly increased (p < 0.05). In female rats given 600 mg/kg bw of O. lamiifolium, the levels of serum urea were also increased. In addition, rats given 600 mg/kg bw had significantly lower blood glucose levels than the control group (p < 0.05). Doses up to 400 mg/kg bw didn't bring a significant change to the histology of the liver. However, in the high dose (600 mg/kg bw) treated group, some female rats' livers showed mild sinusoidal and central vein dilatation, as well as parenchymal necrosis. our findings showed that all compounds derived from the essential oil of O. lamiifolium showed no mutagenicity or cytotoxicity. However, 30% of the compounds tested were hepatotoxic, 20% carcinogenic, and 20% immunotoxin. CONCLUSION: Our findings showed that oral administration of O. lamiifoliums aqueous extract up to a dose of 400 mg/kg bw is not toxic. However, high-dose (600 mg/kg bw) significantly affected the food consumption and weight gain of the experimental rats and the serum concentration of some liver and kidney enzymes were also significantly increased. Additionally, a considerable proportion of the tested compounds were predicted to be hepatotoxic, carcinogenic and immunotoxin. Furthermore, before employing O. lamiifolium preparations as drugs, a chronic toxicity research on the essential oil as well as its components that exhibited toxicity in the in-silico toxicity study is needed. Finally, use high doses of O. lamiifolium leaves with caution.

Breast hydatid cyst presented as a fluctuant painless lump mimicking galactocele: A case report.

Hydatid disease is a zoonosis caused by the Echinococcus species. The liver and lungs are where it generally seen, with breast involvement being extremely uncommon. This is a case of a woman aged 28 years who presented with a progressive painless swelling on the left breast, which was fluctuant and nontender, detected on the upper outer quadrant. The cytologic evaluation yielded a crystal-clear fluidal aspirate composed of a few laminated metachromatic materials and the mass sonographically appeared as an anechoic cystic mass having a double-layered wall with posterior acoustic enhancement. A radical pericystectomy was performed after the preoperative diagnosis of breast hydatid cyst was entertained, and the diagnosis was later confirmed by histopathology. Although isolated breast hydatid cysts are uncommon, they can happen and may mimic other cystic and solid masses of the breast clinically. Thus, radiologic assessment with cytopathologic correlation is imperative for precise preoperative diagnosis and to minimize the risk of intraoperative complications.

Clinicoepidemiologic considerations in the diagnosis of tuberculous lymphadenitis: evidence from a high burden country.

OBJECTIVES: Tuberculosis is the biggest health issue worldwide, with tuberculous lymphadenitis (TBL) being its most common extrapulmonary manifestation. Clinical diagnoses of TBL often pose challenges; thus, this study aimed to analyze the clinical, epidemiologic, and laboratory aspects of TBL in Debre Markos Specialized Comprehensive Hospital, northwest Ethiopia. METHODS: The study was conducted at Debre Markos Specialized Comprehensive Hospital from October 2019 to March 2021. Patients with lymphadenitis displaying cytomorphologic features of tuberculosis were enrolled. A checklist was used to collect clinicodemographic data. RESULTS: Among a total of 294 patients with TBL, 237 (80.61%) were adults aged 15-45 years. A fluctuant consistency (177; 60.20%; n = 294) with predominant involvement of cervical lymph nodes (229; 77.8%) was the most frequent presentation. Most patients did not have either HIV infection (235; 94.37%; n = 261) or known chronic medical illnesses (250; 95.8%). Constitutional symptoms (113; 41.85%; n = 270) and chronic cough (56; 20.74%; n = 270) were infrequent. The erythrocyte sedimentation rate (ESR) was increased in the majority of patients (133; 80%; n = 165), of whom extreme elevation (≥100 mm/hour) seen in 63 (38.18 %) patients and the mean ESR for our participants was 78.64 mm/hour. CONCLUSION: TBL typically presents as a fluctuant neck mass, predominantly in young adults. The majority of patients have no constitutional symptoms or cough. HIV infection or chronic medical illnesses are uncommon. The raised erythrocyte sedimentation rate is a fairly consistent finding.

Early onset, delayed diagnosis and laterality of breast carcinoma: Evidence from a tertiary care hospital.

Objectives: To assess age at onset, delayed diagnosis and laterality of breast carcinoma among women at Debre Markos Comprehensive Specialized Hospital, North West Ethiopia. Methods: Hospital-based descriptive study was conducted on 120 breast carcinoma cases at pathology department of Debre Markos Comprehensive Specialized Hospital, from October 2019 to December 2021. The women aware of symptoms until first medical consultation time was asked. The height and weight of the women were measured using the height and weight scale. The attending physician examined both breasts and regional lymph nodes. Pathological features of breast carcinomas were recorded when biopsy results arrived at the pathology department. Data were entered in Epi data version 3.1. Then, it was exported to SPSS version 25.0 statistical software for analysis. Results: Mean age of women was 39.9 ± 11.6 years, and median age was 38 years. Most women, 87 (72.5%) were aged less than 46 years. One hundred three (85.8%) women had complained breast lump pain for greater than 3 months before diagnosis. About 61 (50.8%) women had left breast carcinomas; 44 (36.7%) had right breast carcinomas and 15 (12.5%) had bilateral breast carcinomas. Of total, 53 (44.2%) cases were invasive ductal carcinomas; 41 (34.2%) had ductal carcinoma in situ; 14 (11.7%) were invasive lobular carcinomas; 8 (6.7%) were lobular carcinoma in situ and only 4 (3.3%) cases were mixed carcinomas. Conclusion: In this study, about two-third of the cases had early onset breast carcinoma. Most of the cases had delayed diagnosis of breast carcinoma. More than half of the cases had left breast carcinoma.

COVID-19 Vaccine: Side Effects After the First Dose of the Oxford AstraZeneca Vaccine Among Health Professionals in Low-Income Country: Ethiopia.

PURPOSE: The Oxford-AstraZeneca is one of COVID-19 vaccine which is expected to be mass-produced and plays a critical role in controlling the pandemic that the globe faced. Ethiopia launched the AstraZeneca vaccination and planned to vaccinate 20% of the population by the end of 2021. Health care professionals are one of the eligible groups of the community to receive the vaccine with priority. Although individuals are advised to take the vaccine to protect themselves and the people around them from COVID-19 infection, many are doubtful about the consequences of the vaccine. So, this study assessed the immediate symptoms associated with taking the Oxford-AstraZeneca COVID-19 vaccine. METHODS: This online study was conducted from April 15 to 30, 2021 at a national level across health care providers who took their first dose of Oxford-AstraZeneca vaccine in Ethiopia. RESULTS: There were 672 study participants engaged in this study and around 75.8% of health care providers who took the vaccine had injection site symptoms like pain (65.48%) and tenderness (57.89%). Most of them (60%) developed their injection site symptom within 12 hours after vaccination and the symptoms lasted for about 24-72 hours on most (63.53%) of the participants. Mild symptoms were identified among 70.98% of the study participants; tiredness and headache were the most reported symptoms with 52.08% and 50.15%, respectively. Only 6.1% of participants reported severe symptoms. CONCLUSION: As like that of other vaccines, the Oxford-AstraZeneca COVID-19 vaccine has some adverse effects and most side effects peaked within the first 24 hours following vaccination and usually lasted 1-3 days. Severe symptoms were uncommon, but they were found to be a major reason why vaccine recipients did not recommend it to others and did not plan to take their second dose. After receiving the COVID-19 vaccination, recipients should be advised about potential vaccine symptoms, how to handle them, and when and where to seek additional guidance if necessary.