Cystic Medulloblastoma in a child

No Abstrac

Head injury at a tertiary referral centre in the Eastern Region of Nepal

Background: The purpose of this epidemiologic study was to determine the pattern and characteristics of head injuries and to establish an epidemiologic data bank for designing preventive strategies for head injuries in the eastern region of Nepal.Patients and Methods: This retrospective review was done at B.P.Koirala institute of Health Sciences, Dharan, Nepal. All the patients with head injury admitted to the Department of Surgery between the periods January 2005 to December 2005 were included in the study.Results: The study population consisted of 334 patients who sustained head injuries. Their ages ranged from 1 to 88 with a mean age of 28.53 years. The majority (66.3%), were young adults in the 2nd to 5th decades The male to female sex ratio was 2.6:1. Road traffic crushes were the most common cause (43.4%) followed by fall from heights (30.8%). X-ray of skull showed lesions in 114 cases (49.8%) such as depressed fracture (11.4%) and linear fracture (24.0%). Common lesions on CT scan included cerebral contusion (21.6%), extradural haematoma (20.9%), linear fracture (23.8%), subarachnoid haemorrhage (18.5%) and pnemocephalus (11.2%). Forty patients (12.0%) sustained moderate head injury. There were 15 deaths. One patient had associated intra-abdominal injury (splenic rupture) and two patient sustained pulmonary trauma and succumbed to haemothorax and aspiration.Conclusion: A clearer understanding of the patterns of head injuries will assist health care providers to plan and manage the treatment of traumatic facial injuries. Such epidemiological information can also be used to guide the future funding of public health programs geared toward prevention

Validating breast self examination as screening modalities for breast cancer in eastern region of Nepal: A population based study

Abstract Breast cancer is one of the most common causes of death in many developed countries amongst middle-aged women and is becoming common in developing countries as well. Aims and Objectives: The objective of this study was to evaluate the performance of Breast Self Examination (BSE) against examination conducted by the trained health personnel. Methodology: A descriptive evaluative study was conducted among women aged 15 to 60 years undertaken in urban and rural areas. It was a population-based study and non-probability sampling method was used for data collection. Respondents conducted Breast Self Examination on their own, and then investigators did clinical examination of breasts of the respondents to verify their findings. Results: Mean age of the respondents was 34.54 ± 9.12 years. Nearly half (44.8%) of the respondents were illiterate. On comparison of each variable of breast self-examination with the physical examination of breast, it was observed that size of the breasts and lump found in the breast had significant relation to performance during examination (P<0.1). The result of Kappa test showed 68% agreement between findings of examinations done by the experts and respondents. Conclusion: Breast Self Examination can be used as an important tool for primary prevention of breast cancer in Nepal, where sophisticated method like screening mammography for general public cannot afford. reast cancer is leading cancer among the women worldwide, with more than 540,000 new cases each year. Over 40 percent of these cases are in the developing countrie

Iliopsoas abscess: Analysis and perspectives from an endemic region of Eastern Nepal

Abstract Objective: To evaluate the clinical profile and outcome in patients with iliopsoas abscess. Methods: A descriptive study was carried out in B.P. Koirala Institute of Health Science, Dharan, Nepal from February 2005 to March 2006. The medical records of all thirty six patients admitted in surgery ward with diagnosis of iliopsoas abscess during the study period were analyzed. Results: Thirty six patients were included the study. There were 22 (61.1%) males and 14 (38.9%) females with a mean age of 24.33 ±19.19 years. Demographic distribution of the patients revealed the highest number 13 (36.1%) from Sunsari district, eastern part of the country. Right sided unilateral involvement was the most common presentation and only 2 cases had bilateral involvement. In none of our patients the dorsolumbar spine radiograph revealed any involvement of the bone. The most common complaints were pain in lower abdomen and lump in iliac fossa with flexion deformity at hip joint. All the patients underwent open surgical drainage and their outcomes were analyzed in term of cure, morbidity and mortality. Staphylococcus aureus was the most common organism 24 (61.5%) isolated. Twenty two (91.66%) of Staphylococcus aureus samples were sensitive to ciprofloxacin. There was one mortality in the group who died of septicaemia secondary to necrotizing fascitis. Six patients had wound infection, which were cured by regular dressing. Conclusion: On the basis of our experience and review of available relevant literature, we can conclude that a high index of suspicion and awareness of the varying clinical picture are required to diagnose this condition properly. Ultrasonography should still be the preferred imaging modality as it is cheap, safe, cost effective and readily available. Ciprofloxacin should be used as a first line drug. Image guided aspiration may be practical in selected cases having little pus and traditional open drainage should be considered without hesitation

Metallopanstimulin as a marker for head and neck cancer

BACKGROUND: Metallopanstimulin (MPS-1) is a ribosomal protein that is found in elevated amounts in the sera of patients with head and neck squamous cell carcinoma (HNSCC). We used a test, denoted MPS-H, which detects MPS-1 and MPS-1-like proteins, to determine the relationship between MPS-H serum levels and clinical status of patients with, or at risk for, HNSCC. PATIENTS AND METHODS: A total of 125 patients were prospectively enrolled from a university head and neck oncology clinic. Participants included only newly diagnosed HNSCC patients. Two control groups, including 25 non-smokers and 64 smokers, were studied for comparison. A total of 821 serum samples collected over a twenty-four month period were analyzed by the MPS-H radioimmunoassay. RESULTS: HNSCC, non-smokers, and smokers had average MPS-H values of 41.5 ng/mL, 10.2 ng/mL, and 12.8 ng/mL, respectively (p = 0.0001). CONCLUSION: We conclude that MPS-1 and MPS-1-like proteins are elevated in patients with HNSCC, and that MPS-H appears to be a promising marker of presence of disease and response to treatment in HNSCC patients

In an in vitro model of human tuberculosis, monocyte-microglial networks regulate matrix metalloproteinase-1 and -3 gene expression and secretion via a p38 mitogen activated protein kinase-dependent pathway.

BACKGROUND: Tuberculosis (TB) of the central nervous system (CNS) is characterized by extensive tissue inflammation, driven by molecules that cleave extracellular matrix such as matrix metalloproteinase (MMP)-1 and MMP-3. However, relatively little is known about the regulation of these MMPs in the CNS. METHODS: Using a cellular model of CNS TB, we stimulated a human microglial cell line (CHME3) with conditioned medium from Mycobacterium tuberculosis-infected primary human monocytes (CoMTb). MMP-1 and MMP-3 secretion was detected using ELISAs confirmed with casein zymography or western blotting. Key results of a phospho-array profile that detects a wide range of kinase activity were confirmed with phospho-Western blotting. Chemical inhibition (SB203580) of microglial cells allowed investigation of expression and secretion of MMP-1 and MMP-3. Finally we used promoter reporter assays employing full length and MMP-3 promoter deletion constructs. Student's t-test was used for comparison of continuous variables and multiple intervention experiments were compared by one-way ANOVA with Tukey's correction for multiple pairwise comparisons. RESULTS: CoMTb up-regulated microglial MMP-1 and MMP-3 secretion in a dose- and time-dependent manner. The phospho-array profiling showed that the major increase in kinase activity due to CoMTb stimulation was in p38 mitogen activated protein kinase (MAPK), principally the α and γ subunits. p38 phosphorylation was detected at 15 minutes, with a second peak of activity at 120 minutes. High basal extracellular signal-regulated kinase activity was further increased by CoMTb. Secretion and expression of MMP-1 and MMP-3 were both p38 dependent. CoMTb stimulation of full length and MMP-3 promoter deletion constructs demonstrated up-regulation of activity in the wild type but a suppression site between -2183 and -1612 bp. CONCLUSIONS: Monocyte-microglial network-dependent MMP-1 and MMP-3 gene expression and secretion are dependent upon p38 MAPK in tuberculosis. p38 is therefore a potential target for adjuvant therapy in CNS TB