Giant Ulcerative Lactating Nodule of Ectopic Breast Mimicking Malignancy.

Objective: Lactating nodules occur in the pregnant and post partum patient and require investigation to rule out the possibility of a malignancy The aim of this paper is to document occurrence of a rarecase of ectopic breast mass in a post-partum woman that mimicked malignancy and proved to be a diagnostic challenge both clinically and cytologically, in order to sensitize physicians to such cases.Design and Setting: Case description, including clinical and pathological features, of a patient seen in Surgical Camp, Hoima, in September 2005.Case Report: A 22 year old woman presented 3 months post-partum with a huge, rapidly growing and ulcerating axillary mass. Both the clinical impression and fine needle aspiration cytology suggested malignancy. However, resection followed by macroscopic and histopathologic study proved it to be a giant ulcerating but benign lactating nodule of ectopic breast.Conclusion: Physicians should be aware that a benign lactating nodule in pregnant or post-partum patients can mimic breast carcinoma, either in the breast or in an ectopic location. Histopathologic study is mandatory to assess such lesions in order to render an accurate diagnosis

Diagnostic accuracy of fine needle aspiration cytology in providing a diagnosis of cervical lymphadenopathy among HIV-infected patients

Background: Opportunistic infections and malignancies cause lymphadenopathy in HIV-infected patients. The use and accuracy of fine needle aspiration cytology in diagnosing of cervical lymphadenopathy among HIV-infected patients is not well studied in Uganda.Objective: The aim of this study was to determine the diagnostic accuracy of fine needle aspiration cytology in providing a diagnosis of cervical lymphadenopathy among HIV-infected patients in Uganda.Methods: We consecutively recruited adult HIV-infected patients with cervical lymphadenopathy admitted to Mulago Hospital medical wards. Clinical examination, fine needle aspiration and lymph node biopsy were performed. We estimated the sensitivity, specificity; negative and positive predictive values using histology as the gold standard.Results: We enrolled 108 patients with a mean age of 33 years (range, 18-60), 59% were men and mean CD4 was 83(range, 22-375) cells/mm3. The major causes of cervical lymphadenopathy were: tuberculosis (69.4%), Kaposi's sarcoma-KS (10.2%) and reactive adenitis (7.4%). Overall fine needle aspiration cytology accurately predicted the histological findings in 65 out of 73 cases (89%) and missed 7 cases (9.5%). With a sensitivity of 93.1%, specificity of 100%, positive predictive value of 100% and negative predictive value of 78.7% for tuberculosis and 80%; 98.4%;88.9% and 98.9% for KS respectively. No fine needle aspiration complications were noted.Conclusions: Fine needle aspiration cytology is safe and accurate in the diagnosis of tuberculosis and KS cervical lymphadenopathy among HIV-positive patients.Keywords: Fine needle aspiration cytology, cervical lymphadenopathy, HI

Sonographic correlation of thyroid nodules with ultrasound aided fine needle non aspiration cytology

Objectives: To describe the sonographic patterns of thyroid nodules in patients undergoing thyroid ultrasound, to correlate sonographic characteristics of thyroid nodules to ultrasound aided fine needle non aspiration(US-FNNA) cytology and to determine the sensitivity and specificity of Ultrasound in characterising thyroid nodules.Design: Cross sectional study.Setting: The department of Radiology at Mulago Teaching and National Referral Hospital in Kampala Uganda. The Hospital is a 1,500-bed unit providing tertiary diagnostic, curative, rehabilitative, preventive and teaching services. Patients were recruited from both Medical and Surgical outpatient thyroid clinics.Subjects: All patients with thyroid nodules > 5 mm and who consented to have US aided-FNNA were enrolled consecutively.Results: One hundred and eighty one (181) participants were enrolled and final diagnoses were concluded in 177 of the participants (analysed) while four participants were excluded due to inadequate samples. The participants' age range was 19 to 83 years (mean age - 42 years ) and 93% were females. Five percent (n=9) were malignant, 18% suspiscious (n=34) and benign (n=134). The sonographic characteristics that were significantly correlated with final cytology diagnosis were a taller than wide AP diameter, micro-calcifications, heterogeneous and hypoechoic echo-patterns. Heterogeneous, hypoechoic and central vascularity had the highest sensitivity while wider than tall, anteroposterior diameter, no lymphadenopathy, and macro/no calcifications had the highest specificity.Conclusion: Sonographic features of micro-calcifications, taller than wide AP diameter, central vascularity and hypoechogenicity warrant US-FNNA. A bigger study correlating thyroid sonography with histological diagnosis is recommended

Regularity of laboratory supplies and delivery of histopathology services in the department of Pathology, Makerere University College of Health Sciences, Uganda, between January 2002 and April 2003

A retrospective study was undertaken in the department of Pathology, Makerere University College of Health Sciences and Mulago Hospital, Uganda, between January 2002 and April 2003 to determine the regularity of laboratory supplies and delivery of histopathology services. The requisition forms and dates of final reporting were obtained from department of Pathology records. The information on delivery of supplies was retrieved from Mulago hospital stores. Formalin (450 L) and isopropyl (2,505 L) were requisitioned, but only 145 L (32.2%) and 70 L (2.8%) respectively were received. Xylene 5L (11.1%) were issued out of 45 L requisitioned. Paraffin wax (900 Kg) was ordered and 200 Kg (22.2%) were supplied. Hematoxylin (850 gms) and silver nitrate (3,700 g) were ordered and none of each was issued. Eosin (100 gms) was supplied out of 200 g requisitioned. Microscope slides (721 packets) and cover slips (520 packets) were requisitioned, only 127 packets (17.6 %) and 90 packets (17.3 %) respectively were supplied. Surgical blades (2,836) were requisitioned and 760 (26.8 %) were given. No detergents and disinfectants were supplied. On average, it took 5 days to get supplies. Turnaround time of making diagnosis was 9 days. Approximately 52 specimens were either lost or misplaced out of 6,700 samples processed during this period. The amount of supplies received was far much lower than the amount requested. Give the high turnaround time in the histopathology service, a computerized laboratory logistics and inventory management systems (LMIS) should be established at the health settings in the country in order to ensure continuous availability of laboratory supplies and improve the turnaround time in laboratory services.KEY WORDS: Laboratory; Supplies; Histopathology; Service

Determination of LDL-cholesterol: direct measurement by homogeneous assay versus Friedewald calculation among Makerere University undergraduate fasting students

The treatment of patients for coronary heart disease risk requires knowledge of the plasma lipid levels. Low density lipoprotein cholesterol (LDL) levels make a strong basis for therapeutic decisions. Although there are incongruities among values of LDL from different methods of determining LDL, the clinician is not routinely informed of the method used. The purpose of this study was to compare LDL levels determined by the Friedewald equation with those assayed by the Kyowa Madox method. The lipid results previously measured by Kyowa Madox method among Makerere University fasting students and reported earlier wereretrieved. The measured values of total cholesterol (TC), High Density Lipoprotein cholesterol (HDL) and triacylglycerols (TG) were used to calculate LDL using Friedewald equation in which LDL= TC-HDL-TG/2.2mmol/L. The values obtained were compared non parametrically with the assayed values previously reported. Our results showed a high value of correlation between measured and calculated LDL so that in general, the two methods can be used interchangeably in this population. However, in cases of dyslipidaemia, the calculated values tend to be lower than the assayed values. It is therefore recommended that clinical laboratories should report the LDL values along with the determination method used, the alert values, the reference ranges, the desirable ranges and the therapeutic targets. © 2010 International Formulae Group. All rights reserved.Keywords: Homogeneous assay, LDL cholesterol, direct measurement, Friedewald equation, comparison

Micro-Dosing of Lime, Phosphorus and Nitrogen Fertilizers Effect on Maize Performance on an Acid Soil in Kenya

High cost of inorganic fertilizers and lime has precluded their use by smallholder farmers to remedy the problem of soil acidity and infertility in Kenya. To address the problem, we tested a precision technique referred to as micro-dosing, which involves application of small, affordable quantities of inorganic inputs on an acid soil in Busia County, Kenya. Experimental treatments were N-fertilizer (0 and 37.5 kg N ha-1), P-fertilizer (0 and 13 kg P ha-1) and lime (0, 0.77 and 1.55 tons lime ha-1). 37.5 kg N and 13 kg P ha-1 are 50% of the recommended fertilizer rates for maize production in Kenya while 0.77 and 1.55 tons lime ha-1 are 25 and 50% of the actual requirement. Soil chemical changes, maize grain yield and nutrient recovery were determined. Lime and P-fertilizer significantly affected only the top-soil pH, Ca, Mg and available P, while the effects of N-fertilizer were evident on both top- and sub-soil N likely due to its faster mobility than P and lime. Grain P-fertilizer recovery efficiencies were 14 and 16-27% due to 13 kg P and 13 kg P + 0.77-1.55 tons lime ha-1, respectively. N-fertilizer recovery efficiencies were 37 and 42-45% due to 37.5 kg N and 37.5 kg N + 0.77-1.55 tons lime ha-1, respectively. Fertilizers applied to supply 37.5 kg N, 13 kg P and 0.77-1.55 tons lime ha-1 increased grain yield above the control by 134, 39 and 12-22%, respectively, therefore micro-dosing of these inputs can increase maize production on Kenyan acid soils

Presyncope Is Associated with Intensive Care Unit Admission in Emergency Department Patients with Acute Pulmonary Embolism

Introduction: Syncope is common among emergency department (ED) patients with acute pulmonary embolism (PE) and indicates a higher acuity and worse prognosis than in patients without syncope. Whether presyncope carries the same prognostic implications has not been established. We compared incidence of intensive care unit (ICU) admission in three groups of ED PE patients: those with presyncope; syncope; and neither.Methods: This retrospective cohort study included all adults with acute, objectively confirmed PE in 21 community EDs from January 2013–April 2015. We combined electronic health record extraction with manual chart abstraction. We used chi-square test for univariate comparisons and performed multivariate analysis to evaluate associations between presyncope or syncope and ICU admission from the ED, reported as adjusted odds ratios (aOR) with 95% confidence intervals (CI).Results: Among 2996 PE patients, 82 (2.7%) had presyncope and 109 (3.6%) had syncope. ICU admission was similar between groups (presyncope 18.3% vs syncope 25.7%) and different than their non-syncope counterparts (either 22.5% vs neither 4.7%; p<0.0001). On multivariate analysis, both presyncope and syncope were independently associated with ICU admission, controlling for demographics, higher-risk PE Severity Index (PESI) class, ventilatory support, proximal clot location, and submassive and massive PE classification: presyncope, aOR 2.79 (95% CI, 1.40, 5.56); syncope, aOR 4.44 (95% CI 2.52, 7.80). These associations were only minimally affected when excluding massive PE from the model. There was no significant interaction between either syncope or presyncope and PESI, submassive or massive classification in predicting ICU admission.Conclusion: Presyncope appears to carry similar strength of association with ICU admission as syncope in ED patients with acute PE. If this is confirmed, clinicians evaluating patients with acute PE may benefit from including presyncope in their calculus of risk assessment and site-of-care decision-making

Effects of lime, phosphorus and rhizobia on Sesbania sesban performance in a Western Kenyan acid soil

Aluminium (Al) toxicity, phosphorus (P) deficiency and low rhizobia populations limit Sesbania (Sesbania sesban) performance in tropical acid soils. The study determined the i) indigenous rhizobia populations that nodulate sesbania and ii) effects of lime (0 and 4 t/ha), P-fertilizer (0 and 60 kg/ha) and acid tolerant rhizobia (0 and inoculation) on soil and selected sesbania accessions performance in Western Kenya acid soil. Study site had acid soil, low available P, nitrogen (N) and rhizobia populations that nodulate Sesbania (146 cells/g soil). Lime increased soil pH, while both lime and P-fertilizer increased available P. Aluminium toxicity tolerant and P-efficient accessions (SSBSA004, SSUG3, SSUG4 and SSUG5) had faster growth, higher nodulation, shoot P, and shoot N and response to treatments than the sensitive one (SSBSA203). After 7 months of growth, SSUG3 had highest shoot length (306 cm) and dry matter (5.64 tons/ha), hence, most suitable for building poles and fuel wood. SSUG5 accumulated the highest shoot N (222 kg N/ha) and was therefore, most suitable soil N replenishment. Thus, in acid P deficient and low rhizobial population soils of Western Kenya, the use of lime, P-fertilizer, rhizobia inoculation and Al toxicity tolerant Sesbania are important for Sesbania establishment and growth. Key words: Rhizobia, Sesbania, soil acidity, aluminum toxicity, lime, phosphorus

One Percent Tenofovir Applied Topically to Humanized BLT Mice and Used According to the CAPRISA 004 Experimental Design Demonstrates Partial Protection from Vaginal HIV Infection, Validating the BLT Model for Evaluation of New Microbicide Candidates

Recent iPrEx clinical trial results provided evidence that systemic preexposure prophylaxis (PrEP) with emtricitabine (FTC) and tenofovir disoproxil fumarate (TDF) can partially prevent rectal HIV transmission in humans. Similarly, we have previously demonstrated that systemic administration of the same FTC-TDF combination efficiently prevented rectal transmission in humanized bone marrow/liver/thymus (BLT) mice. The CAPRISA 004 trial recently demonstrated that topical application of the tenofovir could partially prevent vaginal HIV-1 transmission in humans. To further validate the usefulness of the BLT mouse model for testing HIV prevention strategies, we evaluated the topical administration of tenofovir as used in CAPRISA 004 to prevent vaginal HIV transmission in BLT mice. Our results demonstrate that vaginally administered 1% tenofovir significantly reduced HIV transmission in BLT mice (P = 0.002). Together with the results obtained after systemic antiretroviral PrEP, these topical inhibitor data serve to validate the use of humanized BLT mice to evaluate both systemic and topical inhibitors of HIV transmission. Based on these observations, we tested six additional microbicide candidates for their ability to prevent vaginal HIV transmission: a C-peptide fusion inhibitor (C52L), a membrane-disrupting amphipathic peptide inhibitor (C5A), a trimeric d-peptide fusion inhibitor (PIE12-Trimer), a combination of reverse transcriptase inhibitors (FTC-TDF), a thioester zinc finger inhibitor (TC247), and a small-molecule Rac inhibitor (NSC23766). No protection was seen with the Rac inhibitor NSC23766. The thioester compound TC247 offered partial protection. Significant protection was afforded by FTC-TDF, and complete protection was offered by three different peptide inhibitors tested. Our results demonstrate that these effective topical inhibitors have excellent potential to prevent vaginal HIV transmission in humans