Concomitant-chemoradiotherapy-associated oral lesions in patients with oral squamous-cell carcinoma

Objective:Oral squamous-cell carcinoma(OSCC)accounts for >90% of oral cancers affecting adults mostly between the fourth to seventh decades of life.The most common OSCC treatment is concomitant chemoradiotherapy(CCRT)having both locoregional and distant control,but CCRT has acute and chronic toxic effects on adjacent normal tissue.This study aimed to determine the side effects of CCRT on the oral mucosa and to characterize the clinicopathology of oral lesions in patients with OSCC.Methods:This descriptive,cross-sectional study was certified by the Ethical Review Committee(UHS/Education/126-12/2728)of the University of Health Sciences,Lahore,Pakistan.OSSC patients(n=81)with various histological subtypes,grades,and stages were recruited,and findings on their oral examination were recorded.These patients received 70,90,and 119 Gy of radiotherapy dosages in combination with the chemotherapy drugs cisplatin and 5-fluorouracil.Data were analyzed using SPSS 20.0.Results:The most common presentation of OSCC was a nonhealing ulcer(63%) involving tongue(55.6%).Clinical findings included mucositis(92.6%)and xerostomia of mild,moderate,and severe degrees in 11.1%,46.9%,and 35.8% cases,respectively.Ulcers(87.7%),palpable lymph nodes(64.2%),limited mouth opening(64.2%)and fistula(40.7%) were also observed.In females,the association of radiotherapy dosage with limited mouth opening,xerostomia,and histological grading was statistically significant(P<0.05).The association of chemotherapy drugs with xerostomia(P=0.003)was also statistically significant.Conclusions:CCRT induced mucositis,xerostomia,and trismus in patients with OSCC.

Effect of nutritional counselling on hepatic,muscle and adipose tissue fat content and distribution in non-alcoholic fatty liver disease

AIM: To assess the effectiveness of the current UK clinical practice in reducing hepatic fat (IHCL). METHODS: Whole body MRI and 1H MRS were obtained, before and after 6 mo nutritional counselling, from liver, soleus and tibialis muscles in 10 subjects with non-alcoholic fatty liver disease (NAFLD). RESULTS: A 500 Kcal-restricted diet resulted in an average weight loss of 4% (-3.4 kg,) accompanied by significant reductions in most adipose tissue (AT) depots, including subcutaneous (-9.9%), abdominal subcutaneous (-10.2%) and intra-abdominal-AT (-11.4%). Intramyocellular lipids (IMCL) were significantly reduced in the tibialis muscle (-28.2%). Decreases in both IHCL (-39.9%) and soleus IMCL (-12.2%) content were also observed, although these were not significant. Several individuals showed dramatic decreases in IHCL, while others paradoxically showed increases in IHCL content. Changes in body composition were accompanied by improvements in certain liver function tests: serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT). Significant correlations were found between decreases in IHCL and reductions in both intra-abdominal and abdominal subcutaneous AT. Improvements in liver function tests were associated with reductions in intra-abdominal AT, but not with changes in IHCL. CONCLUSION: This study shows that even a very modest reduction in body weight achieved through lifestyle modification can result in changes in body fat depots and improvements in LFTs.

Effect of dietary supplementation with yeast cell wall extracts on performance and gut response in broiler chickens

Background:The dietary supplementation of yeast cell wall extracts(YCW)has been found to reduce pathogenic bacteria load,promote immunoglobulin production,prevent diseases by pro-inflammatory responses,and alter gut microbiota composition.This study evaluated growth and slaughter results,health,gut morphology,immune status and gut transcriptome of 576 male chickens fed two diets,i.e.C(control)or Y(with 250–500 g/t of YCW fractions according to the growth period).At 21 and 42 d the jejunum of 12 chickens per diet were sampled and stained with hematoxylin/eosin for morphometric evaluation,with Alcian-PAS for goblet cells,and antibodies against CD3+intraepithelial T-cells and CD45+intraepithelial leukocytes.The jejunum sampled at 42 d were also used for wholetranscriptome profiling.Results:Dietary YCW supplementation did not affect final live weight,whereas it decreased feed intake(114 to 111 g/d;P≤0.10)and improved feed conversion(1.74 to 1.70;P≤0.01).Regarding the gut,YCW supplementation tended to increase villi height(P=0.07);it also increased the number of goblet cells and reduced the density of CD45+cells compared to diet C(P<0.001).In the gut transcriptome,four genes were expressed more in broilers fed diet Y compared to diet C,i.e.cytochrome P450,family 2,subfamily C,polypeptide 23b(CYP2C23B),tetratricopeptide repeat domain 9(TTC9),basic helix-loop-helix family member e41(BHLHE41),and the metalloreductase STEAP4.Only one gene set(HES_PATHWAY)was significantly enriched among the transcripts more expressed in broilers fed diet Y.However,a total of 41 gene sets were significantly over-represented among genes up-regulated in control broilers.Notably,several enriched gene sets are implicated in immune functions and related to NF-κB signaling,apoptosis,and interferon signals.Conclusions:The dietary YCW supplementation improved broiler growth performance,increased gut glycoconjugate secretion and reduced the inflammatory status together with differences in the gut transcriptome,which can be considered useful to improve animal welfare and health under the challenging conditions of intensive rearing systems in broiler chickens.

Pancreatic trauma: A concise review

Traumatic injury to the pancreas is rare and difficult to diagnose.In contrast,traumatic injuries to the liver,spleen and kidney are common and are usually identified with ease by imaging modalities.Pancreatic injuries are usually subtle to identify by different diagnostic imaging modalities,and these injuries are often overlooked in cases with extensive multiorgan trauma.The most evident findings of pancreatic injury are posttraumatic pancreatitis with blood,edema,and soft tissue infiltration of the anterior pararenal space.The alterations of post-traumatic pancreatitis may not be visualized within several hours following trauma as they are time dependent.Delayed diagnoses of traumatic pancreatic injuries are associated with high morbidity and mortality.Imaging plays an important role in diagnosis of pancreatic injuries because early recognition of the disruption of the main pancreatic duct is important.We reviewed our experience with the use of various imaging modalities for diagnosis of blunt pancreatic trauma.

Abdominal tuberculosis of the gastrointestinal tract: Revisited

Abdominal tuberculosis is an increasingly common disease that poses diagnostic challenge,as the nonspecific features of the disease which may lead to diagnostic delays and development of complications.This condition is regarded as a great mimicker of other abdominal pathology.A high index of suspicion is an important factor in early diagnosis.Abdominal involvement mayoccur in the gastrointestinal tract,peritoneum,lymphnodes or solid viscera.Various investigative methods have been used to aid in the diagnosis of abdominal tuberculosis.Early diagnosis and initiation of antituberculous therapy and surgical treatment are essential to prevent morbidity and mortality.Most of the patients respond very well to standard antitubercular therapy and surgery is required only in a minority of cases.Imaging plays an important role in diagnosis of abdominal tuberculosis because early recognition of this condition is important.We reviewed our experience with the findings on various imaging modalities for diagnosis of this potentially treatable disease.

Actinomycosis of the sigmoid colon:A case report

Abdominal actinomycosis is a chronic suppurative infection caused by Actinomyces species.The ileo-cecal region is most commonly affected,while the left side of the colon is more rarely involved.The infection has a tendency to inf iltrate adjacent tissues and is therefore rarely confined to a single organ.Presentation may vary from non specif ic symptoms and signs to an acute abdomen.A computed tomography scan is helpful in identifying the inflammatory process and the organs involved.It also allows visual guidance for percutaneous drainage of abscesses,thus aiding diagnosis.Culture is difficult because of the anaerobic character and slow growth of actinomycetes.Colonoscopy is usually normal,but may shows signs of external compression.Preoperative diagnosis is rare and is established only in less than 10% of cases.In uncomplicated disease,high dose antibiotic therapy is the mainstay of treatment.Surgery is often performed because of a difficulty in diagnosis.Surgery and antibiotics are required in the case of complicated disease.Combined medical and surgical treatment achieves a cure in about 90% of cases.The authors report a case of sigmoid actinomycosis where diagnosis was made from the histology,and a review of the literature is presented.

A Retrospective Cross Sectional Study of Blood Culture Results in a Tertiary Hospital, Ekiti, Nigeria

The current study was conducted to determine the epidemiology and antibiotic sensitivity pattern of bacteria isolated from blood of septicemic patients for improved antibiotic therapy. A three-year descriptive study was done at Microbiology Laboratory, Ekiti State University Teaching Hospital, Ado Ekiti, from April 2012 to April 2015. Information compiled from patients’ records includes age, sex, isolated organisms and antibiotic susceptibility patterns. Three hundred and thirteen blood cultures were collected from neonatology and pediatrics wards, Out Patients’ Department (OPD) and from other adult patients. Forty one culture plates yielded mono microbial growth (no polymicrobial growth), giving an incidence of 13.1% positive blood culture (N = 41/313). There were 58.4% Gram negative bacilli and 41.6% Gram positive cocci in the microbial growth. Bacteria isolated were Staphylococcus aureus 34% (14/41), Klebsiella species 22% (9/41), Enterococci 17% (7/41), Proteus species 12% (5/41), Escherichia coli 7% (3/41) and Streptococcal pneumoniae 7% (3/41). There was a (35%) higher occurrence of septicemia in neonates than in any other age groups in the hospital. Bacterial sensitivity to 13 antibiotic agents was determined by antibiotics disc diffusion using modified Kirby Bauer’s method. Gram-positive organisms showed a higher antibiotic sensitivity ranging from 14% - 100% than the Gram-negative bacteria (11% - 80%). Staphylococcus aureus and Klebsiella species are the most prevalent organisms. The third generation Cephalosporins (Ceftriaxone) and Floroquinolone (Levofloxacin, Ofloxacin) have proved reliable for management of these blood infections.

Upper gastrointestinal barium evaluation of duodenal pathology: A pictorial review

Like other parts of the gastrointestinal tract(GIT), duodenum is subject to a variety of lesions both congenital and acquired. However, unlike other parts of the GIT viz. esophagus, rest of the small intestine and large intestine, barium evaluation of duodenal lesions is technically more challenging and hence not frequently reported. With significant advances in computed tomography technology, a thorough evaluation including intraluminal, mural and extramural is feasible in a single non-invasive examination. Notwithstanding, barium evaluation still remains the initial and sometimes the only imaging study in several parts of the world. Hence,a thorough acquaintance with the morphology of various duodenal lesions on upper gastrointestinal barium examination is essential in guiding further evaluation. We reviewed our experience with various common and uncommon barium findings in duodenal abnormalities.

Advanced Papillary Carcinoma of the Breast Presenting as an Ulcerated Anterior Chest Wall Tumour: Case Report

BACKGROUND: Papillary carcinoma of the breast is a rare malignant tumour accounting for 1% - 2% of all breast cancers in women. Papillary carcinomas of the chest wall are always secondary to thyroid, thymus and ovaries. Other variants of breast cancer metastasizing to the chest wall have been reported. CASE: We report a 67-year-old woman presented to us with an ulcerated anterior chest wall mass of 1-year duration, bilateral axillary, supraclavicular and cervical swellings of 8-month duration. There was a history of breast lump which was noticed 5 years prior to presentation, no history of breast malignancy in the past and no family history of breast cancer. Examination revealed an ulcerated, nodular mass over the sternal angle which measured 14 cm × 12 cm × 4 cm;she had bilateral axillary, supraclavicular and cervical lymphadenopathy which were non-tender and matted. She had a firm, non-tender right breast lump measuring 6 cm × 4 cm. Chest examination and abdominal examinations were essentially normal. Chest X-ray revealed erosion of sternal bone without any evidence of intrathoracic extension. Abdominal ultrasound and thyroid scans were normal. Histology of the mass revealed papillary carcinoma. Biopsy of the right breast also revealed papillary carcinoma. She had excision of the fungating tumour and primary closure of defect. She subsequently had combination chemotherapy using ondasetron, cyclophosphamide, adriamycin and cisplantin. CONCLUSION: Papillary carcinoma of the breast is rare and rarely metastasizes to the chest wall. The diagnosis of metastatic chest wall tumour requires meticulous history taking, clinical examination and relevant investigations to ascertain the primary origin of the carcinoma.

Renal Disease among HIV Positive Patients in Senegal

Introduction: Renal disease (RD) in human immunodeficiency virus (HIV) infection is a decisive turning point in the development and prognosis of this disease. In Africa, the prevalence varies between 2.5% and 48.6%. In Senegal, little data are available in the literature. The objective of our study was to describe the epidemiological, clinical, paraclinical, therapeutic and progressional aspects in patients living with HIV (PLWHIV). Patients and methods: This was a retrospective, descriptive and analytical study carried out over a 10-year period in the Department of Internal Medicine and Nephrology at the Aristide Le Dantec Hospital in Dakar, Senegal. We included all 15-year old and above PLHIV with available CD4 count and viral load. Results: Out of 248 PLHIV, 32 had kidney disease (KD), which means a hospital prevalence of 12.9%. The mean age was 51.22 ± 10 years (extremes of 36 and 77 years) with a sex ratio (male/female) of 1.28. Renal signs were dominated by glomerular nephropathy syndrome. It was present at 80%. Tubulo-interstitial nephropathy syndrome and chronic uremic syndrome accounted for 6.25% and 3.1% of cases, respectively. Renal function Impairment was present in 21 patients with 18 cases of acute kidney injury (85.7%) and 3 cases of chronic renal failure (14.3%), including 2 in stage 5 of chronic kidney disease. Renal biopsy (RB) was indicated and performed in 20 (62.5%) patients with glomerular signs in 12 patients (60%). Glomerular lesions were dominated by focal and segmental glomerulosclerosis (FSGS) in 6 cases, membraneous nephropathy (MN) in 4 cases and minimal change disease (MCD) in 2 cases. Tubulo-interstitial and vascular lesions were present in 45% and 12.5% of cases, respectively. In highly active antiretroviral therapy (HAART), 12 (37.5%) patients had total remission, 9 (28.12%) had partial remission. One (3.12%) death from severe metabolic acidosis on chronic renal failure was deplored. Conclusion: This study illustrates the high prevalence of RD in PLHIV in our exercise context.

Scar Endometriosis—Case Report

Endometriosis is one of the common gynecological disorders in women of reproductive age group. Extra pelvic endometriosis is rare and the most common sites are bladder, gastrointestinal tract, lungs, under the skin especially after obstetric surgical interventions. Total surgical excision is the best option for diagnosis and treatment.

Primary Osseous Metaplasia of Right Breast

Osseous metaplasia of the breast is considered to be one of the rare breast conditions. It is characterized by the presence of normal bone tissue within the breast. We report a case of benign osseous metaplasia in a 58-year-old woman presenting with mastalgia and mass in the right breast. A lumpectomy was performed. On the pathological examination, the mass was composed completely of benign bone trabeculae with no epithelial component which was confirmed by negativity of immunohistochemistry.

Uterine Inversion: An Uncommon Progressive Forme of Leiomyosarcoma Uterine: Case Report and Review of Literature

Uterine leiomyosarcoma (LMS) is a rare uterine malignancy that represents approximately 1% of uterine cancers. The nonspecific symptoms cause difficulties in the diagnostic, prognostic and therapeutic. We report an unusual progressive form, with a uterine inversion of LMS fundal externalized out of the vulva in a patient of 48 years old premenopausal.

Immunohistochemical Expression of Biomarkers and Human Papilloma Virus Infection in Esophageal Squamous Cell Carcinoma Patients of Pakistan-HPV and Biomarkers in ESCC

Objective To determine HPV infection status and expression of p16, cyclooxygenase-2(COX-2), Cyclin D1 and epidermal growth factor receptor(EGFR) in ESCC patients of Pakistan. Methods 51 ESCC patients treated at Aga Khan University Hospital(AKUH) were included. HPV infection status was confirmed via PCR while the expression of the four biomarkers was determined using immunohistochemistry. The correlation of all markers with patient clinicopathological features as well as each other was analyzed. Results HPV infection status and p16 overexpression was found to be negative in all the patients while COX-2, Cyclin D1 and EGFR were overexpressed in 56.9%, 62.7% and 49.0% of the patients respectively. COX-2 showed a significant correlation with tumor invasion while EGFR was shown to be significantly correlated with histological grading and COX-2 expression. Conclusion COX-2 and EGFR can be used as prognostic markers. HPV does not seem to be a causative agent for ESCC in Pakistan.

Formulation and Assessment of the Efficacy and Stability of an Ointment Containing Ocimum americanum L.Extract

Background:Ocimum americanum L.is an annual herbaceous plant used to manage pain and inflammation.Lack of standard dosage forms,and safety and efficacy data potentially exposes users of this medicinal plant to the risk of toxic or sub-therapeutic effects,as well as drug-herb interactions.Objective:The study developed a standard dosage form containing O.americanum extract and assessed its anti-inflammatory efficacy and stability.Methods:The fusion method was used to formulate an ointment comprising acetone extract,beeswax,and soft-paraffin.Formulation optimization involved the application of Box-Behnken Design(BBD)to design an exper-iment whose input variables were%beeswax and%soft-paraffin and its melting temperature.Output variables were drug release and viscosity which were quantified using a vertical diffusion cell(VDC)and stanhope-seta viscometer,respectively.Wistar albino rats were used in carrageenan-induced rat hind paw edema(n=6/test,positive and negative control)to assess the anti-inflammatory effect.Stability studies comprised assessment of spreadability,thin layer chromatograms(TLC),and microbial growth in ointment batches stored at 25±2℃/60±5%RH and 40±2℃/75±5%RH.Results:Temperature and%beeswax significantly influenced drug release(P=0.0024).Optimal drug release and viscosity were obtained at 5.4%beeswax,89.6%soft-paraffin melted at 58℃.The predominant drug release mechanism was Higuchi(R^(2)=0.967±0.023),which implied longer contact between formulation and skin favours drug diffusion.Inhibition of edema by the ointment was comparable to 1%(w/w)diclofenac gel(t=2.1;CI=(-8.29)-1.15),and both differed significantly with negative control(t=11.3 and 13.4;CI=14.5-23.9 and 18.1-27.5 respectively).Insignificant changes in spreadability(P=0.112),absence of new spots on chromatograms,and deficiency of microbial colonies on agar plates implied physical,chemical,and microbial stability,respectively.Conclusion:A formulated ointment containing O.americanum extract exhibited predictable and stable drug release characteristics to produce anti-inflammatory activity.The ointment formulation can potentially be considered as an effective option in management of peripheral inflammation.