[Bilateral tuberculous dacryoadenitis: about a case]

La dacryoadénite tuberculeuse est une inflammation rare de la glande lacrymale causé par le bacille Mycobacterium tuberculosis. Elle pose un problème étiopathogénique et diagnostique. Nous rapportons dans cette observation le cas d'une dacryoadénite tuberculeuse bilatérale chez un jeune homme Marocain de 34 ans ayant présenté une tuberculose ganglionnaire et du cavum il y à 14 ans, ayant été confirmé par l'examen anatomopathologique. La tuberculose reste un diagnostic qui doit être toujours évoqué même dans les atteinte bilatérale surtout si il y a un antécédent personnel ou familiale positif de tuberculose. Le pronostic de cette affection est devenu favorable grâce au traitement antibacillaire précoce.

A qualitative systematic review of the prevalence of coronary artery disease in systemic sclerosis

AIMS

To review existing literature on the prevalence/incidence of coronary artery disease (CAD), and secondarily highlight risk factors for CAD in systemic sclerosis (SSc).

METHODS

A PubMed and Cochrane Central Register of Controlled Trials search of studies (till 30 November 2013) relating to SSc and CAD was performed, retrieving 180 titles.

INCLUSION CRITERIA

studies reporting CAD prevalence/incidence in SSc based on autopsy findings, coronary artery calcium scores, coronary angiographic findings and physician/patient-reported CAD.

EXCLUSION CRITERIA

(i) not written in English; (ii) not concerned with human subjects; (iii) single case reports or review articles; (iv) genetic studies; and 95) other surrogate outcome measures of atherosclerosis. Quality assessment was done using the Newcastle-Ottawa score (range 0-9).

RESULTS

Thirteen studies (Newcastle-Ottawa score 5-8) were selected. Of eight studies with controls, seven reported increased CAD prevalence (10-56%) or incidence (2.3%) compared to controls (prevalence 2-44%; incidence 1.5%). Of five studies without controls, CAD prevalence was 8-32%. Five of six studies reported that traditional cardiovascular risk factors were similar/reduced in SSc compared to controls. SSc was an independent risk factor for CAD, in addition to age (n = 2), hypercholesterolaemia (n = 3), male gender (n = 1), hypertension and diabetes (n = 1). Disease duration, renal involvement and pulmonary arterial hypertension were associated with CAD.

CONCLUSIONS

Systemic sclerosis is associated with an increased prevalence/incidence of CAD. SSc is an independent risk factor for CAD. The association of CAD with SSc-related factors requires further research. Meanwhile, patients with SSc should be screened and treated for identified traditional cardiovascular risk factors.

Identification of suitable reference genes for gene expression studies using quantitative polymerase chain reaction in lung cancer in vitro

The present study aimed to examine 10 housekeeping genes (HKGs), including 18s ribosomal RNA (18S), glyceraldehyde‑3‑phosphate dehydrogenase (GAPDH), ribosomal protein large P0 (RPLP0), β‑actin (ACTB), peptidylprolyl isomerase A (PPIA), phosphoglycerate kinase‑1 (PGK1), β‑2‑microglobulin (B2M), ribosomal protein LI3a (RPL13A), hypoxanthine phosphoribosyl transferase‑1 (HPRT1) and TATA box binding protein (TBP) in order to identify the most stable and suitable reference genes for use in expression studies in non‑small cell lung cancer. The mRNA expression encoding the panel of the 10 HKGs was determined using reverse transcription‑quantitative PCR (RT‑qPCR) in human lung cancer cell lines. Three software programs, BestKeeper, NormFinder and geNorm, were used to ascertain the most suitable reference genes to normalize the RNA input. The present study examined three lung cancer cell lines (A549, NCI‑H446 and NCI‑H460). The analysis of the experimental data using BestKeeper software revealed that all 10 HKGs were stable, with GADPH, followed by 18S being the most stable genes and PPIA and HPRT1 being the least stable genes. The NormFinder software results demonstrated that PPIA followed by ACTB were the most stable and B2M and RPLP0 were the least stable. The geNorm software results revealed that ACTB and PGK1, followed by PPIA were the most stable genes and B2M and RPLP0 were identified as the least stable genes. Due to discrepancies in the ranking orders of the reference genes obtained by different analyzing software programs, it was not possible to determine a single universal reference gene. The suitability of selected reference genes requires unconditional validation prior to each study. Based on the three analyzing programs, ACTB, PPIA and PGK1 were the most stable reference genes in lung cancer cell lines.

Population survey and conservation assessment of the globally threatened cheer pheasant (Catreus wallichi) in Jhelum Valley, Azad Kashmir, Pakistan

The cheer pheasant Catreus wallichi is a globally threatened species that inhabits the western Himalayas. Though it is well established that the species is threatened and its numbers declining, updated definitive estimates are lacking, so in 2011, we conducted a survey to assess the density, population size, and threats to the species in Jhelum valley, Azad Kashmir, which holds the largest known population of cheer pheasants in Pakistan. We conducted dawn call count surveys at 17 points clustered in three survey zones of the valley, 11 of which had earlier been used for a 2002-2003 survey of the birds. Over the course of our survey, 113 birds were recorded. Mean density of cheer pheasant in the valley was estimated at 11.8 ± 6.47 pairs per km², with significant differences in terms of both counts and estimated density of cheer were significantly different across the three survey zones, with the highest in the Chinari region and the lowest, that is the area with no recorded sightings of the pheasants, in Gari Doppata. The total breeding population of cheer pheasants is estimated to be some 2 490 pairs, though this does not consider the actual area of occupancy in the study area. On the whole, more cheer pheasants were recorded in this survey than from the same points in 2002-2003, indicating some success in population growth. Unfortunately, increasing human settlement, fires, livestock grazing, hunting, and the collection of non-timber forest products continue to threaten the population of cheer in the Jhelum valley. To mitigate these potential impacts, some degree of site protection should be required for the conservation of cheer pheasants in Pakistan, and more effective monitoring of the species is clearly needed.

Thermoluminescence responses of the Yb- and Yb-Tb-doped SiO2 optical fibers to 6-MV photons

Characteristics of the thermoluminescence (TL) responses of Yb- and Yb-Tb-doped optical fibers irradiated with 6MV photons are reported. The concentration of Yb in the Yb-doped optical fiber was 0.26mol%; the concentrations of Yb and Tb in the Yb-Tb-doped optical fiber were 0.62 and 0.2mol%, respectively. The TL dose responses are linear in the dose range 0.5-4Gy. The radiation sensitivity of the Yb-Tb material is almost two orders of magnitude higher than the sensitivity of the material doped with Yb alone.

Budesonide loaded nanoparticles with pH-sensitive coating for improved mucosal targeting in mouse models of inflammatory bowel diseases

The purpose of this study was to investigate the therapeutic potential of budesonide loaded nanocarriers for the treatment of inflammatory bowel disease (IBD). First, budesonide was encapsulated in poly(lactic-co-glycolic) acid (PLGA) nanoparticles by an oil in water (O/W) emulsion technique. A second batch of the same nanoparticles was additionally coated with a pH-sensitive methyl-methacrylate-copolymer. The particle sizes of the plain and the coated PLGA were 200±10.1nm and ~240±14.7nm, respectively. As could be shown in vitro, the pH-sensitive coating prevented premature drug release at acidic pH and only releases the drug at neutral to slightly alkaline pH. The efficacy of both coated and plain nanoparticle formulations was assessed in different acute and chronic colitis mouse models, also in comparison to an aqueous solution of the drug. The dose was always the same (0.168mg/kg). It was found that delivery by coated PLGA nanoparticles alleviated the induced colitis significantly better than by plain PLGA particles, which was already more effective than treatment with the same dose of the free drug. These data further corroborate the potential of polymeric nanocarriers for targeted drug delivery to the inflamed intestinal mucosa, and that this concept can still be further improved regarding the oral route of administration by implementing pH-dependent drug release characteristics.

Beyond pregnancy--the neglected burden of mortality in young women of reproductive age in Bangladesh: a prospective cohort study

OBJECTIVE

To describe proportionate mortality and causes of death unrelated to pregnancy.

DESIGN

Prospective cohort study.

SETTING

Rural northwest Bangladesh.

POPULATION

A cohort of 133,617 married women of reproductive age.

METHODS

Verbal autopsies were conducted for women who died whilst under surveillance in the cohort trial. Physician-assigned causes of death based on verbal autopsies were used to categorise deaths.

MAIN OUTCOME MEASURES

The proportion of deaths due to non-communicable diseases, infectious diseases, injury or pregnancy.

RESULTS

Of the 1107 deaths occurring among women between 2001 and 2007, 48% were attributed to non-communicable diseases, 22% to pregnancy, 17% to infections, 9% to injury and 4% to other causes.

CONCLUSIONS

Although focus on pregnancy-related mortality remains important, more attention is warranted on non-communicable diseases among women of reproductive age.

[Marcus Gunn Syndrome. Study of 3 rare cases]

PURPOSE

reporting three rare cases of Marcus Gunn Syndrome and analyzing the clinical features of this entity.

METHODS

Case reports of three patients with a Marcus Gunn Syndrome, treated at the Ophthalmology B CHU service Rabat - Morocco.

RESULTS

Our patients are two boys aged 1 and 2 years old, and a 31 year old woman with a Marcus Gunn Syndrome. As special features, in the boys' cases this syndrome is bilateral, as for the other case it is associated with congenital fibrosis clinically predominant of the Ipsilateral inferior rectus muscle in an adult. Surgical treatment was not offered for children because of their young age. The adult patient has benefited from a recession of the inferior rectus muscle and a pleating in the superior rectus muscle. The forced duction test objectified a fibrosis of the inferior rectus muscle. Surgical correction of Ptosis and Synkinesis has not been indicated in this patient, given the residual oculomotor disorder and the risk of exposure keratitis.

CONCLUSION

Marcus Gunn Syndrome is exceptional in adults. This can be explained by the tendency of the lid retraction to fade with age. Bilateral involvement in Marcus Gunn Syndrome is rare. Its association with congenital fibrosis of extraocular muscles has allowed a better etiopathogenic approach highlighting a supra nuclear origin of this Syndrome.

Development of an adhesive surgical ward round checklist: a technique to improve patient safety

Checklists have been shown to improve patient outcomes. Checklist use is seen in the pre-operative to post-operative phases of the patient pathway. An adhesive checklist was developed for ward rounds due to the positive impact it could have on improving patient safety. Over an eight day period data were collected from five consultant-led teams that were randomly selected from the surgical department and divided into sticker groups and control groups. Across the board percentage adherence to the Good Surgical Practice Guidelines (GSPG) was markedly higher in the sticker study group, 1186 (91%) in comparison with the control group 718 (55%). There was significant improvement of documentation across all areas measured. An adhesive checklist for ward round note taking is a simple and cost-effective way to improve documentation, communication, hand-over, and patient safety. Successfully implemented in a tertiary level centre in Dublin, Ireland it is easily transferable to other surgical departments globally.

A meta-analysis of outcomes after open and laparoscopic Nissen's fundoplication for gastro-oesophageal reflux disease in children

The objective of this study is to meta-analyse the published literature comparing outcomes after open (ONF) versus laparoscopic Nissen fundoplication (LNF) for gastro-oesophageal reflux disease in children. Electronic databases were searched from January 1993 to October 2009. A systematic review was performed to obtain a summative outcome. Six comparative studies were analysed. There were 466 patients in the laparoscopic group and 255 in the open group. There was no significant difference in operative time between LNF compared with ONF (p = 0.35). Children stayed in hospital for less time after undergoing LNF compared with ONF [random effects model: SMD = 0.93, 95% CI (0.41, 1.44), z = 3.53, p < 0.01]. Children feed earlier after LNF [random effects model: SMD = 4.13, 95% CI (1.00, 7.27), z = 2.58, p < 0.001] and had less morbidity [fixed effects model: RR = 3.22, 95% CI (1.98, 5.25), z = 4.71, p < 0.01; random effects model: RR = 2.90, 95% CI (1.49, 5.66), z = 3.12, p < 0.01]. No difference in recurrence at 12 months was highlighted (p = 0.29). In conclusion, the laparoscopic Nissen's fundoplication in children may be considered a safe and effective alternative to open surgery; however, careful case selection is required.

Profile of drug users in Karachi City, Pakistan

Drug use has been identified as a major public issue in Pakistan. A descriptive questionnaire survey in Karachi city was made to identify the socioeconomic profile and beliefs and practices of 500 drug users The most commonly used drugs were cocaine (19.0%) and crack-cocaine (15.0%), followed by amphetamine, (11.0%), alcohol, caffeine, barbiturates and benzodiazepines (10.0% each). Key psychological factors leading tc drug use were problems with parental or marital relations or break-up of a relationship (45.0%). Drugs were seer as an escape from stressful life events (28.0%) or feelings of failure (18.2%). Many drug users blamed the origin of their drug use on bad social influences (47.0%) or socioeconomic problems (23.4%). Preventive measures are needed to decrease the rate of drug addiction in Karachi.

Treatment-related toxicities in patients with squamous cell carcinoma of the head and neck (SCCHN)

e17041

Background: Although treatment effects and toxicities have been reported from randomized clinical trials of patients with squamous cell carcinoma of the head and neck (SCCHN), little information is available from real-world clinical practice where heterogeneous treatment patterns and patient populations may lead to different estimates than those observed in clinical trials. Methods: Using a population-based tumor registry at a large, Midwestern integrated health system, we identified all cases of stage III or IV SCCHN diagnosed 2000–2006. The incidence/severity of acute and late toxicities associated with SCCHN treatment was obtained from detailed medical record review of health system encounters, including physician notes. Grading of toxicities (using CTCAE3 criteria), distinction between acute and late toxicity, and analyses by treatment are ongoing. The incidence and severity of toxicities will be presented by treatment regimen, tumor location and tumor stage. We presented here an interim analysis. Results: Among the target population of 194 patients that will ultimately be included in this study, 137 medical record reviews have been completed to date. The percentages of patients with toxicities, including 95% confidence intervals are presented in the table , below. Conclusions: Toxicity in patients with advanced SCCHN is common. Data from clinical practice quantifying the incidence are lacking, these data from an observational real-world study provide important baseline information on the incidence of toxicities in patients with advanced SCCHN and also call for safer effective treatment for SCCHN.

[Table: see text]

[Table: see text]

Jaundice in falciparum malaria; changing trends in clinical presentation--a need for awareness

OBJECTIVES

To describe the clinical characteristics, laboratory parameters and prognostic factors in patients with falciparum malaria (FM) with jaundice.

METHODS

A cross-sectional comparative study was conducted at the Department of Medicine, medical unit II, Jinnah Postgraduate Medical Centre, Karachi. Adult patients with jaundice and smear positive plasmodium falciparum infection, who fulfilled the inclusion criteria were selected for the study from amongst all cases of FM who presented during the study period. Patients were divided in to two groups on the basis of rising bilirubin and adverse outcome. The data was analyzed on SPSS ver 12. Results were expressed as, percentages, mean and standard deviations. P-value < 0.05 was taken as significant.

RESULTS

Among 76 patients of FM, 35 (46.05%) developed jaundice. Fifteen (42.86%) patients had bilirubin 3-10 mg/dl while 20 (57.14%) had bilirubin > 10 mg/dl. Comparative analysis of the groups showed that elevation of ALT and AST was modest in comparison with conjugated hyperbilirubinaemia while prolonged duration of illnes impaired consciousness, hepatomegaly, acute renal failure with deranged renal parameters, low platelet counts and high parasite density were significantly associated with rising bilirubin and adverse outcome. Twenty-one (60%) patients recovered completely while 14(40%) succumbed to the disease.

CONCLUSION

FM is one of the causes of severe jaundice in adults in this part of the world. This presentation of complicated FM needs to be recognized globally in order to institute prompt and specific therapy. Delayed diagnosis and inappropriate treatment is the leading cause of complications and increased mortality in FM.

Parasite density and the spectrum of clinical illness in falciparum malaria

OBJECTIVE

To determine the impact of percentage parasitemia and clinical features on morbidity and mortality in patients with P. falciparum malaria.

STUDY DESIGN

Case series.

PLACE AND DURATION OF STUDY

Department of Medicine, Medical Unit II, Jinnah Postgraduate Medical Centre, Karachi, Pakistan from May to November 2005.

PATIENTS AND METHODS

Seventy-six adult patients of smear positive P. falciparum malaria were selected for the study. Parasite density was estimated on thin blood film and expressed as percentage of red blood cells parasitized. Patients were divided into three groups on the basis of parasite density. The data was analyzed on SPSS version 12. Results were expressed as percentages, mean and standard deviations. P-value <0.05 was taken as significant.

RESULTS

Data of 76 study patients who fulfilled the inclusion criteria was analyzed on the basis of parasite density. Thirty-one (40.79%) patients had parasite density < 5%, 22 (28.95%) had parasite densities between 5% and 10% and 23(30.26%) patients had parasite density >10%. Comparative analysis of the groups showed that pallor, impaired consciousness, jaundice or malarial hepatitis, thrombocytopenia, acute renal failure, DIC, and mortality were all strongly associated with the density of Plasmodium falciparum malaria (p=0.001). Parasite density was not related to age, gender and hepatosplenomegaly.

CONCLUSION

High parasite density was associated with severe clinical illness, complications and mortality. Parasite counts of > 5% may be considered as hyperparasitaemia in this population of the world.