External Fixation as a Primary and Definitive Treatment for Complex Tibial Diaphyseal Fractures: An Underutilized and Efficacious Approach

Background

External fixation is one of the most often utilized treatment options for complicated tibial diaphyseal fractures (TDF). The purpose of this study was to assess the efficacy of unilateral external fixators as primary and definitive therapy for complex TDF in a resource-limited setting.

Materials and Methods

A retrospective study between June 2016 and March 2021 included 110 subjects with TDF who were treated with an external fixator as definitive fixation in hospitals affiliated with Ibb University. The patient's demographic characteristics, complications, and outcomes were gathered and analyzed. Factors associated with pin site infection were also investigated.

Results

The mean age was 42.1 ± 10.1 years, with 92.7% being male. Rural residents accounted for 22.7%. Smoking and diabetes mellitus were present in 27.3% and 30.0%, respectively. General complications occurred in 12.0%, with pulmonary embolism being the most common at 4.5%. Orthopedic complications included pin-track infections in 27.3% (30) and osteomyelitis in 1.8% (2). Pin site infections required medical treatment in 21 cases and external fixator changes in five. Two cases each needed several debridements for osteomyelitis and soft tissue. Full union occurred in 79.1% (87) over 23.1 ± 3.2 weeks and final alignment in 97.3% (107) over 34.8 ± 4.8 weeks. Malunions occurred in 1.8% (2), and one case had hypertrophic nonunion. Factors like rural residency, smoking, diabetes, open fractures, worst fracture grade (Gustilo and Anderson type C), and general complications occurrence significantly correlated with pin site infection (all p-values < 0.05).

Conclusion

A unilateral external fixator as a primary and definitive treatment is a viable, simple, and effective option for TDF with a high success rate even in a resource-limited setting. In this study, residents in rural areas, smoking, diabetes, open fracture, worst fracture grade, and general complication occurrence were associated with pin site infection occurrence.

Major Histocompatibility Class-I (MHC-I) downregulation in glioblastoma is a poor prognostic factor but not a predictive indicator for treatment failure

BACKGROUND

MHC-I expression is a crucial factor in cancer immunity, and its regulations can impact tumor progression and recurrence. The mechanism through which glioblastoma use MHC-I to avoid immunosurveillance has been rarely investigated.

METHODS

A retrospective cohort of 35 patients with IDH-mutant WHO-Grade 4 astrocytoma and IDH-wildtype glioblastoma were examined for MHC-I using protein and gene expression assays. The association between IDH mutation, TP53 mutation, and MHC-I expression with recurrence-free interval were investigated.

RESULTS

The average patients' age was 49.6 year. IDH was wildtype in 13 tumors. MHC-I protein expression was absent in 30 tumors, faint in 4 tumors, and membrane bound dense expression in single tumor. MHC-I expression was upregulated in 10 tumors and 25 tumors showed MHC-I downregulation. P53 was positively expressed in 19 cases and lost in 13 cases. A significant statistical difference was observed in the RFI between tumors with distinct MHC-I expression and IDH-mutation [p-value = 0.008]. IDH-wildtype tumors with upregulated MHC-I expression showed late tumor recurrence compared to IDH-wildtype tumors with downregulated MHC-I expression. There was insignificant statistical difference in RFI among patients with varying degree of MHC-I expression, who received TMZ or TMZ and other chemotherapies [P-value = 0.44] CONCLUSIONS: Glioblastoma with upregulated MHC-I showed a delayed tumor recurrence in comparison to those with downregulated MHC-I expression. However, downregulated MHC-I may not necessarily be an indicator of poor problems.

A Case of Cardiac Arrest Due to Transcatheter Aortic Valve Infolding

Prosthetic valvular infolding during transcatheter aortic valve implantation (TAVI) is an under-recognized yet significant complication that can occur. Here, we describe the case of a 61-year-old male with a history of heart failure with reduced ejection fraction (HFrEF) and low-flow, low-gradient severe aortic valve stenosis of a bicuspid aortic valve who presented to undergo TAVI. During the procedure, repositioning of the valve resulted in prosthetic valvular infolding and resultant severe aortic regurgitation (AR), culminating in cardiac arrest. Swift balloon valvuloplasty corrected the valve geometry and eliminated any AR, allowing hemodynamic recovery and completion of the procedure. Our case and review highlight methods, both angiographic and echocardiographic, to recognize prosthetic valvular infolding the moment it presents, as well as strategies to correct the infolding with minimal detriment to the patient.

Salmonella enteritidis abdominal aorta mycotic aneurysm presented with acute cholestatic jaundice: A case report and literature review

Mycotic aneurysm is one of the extra-intestinal manifestations of Salmonella Enteritidis infection. The diagnosis of this condition is challenging owed to its variation in clinical presentations. We presented a case of a 54-year-old man with underlying diabetes mellitus and chronic smokers presented with acute right flank pain and fever associated with mild jaundice. The initial laboratory investigations suggested features of obstructive jaundice and urinary tract infection. The contrast enhancing computed tomography of the abdomen revealed the presence of saccular mycotic aneurysm located at the infrarenal abdominal aorta. The blood culture grew Salmonella Enteritidis which was susceptible to ceftriaxone, trimethoprim-sulfamethoxazole, ciprofloxacin, ampicillin, and amoxicillin-clavulanic acid. Intravenous ceftriaxone was initiated, and he underwent open surgery and artery repair at day 8 of admission. He responded well to the treatment given and subsequently discharged home after completed three weeks of intravenous ceftriaxone.

Evaluation of Phosphorus Storage and Performance of Broilers Using Phytase Synthetic Enzyme

Phytic acid is a stored form of phosphorus in cereals, 65 to 70% of phosphorus in plant sources is phytate, and broilers are only able to use part of the phosphorus in plant sources. To meet the needs of chickens, it is necessary to use other artificial resources, which not only impose part of the cost of the breeding period because of its presence in the manure but is one of the factors polluting the environment. This study aimed to use different levels of phytase enzyme to reduce dietary phosphorus levels. 600 Ross 308 broilers were used in this experiment with five treatments and six replications, and in each replication, 20 chickens were used in a completely randomized design (CRD). Experimental treatments include 1) basal diet (control) 2) basal diet with 15% less phosphorus 3) basal diet with 15% less phosphorus + 1250 (FTU) phytase enzyme 4) basal diet with 15% less phosphorus + 2500 (FTU) phytase enzyme 5) basal diet with 15% less phosphorus + 5000 (FTU) phytase enzyme. The evaluated traits included weekly feed intake, weekly weight gain, feed conversion ratio, carcass characteristics, ash, calcium, and bone phosphorus. The use of phytase enzyme in different diets had no significant effect on food intake, weight gain, and feed conversion ratio (P>0.05). However, the use of phytase in different diets significantly affected the percentage of Gizzard, Heart, Liver, Proventriculus, and Spleen (P<0.05). The most changes were the increase in the ratio of feed intake and weight gain in the fourth week compared to the third week so that the changes in the ratio of feed intake ranged from 1.85 to 1.91, and this ratio for weight gain also ranged from 3.12 to 3.86 was recorded, and the lowest feed conversion ratio was obtained at the same age. The percentage of raw ash in broiler chickens was significantly increased by adding dietary phytase. The lowest amount of ash, calcium, and phosphorus belonged to the second group (diets with low phosphorus and no enzyme). The difference between the other groups and the control was not significant. Feed intake, weight gain, and feed conversion ratio with the addition of phytase enzyme were not affected by phosphorus reduction and had no significant effect on carcass characteristics. Environmental pollution can be prevented by reducing the level of dietary phosphorus and reducing excreted phosphorus.

Effect of Licorice Essential Oil (Glycyrrhizaglabraglabra) on Performance and Some Biochemical Parameters of Broiler Chickens

Due to its beneficial components, such as glycyrrhizin, licorice is regarded a medicinal and fragrant plant. This research was designed to investigate the efficacy of licorice essential oil as an alternative to chemical antibiotics on broiler production, carcass features, cellular and humoral safety, and numerous biochemical variables in broiler blood serum. A total of 160 day-old broiler chicks were assigned to four treatment groups using a totally randomized approach. Each treatment consisted of 4 replicates, with 10 chicks in each replication. The experimental treatments included a control group, a group receiving an elemental diet containing 0.1% licorice essential oil, a group receiving an elemental diet containing 0.2% licorice essential oil, and a group receiving an elemental diet containing 0.3% licorice essential oil. Broilers had ad libitum access to feed and water in accordance with a three-phase feeding schedule consisting of a starter, grower, and finisher diet. There was no statistically significant difference (P>0.05) in body weight, feed intake, or feed conversion ratio between birds given the control or essential oil licorice at various stages of the experiment. However, birds receiving 0.1% licorice essential oil had a lower gallbladder relative weight and 0.3% licorice essential oil had less abdominal fat than the control group (P<0.05). Blood glucose, cholesterol, and LDL concentrations all fell considerably in licorice essential oil-treated birds relative to controls (P<0.05). The cellular immune response of birds fed licorice-containing diets did not differ from that of control birds (P>0.05), however there was a significant difference in the humoral immune response at 0.1% licorice essential oil compared to the control group (P<0.05). In overall, the results of this experiment demonstrated that incorporating licorice essential oil into a bird's diet improves its health and safety.

Jejunal perforation and upward migration of double J stents during the cystoscopic procedure: a case report and review of literature

While double J (DJ) stenting is common worldwide in the urological procedure, it may associate with severe and catastrophic complications. Penetration of the jejunum and upward migration of double J (DJ) stents during cystoscopic DJ stent procedure are rare complications with few reported cases in the literature. We present a 65-year-old male presented with acute renal failure and peritonitis one week after failed cystoscopic removal of DJ stents. Radiographic investigations showed upward migration of the right DJ stent and a total displacement of the left DJ stent to the peritoneal cavity with peritonitis, bladder perforation, and jejunal injuries. The right DJ stent was removed via the ureteroscopic procedure. Then, open abdominal surgery was performed to remove the left DJ stent and repair the injured bladder wall and jejunal segment. In conclusion, synchronous upward DJ stent migration and peritoneal DJ stent malposition with jejunal and bladder injuries are rare and severe complications of the cystoscopic DJ stent procedure. The treatment should be performed depending on the time of diagnosis, nature of the injury, and general clinical conditions of the patient.

Giant hydronephrosis presented as a huge abdominal mass in a 16-year-old female: a case report

Giant hydronephrosis owing to ureteropelvic junction obstruction is a rare condition characterized by the accumulation of more than 1000 ml of urine in the pyelocaliceal system. It could mimic the other benign cystic kidney disease or other causes of abdominal mass in radiologic images. We reported a 16-year-old female who presented with three months of abdominal pain and gradual abdominal mass ingrowth. Abdominal computed tomography scan showed a giant left cystic mass favored hydronephrosis secondary to ureteropelvic junction obstruction. The patient underwent a left nephrectomy, and more than 12 litters of turbid urine were suctioned from the affected kidney. In conclusion, giant hydronephrosis is an infrequent entity and should be considered in the differential diagnosis of large cystic abdominal masses. The treatment is determined by the underlying cause and the visual appeal of the affected kidney.

Cecal duplication cyst presenting with acute abdomen: a case report

Cecal duplication cyst is a rare congenital malformation with a few reported adult cases. We present a 23-year-old man who presented with low-grade fever, constipation, and right lower quadrant pain for three days. An abdominal computed tomography scan showed a cystic mass of 8.8x7.5x6 cm adjoining to the posterior wall of the cecum. The patient underwent abdominal laparotomy, and a right hemicolectomy was performed with resection of the duplication cyst. The histopathological study confirmed the diagnosis of a non-communicating cecal duplication cyst. In conclusion, it is essential to include cecal duplication cyst in the differential diagnosis of the acute abdomen to guarantee the best treatment strategy.

Role of tunica vaginalis flap and dartos flap in tubularized incisional plate for primary hypospadias repair: A retrospective monocentric study

BACKGROUND

In the tubularized incised plate (TIP) procedure, flap interposition between the skin and neourethra is highly recommended to decrease the postoperative fistula rate. However, there is no consensus regarding the ideal flap for this procedure. This study aimed to report our experiences in the one-stage TIP hypospadias surgery utilizing dartos flap (DF) (penile skin subcutaneous tissue) and tunica vaginalis flap (TVF) (parietal layer of the testis) as a tissue coverage of neourethra.

METHODS

In a retrospective study from Sep 2018 to May 2021, 16 cases of hypospadias with different types, ranging from midpenile to penoscrotal types, were managed with TIP urethroplasty using DF or TVF as a tissue coverage of neourethra were enrolled. The demographic characteristics of the participants, type of hypospadias, outcome, and complications were analyzed and compared.

RESULTS

We used TVF and DF as soft tissue coverage in 11 (68.8%) and 5 (31.3%) patients, respectively. The mean age was 56.38 ± 47.83 months. Mid-penile, proximal, and penoscrotal hypospadias were presented in 3 (18.8%), 8 (50.0%), and 5(31.2%) patients, respectively. The total success rate was 14 (87.5%), while 2 (12.5%) patients developed a urethrocutaneous fistula, which required delayed closure later. In comparison between TVF and DF groups: the TVF was applied in all patients with moderate and severe chordee and all patients with penoscrotal hypospadias, and six patients with proximal hypospadias, while only three patients with mild chordee and two patients with proximal hypospadias used the DF and showed statistical significance between groups (p < 0.001 and 0.012) respectively. The success rate was 90.9% vs. 80.0% in TVF and DF groups, respectively, with no statistical significance between groups (p = 1.000).

CONCLUSIONS

In the primary TIP repair, the TVF is a practical option as a DF for the interposition cover of a neourethra, especially in penoscrotal and proximal hypospadias with severe chordee.

Evaluation of Methylation Panel in the Promoter Region of p16INK4a , RASSF1A, and MGMT as a Biomarker in Sputum for Lung Cancer

Lung cancer is the most common cause of cancer death in the world. Effective early detection and appropriate medications can help treat this deadly cancer. Therefore, early detection of lung cancer is of utmost importance, especially in screening high-risk populations (such as smokers) with an urgent need to identify new biomarkers. The present study aimed to demonstrate the potential of using the panel of DNA methylation as a biomarker for the early diagnosis of lung cancer from sputum samples. The methylated promoter of p16^INK4a , RASSF1A, and MGMT genes was estimated by the methylation-specific polymerase chain reaction in a sample of 84 lung cancer patients (65 smokers and 19 non-smokers). Based on the results, p16^INK4a promoter methylation was significantly associated with smoking habit and lung cancer progression in terms of histological grading and patient staging. The sensitivity and specificity of the p16^INK4a gene as a biomarker for lung cancer were 71% and 90%, respectively. The methylated promoter of RASSF1A was less sensitive (48%) as a biomarker for lung cancer with 83%. The results demonstrated a strong association between promoter methylation of RASSF1A and late stages of lung cancer (P=0.0007). The sensitivity of the MGMT gene as a biomarker for lung cancer was 61% with high specificity (92%), compared to other candidate genes in this study. The epigenetic alteration in the promoter region of p16^INK4a , RASSF1A, and MGMT genes is highly associated with cancer cell development. It is suggested that the use of these candidate biomarkers can be used as an adjunct to computed tomography screening to diagnose patients at high risk for lung cancer after validation.

Giant urinary bladder calculi in a 60-year-old man: a case report

Urinary bladder calculi comprise 5% of all urinary tract calculi. Giant bladder calculi are defined as a stone more than 100g in weight. However, giant bladder calculus weighted more than 500g is rare in current practice. We present a 60-year-old man who presented with dysuria, difficulty in urination, and suprapubic pain started four years ago. The plain radiology image showed big intravesical caliculi measured about 10x9cm. The calculi was removed via open cystolithotomy without postoperative complication. The caliculi weighed 750g. In conclusion, the main goal of treatment is to remove the calculi and relieve the accompanying symptoms.

Synchronous cervical necrotizing fasciitis and pharyngocutaneous fistula: A case report

Introduction and importance

Necrotizing fasciitis is a fulminant infection that spreads along the fascial planes. It is a rare entity with potentially fatal outcomes. The head and neck involvement is infrequent, with primary source either odontogenic or pharyngeal infection by single or mixed bacterial flora. To our knowledge, synchronous cervical necrotizing fasciitis (CNF) and pharyngocutaneous fistula is rarely reported in pieces of literature.

Case presentation

We present a 38-years-old female patient who presented with CNF and pharyngocutaneous fistula. Diabetes mellitus was accidentally discovered during the investigation. The patient was successfully treated with broad-spectrum antibiotics, serial surgical debridement sessions, wound irrigation, and multiple muscular and myocutaneous skin flaps.

Clinical discussion

Rapid diagnosis, radical surgical debridement of all necrotic tissue, intravenous broad-spectrum antibiotics, and close monitoring of patients with CNF are crucial to avoid critical complications and better patient survival. Due to the poor healing process in the neck area, the pharyngocutaneous fistula should be repaired with good musculocutaneous flaps such as the pectoralis major myocutaneous flap. Meticulous suturing of the flap to the mucosa, reinforcement of the repair with muscle, and suturing of the skin without tension are essential to obtaining a successful outcome.

Conclusion

Synchronous CNF and pharyngocutaneous fistula are rare events. Initial diagnosis and serial surgical debridement, along with aggressive broad-spectrum antibiotics and adequate resuscitation with great attention to the poor healing process in the diabetic patients' neck area, are critical for a beneficial result. In our case, the reconstruction was performed successfully using multiple muscular and skin flaps.

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Cervical necrotizing fasciitis (CNF) is a fetal infection with a high mortality rate even under ideal medical conditions.

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Synchronous CNF and pharyngocutaneous fistula are rare occurrence.

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In CNF with pharyngocutaneous fistula, initial diagnosis, surgical debridement, broad-spectrum antibiotics and resuscitation with attention to poor healing process, are critical for a beneficial result.

Caroli's disease incidentally discovered in a 16-years-old female: a case report

Caroli´s disease is a congenital hepatic disorder characterized by nonobstructive saccular or fusiform dilatation of the intrahepatic bile ducts with the absence of congenital hepatic fibrosis. Caroli´s disease is rare, with few reported cases in the literature, making it hard to distinguish from other liver abnormalities. We present a case of Caroli´s disease discovered indecently in a 16-year-old female who presented with recurrent abdominal pain and intermittent jaundice in the last three years. Abdominal Computed tomography (CT) showed mild liver enlargement with multiple cystic dilatations of the intrahepatic saccular bile ducts cystic dilatations without hepatic fibrosis. The patient was treated conservatively with ursodeoxycholic acid and antibiotic therapy and discharged with regular follow-up. In conclusion, Caroli´s disease should be considered in the differential diagnosis in patients with recurrent abdominal pain and cholangitis without risk factors or relevant history.

Prehospital Delay and Its Associated Factors in Sudanese Patients Presenting With Acute Appendicitis at a Teaching Hospital

Background

Delayed prehospital presentation of acute appendicitis may increase the risk of perforation and other complications. This study investigated the prevalence of prehospital delay in the presentation of acute appendicitis, clinical features, and outcomes in Sudanese patients.

Method

A retrospective study conducted from January 2017 to December 2020 in a teaching hospital affiliated with Gezira University enrolled 191 patients with prehospital delay presentation of acute appendicitis (at least 48 hours from symptom onset). Patient characteristics, causative factors, primary treatment, and complication rate were gathered and analyzed.

Result

The mean age of the patients was 36.55 ± 16.3 years (range: 15-78 years), with 122 (64%) males and 69 (36%) females. Most cases of prehospital delay were misdiagnosed firstly as other diseases (n = 124, 65%). The physicians made misdiagnosis of acute appendicitis in 65 (53%) patients. Age less than 30 years, male gender, living in rural areas, and lower educational level are associated with a high incidence of prehospital delay presentation of acute appendicitis (p < 0.05). Most cases have appendicular mass (46%, p < 0.001). Wound infection was the most common postoperative complication (7.85%, p < 0.001).

Conclusion

The high incidence rate of prehospital delay presentation of acute appendicitis is associated with patients' age ofless than 30 years, male gender, living in a rural area, and lower educational level. With the high rate of misdiagnosed acute appendicitis, it is essential to increase the knowledge about the signs and symptoms of appendicitis among our physicians and health practitioners.

Delayed presentation of congenital diaphragmatic hernia: a case report

Congenital diaphragmatic hernia (CDH) is known as a structural defect caused by inadequate fusion of the pleuroperitoneal membrane forming the diaphragm, allowing peritoneal viscera to protrude into the pleural cavity. It affects nearly one out of 2500 live births. We here report the case of a six-month-old boy with left diaphragmatic hernia presenting with poor feeding, breathing difficulty, cough, and recurrent pneumonia in the last 2 months. Chest X-ray and computed tomography scan revealed left sided CDH. The defect was corrected through open surgical repair without complications. At 5-month follow-up a radiograph was performed which revealed full recovery. The primary goal of this report was to alert physicians to suspect this diagnosis in patients with unexpected presentation of diaphragmatic hernia.

Stromal expression of CD10 in invasive breast carcinoma and its association with tumour stage, grade, ER, PR and HER2 status

INTRODUCTION

Tumour microenvironment (TME) has been postulated to be involved in cancer development and disease progression. Studies have shown CD10 expressed in cancer-associated fibroblasts (CAF) within TME is associated with aggressive biological behaviour and poor prognosis. The aim of this study was to evaluate stromal CD10 expression in invasive breast cancer and its correlation with tumour stage, grade, Estrogen receptor (ER), Progesterone receptor (PR) and HER2 status.

MATERIALS AND METHODS

A total of 226 invasive breast carcinoma cases were selected and assembled into tissue microarrays (TMAs). The stromal expression of CD10 was immunohistochemically analysed.

RESULTS

Stromal CD10 was positive in 67 (29.6%) cases of invasive breast carcinoma. The frequency of positive stromal staining was significantly higher in the cases with ER-negative (P=0.000). CD10 stromal negativity was significantly higher in luminaltype cases (P=0.001). However, there was no correlation between stromal CD10 expression with tumour grade, stage, PR and HER2 status.

CONCLUSION

Positive CD10 stromal expression correlates with ER-negative invasive breast carcinomas, while negative CD10 stromal expression correlates with luminal type invasive breast carcinomas. This demonstrates that stromal CD10 expression within the TME constitutes a potential prognostic marker and therapeutic target. Future studies are necessary to evaluate other stromal markers within the TME immunohistochemically as well as its molecular basis in order to confirm the definite role of stromal CD10.

A case report of forgotten double J stent with giant calculus formation from the renal pelvis to the bladder

Double j stent is commonly used in urological procedures. Its main purpose is to afford the sufficient drainage from the renal pelvis to the urinary bladder. Following increased usage of double-J stent, several consequences associated to it have been reported. In this work, we report on a case of “forgotten” double j stent for 1 year in a 32-year-old male patient who visited emergency department with bilateral flank pain, fever, and vomiting for a duration of 3 days. A double-J stent was detected in the plain abdominal X-ray. It was also observed that a 20 × 15 mm stone has impacted the left renal pelvis. Therefore, two operations were performed successfully until the full recovery of the patient. Hence; the main aim of this paper is to increase awareness about the potential complications of “forgotten” double J Stent.

Indigenous management of Dystocia in ruminant livestock of northern guinea savanna of Nigeria

This study, conducted in Bauchi and Zaria areas of the northern guinea savanna zone of Nigeria involved livestock that encountered problems during parturition Ninety eight Hausa-Fulani livestock holdings involving cattle, sheep and goats were investigated. The study focused on causes of and remedies for dystocia. The study showed that farmers have traditional means of handling difficult birth in ruminants. The identifiable causes of dystocia included age and size of dam, abnormal foetal presentation, poor health, multiple foetuses and weight and sex of the young. The management of this problem included the use of hand to correct foetal position, lubrication of the vulvo-vagina passage with mashed okra fruit for easy passage, and oral administration of solutions from native herbs, snake scales, potash and ashes.

Primary follicular lymphoma of the pancreas: A rare tumour mimicking pancreatic carcinoma

INTRODUCTION

Primary pancreatic lymphomas are extremely rare. Clinically, primary pancreatic lymphoma mimics symptoms of carcinoma of the pancreatic head. Clinical and radiological features may overlap with other pancreatic conditions such as carcinoma, neuroendocrine tumours and autoimmune pancreatitis.

CASE REPORT

We report a case of a 75-year-old man who presented with symptoms of obstructive jaundice. Ultrasonography and computed tomography (CT) showed an ill-defined lobulated soft tissue lesion at the head/uncinate process of the pancreas measuring 4.5 x 4.9 x 5.8 cm. The patient underwent pancreaticoduodenectomy for suspected pancreatic head/uncinate process carcinoma. Histopathology and immunohistochemical assessment of the pancreatic lesion established the diagnosis of a low-grade follicular lymphoma.

DISCUSSION

Clinical and imaging features of primary pancreatic lymphoma may often overlap with pancreatic carcinoma. There is a value of obtaining preoperative tissue diagnosis such as tissue biopsy and fine needle aspiration (FNA) cytology with or without flow cytometry to make an accurate diagnosis of non-Hodgkin lymphoma and alleviate the need of more radical surgery in pancreatic lymphoma.

Diffuse hepatic haemangiomatosis: A case report and review of literature

Hepatic haemangioma is a solitary liver lesion and prevalent among the female patients. We report a case of diffuse hepatic haemangiomatosis in a 62-year-old man, who was referred for an incidental finding of multiple liver nodules. History and physical examinations were unremarkable. Computed tomography and magnetic resonance imaging of the liver were performed and showed multiple haemangiomatosis. In view of the rarity of this condition in men, a liver biopsy was done and confirmed haemangiomas. Available published literature on diffuse hepatic haemangiomatosis was reviewed.

Role of Serum Osteoprotegerin as a Diagnostic Indicator of Primary Osteoporosis in Perimenopausal and Postmenopausal Women: An Indian Perspective

Introduction: Osteoporosis (OP) is a major health problem in the older population. The aim of the study was to assess the role of serum osteoprotegerin (OPG) as a diagnostic indicator of primary osteoporosis in peri- and post-menopausal women in an Indian population.

Materials and Methods: After ethical approval, 90 cases (45 cases and 45 controls) of peri- and post-menopausal females above 40 years of age presenting to our outpatient department were included in the study. It was a case controlled study conducted between July 2014 to July 2015. Based on the clinical features, t-score and radiological evidence from the DEXA scan, they were equally divided into two groups (cases and controls). Serum osteoprotegerin (OPG) levels were measured amongst cases and controls.

Results: The total calcium (mg/dl) level was lower among the cases and the difference was significant (p-Value= <0.001). Similarly, alkaline phosphatase (u/l), osteoprotegerin (u/ml) levels were higher in the cases as compared to controls and the difference was significant (p-Value= <0.001). The mean osteoprotegerin level showed a slight increase with increase in severity of the grading of BMD of spine. The results suggested a cut-off value of ≥10.5 u/ml (86.7% sensitive and 80% specific with accuracy of 84.5%) between normal and osteoporosis.

Conclusion: From the present study, we conclude that osteoprotegerin is a valid biomarker to diagnose postmenopausal women with low bone mineral density.

Secondary structure and (1)H, (13)C and (15)N resonance assignments of Skint-1: a selecting ligand for a murine γδ T cell subset implicated in tumour suppression

A study describing the (1)H, (13)C and (15)N backbone and side chain chemical shift assignments and secondary structure of Skint-1 a prototypic member of a family of mouse genes, of which Skint-1 is involved in the development of the dendritic epidermal T cell (DETC) subset of γδ T cells.

Comparison of several methods of sires evaluation for total milk yield in a herd of Holstein cows in Yemen

A total of 956 lactation records of Holstein cows kept at Kaa Albon station, Imuran Governorate, Yemen during the period from 1991 to 2003 were used to investigate the effect of some genetic and non-genetic factors (Sire, parity, season of calving, year of calving and age at first calving as covariate) on the Total Milk Yield (TMY), Lactation Length (LL), and Dry Period (DP). Components of variance for the random effects (mixed model) were estimated by Restricted Maximum Likelihood (REML) methodology. Sires were evaluated for the TMY by three methods, Best Linear Unbiased Prediction (BLUP) using Harvey program, Transmitting Ability (TA) according to the Least Square Means of sire progeny (TALSM) and according to Means (TAM). Results showed that TMY and DP were affected significantly (P < 0.01) by all factors except season of calving and age at first calving, while LL was affected significantly (P< 0.01) only by year of calving and parity. The averages of the TMY, LL, and DP were 3919.66 kg, 298.28 days, and 114.13 days respectively. The corresponding estimates of heritability (h²) were 0.35, 0.06, and 0.14 respectively. The highest and lowest BLUP values of sires for the TMY were – 542.44 kg and 402.14 kg, while the corresponding estimates for TALSM and TAM were – 470.38, 380.88 kg and – 370.12, 388.50 kg respectively. The Spearman rank correlation coefficients among BLUP, TALSM and TAM ranged from 0.81 to 0.67. These results provide evidence that the selection of sires will improve the TMY in this herd because of the wide differences in genetic poetical among sires, and a moderate estimation of heritability.

NK/T cell lymphoma associated with peripheral eosinophilia

NK/T cell lymphoma, nasal type is an aggressive and uncommon malignancy. Disease that occurs outside of the aerodigestive tract exhibits an even more aggressive clinical behaviour and does not respond as well to conventional therapy compared to its nasal counterpart. We report such a case of NK/T cell lymphoma, nasal type, that presented as an anterior chest wall mass, arising from the left pectoralis muscle. An interesting feature we wish to highlight is the associated eosinophilia that corresponded to disease activity, exhibiting fluctuations with surgical resection and chemotherapy. To the best of our knowledge this is the third reported case of NK/T cell lymphoma that is associated with peripheral eosinophilia. Our case highlights the role of certain NK cell subsets that play a major role in eosinophilic activation in NK/T lymphomas and calls for more research into further classification of this disease by virtue of its NK cell subsets.

Thyroid surgery in a district hospital in Southern Ethiopia: experience from a rural center

BACKGROUND

Diseases of the thyroid are not uncommon, particularly in the highlands of Ethiopia. The aim of the present study was to describe the experience of thyroid surgery in a rural hospital in Southern Ethiopia.

METHODS

The present study was based on review of surgical cases of thyroid diseases operated in a rural hospital in Southern Ethiopia during the period 2009-2010.

RESULTS

During the study period, 211 patients underwent surgery for goiter. The mean age was 31.9 years (range: 14-80 years). The sex ratio, M:F, was 1:9. A total of 103 patients had unilateral nodules, and in 108 patients the nodules were located bilaterally. The mean duration of symptoms was 5.7 years (range: 0.7-25 years). In total, 161 (76.7 %) subtotal thyroidectomy operations, and 50 (23.3 %) hemi-thyroidectomy operations were performed. Histological examination revealed multinodular goiters in 203 (96.2 %) cases. Papillary and follicular cancers were found in 7 (3.3 %) and 1 (0.5 %) cases, respectively.

CONCLUSIONS

Thyroid surgery is feasible in a small rural Ethiopian District Hospital. The provision of surgical services in rural areas of low income and middle income countries is extremely important and delivers more health opportunities to the local people.

Polypharmacy in the management of patients with schizophrenia on risperidone in a tertiary-care hospital in Malaysia

The present study was conducted primarily to determine the occurrence of polypharmacy in patients with schizophrenia on risperidone. The secondary aim was to ascertain the incidence of inappropriate prescribing with anticholinergics. A retrospective review of the medical records of all patients who were being followed up at the out-patient clinic of a tertiary-care hospital in Malaysia was conducted. Only patients who were being prescribed risperidone between 1 June 2008 and 31 December 2008 were included in the study. Demographic data such as patient's age, gender and race were obtained from the patient's medical records. In total, 113 patients met the selection criteria. Polypharmacy was found to occur in 34 patients (30.09%), with the majority (76.47%) being on two antipsychotics. In total, 27 patients (34.18%) on monotherapy with risperidone were prescribed an anticholinergic on scheduled dosing, while 19 patients (24.05%) were prescribed it on an as-needed basis. Of the patients on polypharmacy, 26 (76.47%) were on scheduled dosing of anticholinergics, while three (8.82%) were taking the medication on an as-needed basis. Polypharmacy should be avoided, and the use of anticholinergics should be closely reviewed. By adopting more efficient prescribing practices, costs can be reduced and financial resources can instead be channelled towards more beneficial areas for the patients.

The need for a comprehensive response to HIV/ AIDS in north-western Somalia: evidence from a seroprevalence survey

The prolonged civil strife in the North-West Zone of Somalia (Somaliland) has hampered the development of social infrastructure and public health services. There are limited data on HIV/AIDS. In 2004, a sentinel HIV seroprevalence survey was conducted. Blood samples were collected from 1561 women attending antenatal care clinics, 249 tuberculosis (TB) patients and 243 people attending sexually transmitted disease (STD) clinics. Samples were tested for syphilis and HIV. Overall HIV prevalence was 1.4%, significantly higher than that observed in many other countries in the Region. Prevalence was 1.2% among pregnant women 15-24 years, 12.3% among patients with STD and 5.6% among TB patients. The prevalence of syphilis was 1.3% in the pregnant women.

Sanjad-Sakati syndrome/Kenny-Caffey syndrome type 1: a study of 21 cases in Kuwait

We studied 21 patients with Sanjad-Sakati syndrome (SSS) from 16 families. Parental consanguinity was recorded in 2 families (12.5%). All patients had severe intrauterine growth retardation, short stature, small hands and feet, blue sclera, deep-set eyes, microcephaly, persistent hypocalcaemia and hypoparathyroidism. Medullary stenosis was detected in 2 patients. Cytogenetic and fluorescent in situ hybridization studies were normal. All affected persons had homozygous deletion of 12 bp (155-166del) in exon 3 of the TBCE gene. All of the parents were heterozygous carriers of this mutation. The high frequency of SSS and low frequency of consanguineous marriages in this study may reflect a high rate of heterozygous carriers.

Iodine status among pregnant women in Kuwait

Up to now, little has been known about iodine intake and the prevalence of iodine deficiency (ID), if any, in Kuwait. Urinary iodine excretion (UIE) and changes in thyroid function during pregnancy were thus evaluated.

METHODS

Urinary iodide level was measured in random urine samples collected from 326 pregnant women at different gestational trimesters. Blood samples were drawn for free T4 (FT4) and TSH level determination.

RESULTS

Median UIE levels fall within the normal range during all gestational trimesters i.e. >100 microg/l. However, if the new suggested recommendation for pregnant women <140 microg/l, is applied, median UIE values during trimesters 2 and 3 indicate ID. Mean serum TSH levels increased between trimesters 1 and 3 (p<0.05), whereas serum FT4 decreased between first and second trimesters (p<0.05), and this reduction continued at the third trimester. Furthermore, an increase in TSH levels for subjects with mild and moderate ID (Mi and Mo, respectively) were noticed (p<0.05) during the second trimester. However, FT4 levels dropped in subjects with Mi and Mo ID during the first trimester (p<0.05). In conclusion, these results suggest that 56.8% of pregnant women had median UIE level <145 microg/l, associated with high TSH and low FT4 levels.

CONCLUSION

Data obtained may indicate insufficient iodine intake among pregnant women in Kuwait.

Liposarcoma in the nasal cavity of a cow

Liposarcomas are rare neoplasms in domestic animals, but have been reported to occur in many species. In humans, liposarcoma is one of the most common malignant mesenchymal tumors. Classification of liposarcomas in humans has been well established and categorization by type can be of prognostic value; no such unique classification scheme has been established for liposarcomas in animals. Liposarcoma of the head and neck in humans are uncommon, and are rarely reported in the nasal cavity, sinuses, and nasopharynx. To our knowledge, a liposarcoma has never been reported in the nasal cavity of a domestic animal. In this report we describe a liposarcoma that developed in the nasal cavity of a cow, with local invasion into the oral cavity.

Crystallization and preliminary X-ray diffraction analysis of calexcitin from Loligo pealei: a neuronal protein implicated in learning and memory

The neuronal protein calexcitin from the long-finned squid Loligo pealei has been expressed in Escherichia coli and purified to homogeneity. Calexcitin is a 22 kDa calcium-binding protein that becomes up-regulated in invertebrates following Pavlovian conditioning and is likely to be involved in signal transduction events associated with learning and memory. Recombinant squid calexcitin has been crystallized using the hanging-drop vapour-diffusion technique in the orthorhombic space group P2(1)2(1)2(1). The unit-cell parameters of a = 46.6, b = 69.2, c = 134.8 A suggest that the crystals contain two monomers per asymmetric unit and have a solvent content of 49%. This crystal form diffracts X-rays to at least 1.8 A resolution and yields data of high quality using synchrotron radiation.

Sex identification of normal persons and sex reverse cases from bloodstains using FISH and PCR

Sex identification of dry blood is of crucial importance in forensic medicine.

SUBJECTS AND METHODS

Sixty normal (with matching phenotypic and genotypic sex) persons (36 males and 24 females), and 7 cases of sex reverse, i.e., persons with one genotypic sex and ambiguous or external genitalia of the opposite sex (3 phenotypic females with Swyer syndrome and the 46,XY karyotype, and 4 phenotypic Klinefelter-like males with the 46,XX karyotype) were subjected to sex identification by FISH and PCR using bloodstains.

RESULTS

The FISH technique using an X/Y cocktail probe (DXZI & DYZI, Oncor) has identified the sex correctly in 91.69% of interphase nuclei of the 36 males of the study, and in 92.29% of cells of the 24 females and incorrectly identified the 3 phenotypic females with Swyer syndrome as males and the 4 Klinefelter-like males as females. The 60 normal individuals in the study were correctly typed to their phenotypic sex by the 2 PCR methods used, i.e., the single PCR using the amelogenin sequence specific for the X and Y chromosomes and the multiplex PCR using SRY gene (male-specific) and the AR gene (X-specific). Out of the 7 sex reverse cases, one Klinefelter-like male was incorrectly identified by PCR as female due to the absence of amplification of the SRY gene and the amelogenin male-specific 788 bp fragment.

CONCLUSION

The present study demonstrates that both FISH and PCR techniques are fast, easy to perform, reliable and efficient for sex identification but PCR is more accurate. It also emphasises that the sex identified is the genotypic sex which does not necessarily correspond to the phenotypic one and if evidences at the scene of crime indicate opposite sex of the accused, persons with sex reverse have to be ruled out using different X- and Y-specific probes and PCR.

The atomic resolution structure of methanol dehydrogenase fromMethylobacterium extorquens

The crystal structure of methanol dehydrogenase (MDH) from Methylobacterium extorquens has been refined without stereochemical restraints at a resolution of 1.2 A. The high-resolution data have defined the conformation of the tricyclic pyrroloquinoline quinone (PQQ) cofactor ring as entirely planar. The detailed definition of the active-site geometry has shown many features that are similar to the quinohaemo-protein alcohol dehydrogenases from Comamonas testosteroni and Pseudomonas putida, both of which possess MDH-like and cytochrome c-like domains. Conserved features between the two types of PQQ-containing enzyme suggest a common pathway for electron transfer between MDH and its physiological electron acceptor cytochrome cL. A pathway for proton transfer from the active site to the bulk solvent is also suggested.

The structure of the C-C bond hydrolase MhpC provides insights into its catalytic mechanism

2-Hydroxy-6-ketonona-2,4-diene-1,9-dioic acid 5,6-hydrolase (MhpC) is a 62 kDa homodimeric enzyme of the phenylpropionate degradation pathway of Escherichia coli. The 2.1 A resolution X-ray structure of the native enzyme determined from orthorhombic crystals confirms that it is a member of the alpha/beta hydrolase fold family, comprising eight beta-strands interconnected by loops and helices. The 2.8 A resolution structure of the enzyme co-crystallised with the non-hydrolysable substrate analogue 2,6-diketo-nona-1,9-dioic acid (DKNDA) confirms the location of the active site in a buried channel including Ser110, His263 and Asp235, postulated contributors to a serine protease-like catalytic triad in homologous enzymes. It appears that the ligand binds in two separate orientations. In the first, the C6 keto group of the inhibitor forms a hemi-ketal adduct with the Ser110 side-chain, the C9 carboxylate group interacts, via the intermediacy of a water molecule, with Arg188 at one end of the active site, while the C1 carboxylate group of the inhibitor comes close to His114 at the other end. In the second orientation, the C1 carboxylate group binds at the Arg188 end of the active site and the C9 carboxylate group at the His114 end. These arrangements implicated His114 or His263 as plausible contributors to catalysis of the initial enol/keto tautomerisation of the substrate but lack of conservation of His114 amongst related enzymes and mutagenesis results suggest that His263 is the residue involved. Variability in the quality of the electron density for the inhibitor amongst the eight molecules of the crystal asymmetric unit appears to correlate with alternative positions for the side-chain of His114. This might arise from half-site occupation of the dimeric enzyme and reflect the apparent dissociation of approximately 50% of the keto intermediate from the enzyme during the catalytic cycle.

Crystallization and preliminary X-ray analysis of the controller protein C.AhdI from Aeromonas hydrophilia

Single crystals of purified homodimeric controller protein from Aeromonas hydrophilia (C.AhdI) have been grown under several different conditions using vapour diffusion. X-ray diffraction data have been collected using synchrotron radiation from crystals of both the native and a selenomethionine (SeMet) derivative of the protein. The native crystal form belongs to space group P2(1) and data were collected to a resolution of 2.2 A. Two crystal forms of the SeMet protein have been obtained and were found to belong to space groups P1 and P2(1); data have been recorded to 2.0 and 1.7 A resolution, respectively, for the two crystal forms. Three-wavelength MAD data were collected to 1.7 A for the SeMet derivative crystal, which is isomorphous with the native P2(1) crystal.