Effectiveness of Histopathological Examination of Ultrasound-guided Puncture Biopsy Samples for Diagnosis of Extrapulmonary Tuberculosis

Objective To evaluate the diagnostic value of histopathological examination of ultrasound-guided puncture biopsy samples in extrapulmonary tuberculosis(EPTB).Methods This study was conducted at the Shanghai Public Health Clinical Center.A total of 115patients underwent ultrasound-guided puncture biopsy,followed by MGIT 960 culture(culture),smear,Gene Xpert MTB/RIF(Xpert),and histopathological examination.These assays were performed to evaluate their effectiveness in diagnosing EPTB in comparison to two different diagnostic criteria:liquid culture and composite reference standard(CRS).Results When CRS was used as the reference standard,the sensitivity and specificity of culture,smear,Xpert,and histopathological examination were(44.83%,89.29%),(51.72%,89.29%),(70.11%,96.43%),and(85.06%,82.14%),respectively.Based on liquid culture tests,the sensitivity and specificity of smear,Xpert,and pathological examination were(66.67%,72.60%),(83.33%,63.01%),and(92.86%,45.21%),respectively.Histopathological examination showed the highest sensitivity but lowest specificity.Further,we found that the combination of Xpert and histopathological examination showed a sensitivity of 90.80%and a specificity of 89.29%.Conclusion Ultrasound-guided puncture sampling is safe and effective for the diagnosis of EPTB.Compared with culture,smear,and Xpert,histopathological examination showed higher sensitivity but lower specificity.The combination of histopathology with Xpert showed the best performance characteristics.

Antioxidant Effect of Sepia Ink Extract on Extrahepatic Cholestasis Induced by Bile Duct Ligation in Rats

Objective The aim of our study was to assess the complications of hepatic fibrosis associated with bile duct ligation and the potential curative role of sepia ink extract in hepatic damage induced by bile duct ligation. Methods Rattus norvegicus rats were divided into 3 groups: Sham-operated group, model rats that underwent common bile duct ligation (BDL), and BDL rats treated orally with sepia ink extract (200 mg/kg body weight) for 7, 14, and 28 d after BDL. Results There was a significant reduction in hepatic enzymes, ALP, GGT, bilirubin levels, and oxidative stress in the BDL group after treatment with sepia ink extract. Collagen deposition reduced after sepia ink extract treatment as compared to BDL groups, suggesting that the liver was repaired. Histopathological examination of liver treated with sepia ink extract showed moderate degeneration in the hepatic architecture and mild degeneration in hepatocytes as compared to BDL groups. Conclusion Sepia ink extract provides a curative effect and an antioxidant capacity on BDL rats and could ameliorate the complications of liver cholestasis.

Primary intramedullary melanoma of lumbar spinal cord: A case report

BACKGROUND Primary intramedullary melanoma is a very rare tumor,most frequently occurring in the cervical and thoracic spinal cord.CASE SUMMARY We present a rare case in which the primary intramedullary melanoma was located in the lumbar spine.A 56-year-old man complained of progressive intermittent pain in the lumbar area.Thoracic magnetic resonance imaging showed a spinal intramedullary tumor between the L3 and S1 levels.The tumor was resected entirely,and the diagnosis of malignant melanoma was confirmed by histopathology.CONCLUSION Primary melanoma of the spinal cord,particularly intramedullary localization,has rarely been reported in the previous literature.We describe a primary malignant melanoma of the lumbar spinal cord and discuss the challenges associated with the diagnosis.

Diagnosis and treatment of eosinophilic fasciitis:Report of two cases

BACKGROUND Eosinophilic fasciitis(EF)is a rare disease characterized by inflammation of the fascia with immune system involvement.Failure to promptly diagnose and treat this disease can seriously affect the quality of life of patients.However,no clear and uniform criteria for diagnosis and treatment exist.CASE SUMMARY In this paper,we report two cases of EF,both of which showed symmetrical limb swelling and rigidity,increased eosinophils in the peripheral blood and bone marrow,increased red blood cell sedimentation rate,increased antinuclear antibody titer,and pathological changes in the tissues such as eosinophil and lymphocyte infiltration.Both patients were treated with hormones and cyclosporine,and showed significant improvements in their conditions.CONCLUSION EF is an autoimmune disease causing swelling and sclerosis of the fascia and eosinophilia.It is diagnosable by magnetic resonance imaging,positron emission tomography-computed tomography,blood routine tests,and bone marrow puncture.Glucocorticoids and immunosuppressants are effective treatments.

Evaluation of Toxicological Profile of a Polyherbal Formulation

In current study toxicological profile of a commonly used herbal formulation was evaluated that is used extensively for gynecological disorders like menorrhagia, metrorrhagia, leucorrhea, irregular menstrual cycle, pre-menstrual syndrome and post-menopausal bleeding. It was also claimed to strengthen endometrium and ovaries. Since this herbal formulation was been used by a large number of population hence there was a need to assess acute and sub-chronic toxicity. Acute oral toxicity (LD50) was observed in albino mice using standard protocols whereas sub-chronic, hematological and histopathological studies were assessed on 24 albino rabbits after giving herbal formulation for 60 days in two doses (20 and 60 mg/kg) against control groups. The outcomes of present study showed that the drug is safe up to 5000 mg/kg following acute oral toxicity test and no mortality was observed during sub chronic toxicity studies. Results of sub-chronic toxicity did not show any significant changes in biochemical, hematological and histopathological parameters. However, some indicators such as urea, creatinine, hemoglobin, and RBC count were altered, but these changes do not correlate with the histopathological results and may be associated to intra individual variations. Despite the safety of the drug in few animals, clinical trials and more investigations on a large number of animals are essentially needed to establish safety and efficacy of the herbal formulation.

Effect of CO_2 laser sclerectomy with iridectomy on ocular hypertension in rabbits

AIM:To evaluate the efficiency and safety of an optimized CO2 Laser glaucoma surgery system for laser sclerectomy with iridectomy.METHODS:Rabbit trials were performed to evaluate the efficiency and safety.RESULTS:IOP was significantly decreased in laser group compared with trabeculectomy group(P<0.05) from 7th postoperative day to 60th day.Compared with trabeculectomy group,histopathology studies confirmed fewer complications and better effects were found in laser group.CONCLUSION:CO2 laser sclerectomy with iridectomy is effective and safe in terms of IOP lowering.

Neurothekeoma located in the hallux and axilla:Two case reports

BACKGROUND Neurothekeomas(NTKs)are rare benign soft tissue tumours that typically occur in the head,trunk,and upper limbs and are rare in other parts of the body.CASE SUMMARY Herein,we present two rare cases in which primary NTKs were located in the hallux and axilla.A 47-year-old woman complained of a verrucous bulge on the plantar side of the left hallux.The surface skin of the tumour was abraded due to poor wound healing.A 6-year-old boy complained of a gradually growing subcutaneous mass in the axilla.The tumours of both patients were completely resected,and the diagnosis of NTK was confirmed by histopathology.At the oneyear follow-up,both patients had a good prognosis without local recurrence.CONCLUSION To date,NTKs located in the hallux and axilla have rarely been reported in the literature.We describe NTKs that occurred in unconventional areas and summarize the challenges in their diagnosis and differential diagnosis.

Misdiagnosed dystrophic epidermolysis bullosa pruriginosa:A case report

BACKGROUND Dystrophic epidermolysis bullosa pruriginosa(DEB-Pr)is a rare subtype of DEB,characterized by recurrent pruritus of the extremities,pruritus papules,nodules,and mossy-like plaques.To date,fewer than 100 cases have been reported.We report a misdiagnosed 30-year-old man with sporadic late-onset DEB-Pr who responded well to tacrolimus treatment,thereby serving as a guide to correct diagnosis and treatment.CASE SUMMARY A 30-year-old man presented with recurrent itching plaques of 1-year duration in the left tibia that aggravated and involved both legs and the back.Examination revealed multiple symmetrical,purple,and hyperpigmented papules and nodules with surface exfoliation involving the tibia and dorsum of the neck with negative Nissl's sign,no abnormalities in the skin,mucosa,hair,or fingernail,and no local lymph node enlargement.Blisters were never reported prior to presentation.Serum immunoglobulin E level was 636 IU/mL.Clinical manifestations suggested DEB-Pr.Histological examination showed subepidermal fissure,scar tissue,and milia.Direct immunofluorescence showed no obvious abnormalities.However,we were unable to perform electron microscopy or genetic research following his choice.We treated him with topical tacrolimus.After 2 wk,the itching alleviated,and the skin lesions began to subside.No adverse reactions were observed during treatment.CONCLUSION Topical tacrolimus is a safe treatment option for patients with DEB-Pr and can achieve continuous relief of severe itching.

Prevalence and Endoscopic Findings of <i>Helicobacter pylori</i>Infection among Dyspeptic Patients in Kenya

Background: Helicobacter pylori is the most common cause of chronic human infections worldwide with the highest reported prevalence in Africa. It is associated with numerous upper gastrointestinal diseases such as gastritis, peptic ulcers, and gastric cancer. Endoscopic findings in the stomach usually associated with Helicobacter pylori infections include gastritis and gastro-esophageal reflux disease (GERD), however, these findings are suggestive but not diagnostic of Helicobacter pylori infection. Methods: This was a prospective study conducted between January 2018 and February 2019 at the Aga Khan University Hospital where dyspeptic patients scheduled for gastroduodenoscopy were enrolled. These patients were evaluated for Helicobacter pylori infection by rapid urease test, culture and histopathology. Diagnostic findings and patient history collected from medical files were documented and data analyzed. Results: A total of 487 dyspeptic patients undergoing esophagogastroduodenoscopy (EGD) were enrolled in the study and 199 dyspeptic patients were positive for Helicobacter pylori infection. The prevalence was 54.6% in males and 45.4% in females (p = 0.1546. The most common clinical indication and endoscopic findings were heart burn (25.2%) and gastritis (53.7%). Histopathology revealed that 86.1% of the dyspeptic patients had chronic active gastritis (p < 0.005) and 52.8% of them had H. pylori infection. Conclusions: Classical endoscopic findings such as GERD are not always indicative of H. pylori infection as its association with H. pylori infection was not statistically significant in this study.