Falciparum Malaria Presenting With Tetany: Endocrinopathies Associated With Falciparum Malaria.

Malaria is a common public health problem which may have high morbidity and mortality. Physicians should be aware of the unusual presentations of this disease so that it can be timely diagnosed and treated. Herein we are presenting a case of falciparum malaria who presented to the hospital with carpopedal spasm and tetany. We will subsequently discuss mineral homeostasis and the mechanisms of hypocalcaemia in falciparum malaria and the dysregulation of calcium, phosphorus and magnesium metabolism.

Crimean-Congo haemorrhagic fever presenting with acute compartment syndrome of the extremities (think beyond normal infections).

Crimean-Congo haemorrhagic fever (CCHF) is a viral zoonosis transmitted to humans and animals (which act as a reservoir) through the bite of a 'Hyalomma' tick. CCHF virus belongs to the genus Nairovirus Humans are infected when they come in direct contact with the blood or secretions of infected livestock or other infected humans. This disease initially presents with non-specific febrile symptoms common to many viral illnesses and later progresses to disseminated intravascular coagulation (DIC) with haemorrhagic manifestations.We present the case of a middle-aged man with CCHF. He presented to the hospital with DIC and acute compartment syndrome in the right forearm, requiring urgent orthopaedic intervention. The diagnosis was delayed because there was no clear history of contact. The patient was started taking ribavirin on the fifth day of hospital admission. He recovered fully.

Clinical value of peripheral blood M2/M1 like monocyte ratio in the diagnosis of breast cancer and the differentiation between benign and malignant breast tumors.

BACKGROUND: During tumor progression, circulating monocytes and macrophages are actively recruited into tumors where they alter the tumor microenvironment to accelerate tumor progression. In response to multiple microenvironmental signals from the tumor and stromal cells, macrophages change their functional phenotypes. Based on their function, macrophages are commonly classified into both, classical M1 and alternative M2 macrophages. M2-like tumor-associated macrophages promote breast tumor growth and survival, and may migrate into the peripheral blood. However, the level of circulating M2/M1-like monocyte ratio in the peripheral blood of breast cancer patients has not been yet clarified. AIM: To compare peripheral blood M2/M1 monocyte ratio among breast cancer patients, benign breast tumor patients and healthy subjects. Also, to investigate the role of peripheral blood M2/M1 monocyte ratio as a circulating breast cancer tumor marker and to asses the validity of this marker in differentiation between benign and malignant breast tumors. METHODS: Flow cytometry technique was used to determine the peripheral blood M2/M1 monocyte ratio in three groups of subjects, i.e. 45 patients with breast cancer, 40 patients with benign breast tumor, and 40 healthy subjects as a control group. The results of carbohydrate antigen15-3 (CA15-3) determination were analyzed comparatively. RESULTS: The peripheral blood M2/M1 monocyte ratio in patients with breast cancer (0.27±0.1) was significantly higher (P<0.001) than that in healthy subjects (0.07±0.05) and than in benign tumor subjects (0.08±0.04). The area under the receiver operating characteristic (ROC) curve of peripheral blood M2/M1 monocyte ratio determination was significantly higher (P≤0.001) than that of CA15-3 levels. CONCLUSION: M2/M1-like monocyte ratio is of a high diagnostic value for breast cancer and is a promising differentiating marker between benign and breast cancer tumor groups.

Hodgkin's lymphoma. An immunohistochemical profile in northern Iraq.

OBJECTIVE: To evaluate the expression of several immunohistochemical markers in Hodgkin's lymphoma (HL), and to determine the relative frequency of HL subtypes. METHODS: 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. RESULTS: 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. CONCLUSION: 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.