Assessment of The Diagnostic Value of TOX Versus CD3 Immunohistochemical Markers in Detection of Early Mycosis Fungoides Cases

Background: Primary cutaneous lymphoma (PCL) with clonal proliferation of atypical CD4+ skin-homing T lymphocyte cells is called Mycosis Fungoides (MF). TOX staining is observed in subtypes of PCL, as MF & Sézary Syndrome (SS) in comparison to controls. Early MF is difficult to diagnose, & its distinction from inflammatory diseases may be impossible.Objective: This study aimed to evaluate the expression of the TOX versus CD3 as a diagnostic marker for early MF.Patients and methods: retrospective-cross sectional study includes 30 MF and 30 benign cutaneous inflammatory diseases (BCID) cases. All were evaluated using H & E and immunohistochemical staining for TOX & CD3. Results: There was statistically significant increase of TOX & CD3 expression in MF than BCID & ability of TOX to detect all true positive cases (100.0%) compared to (76.7%) for CD3, (P < 0.001).Conclusion: TOX had the highest sensitivity (100.0%) & accuracy (88.3%). TOX is useful marker in the diagnosis of early MF & differentiating it from BCID

Concurrent intracranial chloromas and leukemia cutis in chronic myeloid leukemia

Granulocytic sarcoma (chloroma) is an extramedullary solid tumor composed of immature white blood cells. Most common involvement sites are bone, periostium, soft tissue, lymph nodes and skin. Intracranial granulocytic sarcoma rarely occurs in meningeal or parenchymal form1. We report the of concurrent occurrence of intracranial chloromas and leukemia cutis in 26 years old male patient, known case of Chronic Myeloid Leukemia for 3 years [+ve Philadelphia (Ph) chromosome in bone marrow cells] who now presented to the Civil Hospital Karachi with continuous headache and multiple cutaneous nodules all over the body for last 2 months. The CT exam of the Head revealed multiple hyper dense extra-axial nodular masses (with mean value of 48 HU) which showed vivid enhancement on post contrast images, along with multiple subcutaneous enhancing nodules seen in the scalp and maxillofacial region. The CSF cytological examination confirmed presence of immature leukemic cells in the subarachnoid space. The subcutaneous chest nodule histopathology showed granulocytic sarcoma. To the best of authors’ knowledge, the concurrent occurrence of granulocytic sarcomas at different locations in a single patient with Chronic Myeloid Leukemia has not been reported earlier in the literature

Magnetic resonance imaging of intracranial extramedullary haematopoiesis in β-thalassemia: a case report

We report the Magnetic Resonance Imaging of intracranial extramedullaryhematopoiesis in 21 years old β-thalassemic patient who presented to the Neurology Department of Civil Hospital Karachi with seizures. The MR exam revealed multiple intracranialextra-axial masses;isointense on T1W sequence and hypointenseon T1W, T2W, FLAIR, DWI sequence and ADC (b value= 1000 sec/mm2) with avid post contrast enhancement. Plain CT of the Head documented the presence of multiple hyperdenseextra-axial masses with mean value of 45 HU. Extramedullary hematopoiesis is the formation and development of blood cells in tissues outside of the medulla of the bone. The most common sites of involvement are the liver, spleen, and lymph nodes.Intracranial extra medullary hematopoiesis is a relatively rare manifestation of Thalassemia. There is paucity of literature for MR findings regarding intracranial EMH. It is essential to distinguish it from other central nervous system tumors, because treatment and prognosis are entirely different

A giant right subclavian- axillary artery aneurysm presenting as brachial plexopathy

We present a rare case of 60 years old lady with diabetes and uncontrolled systemic hypertension, who was referred to the Surgical Department of Civil Hospital Karachi in September 2016 with rapidly progressive mass at right shoulder region and acute onset of ipsilateral limb sensory and motor deficit for last 3 weeks. The nerve conduction studies (NCS) revealed right brachial plexopathy. Computed Tomography demonstrated an 8.2x8.7cm (width x length) fusiform giant aneurysm of right subclavian-axillary artery with reactive axillary lymphadenitis. Early Aneurysmectomy and arterial reconstruction with saphenous vein graft interposition was planned. Unfortunately, she succumbed to death due to spontaneous aneurysm rupture. Aneurysms of the subclavian- axillary artery are rare in the clinical setting, accounting for less than 1% of all peripheral arterial aneurysms

What can Pakistan do to address maternal and child health over the next decade?

Pakistan faces huge challenges in meeting its international obligations and agreed Millennium Development Goal targets for reducing maternal and child mortality. While there have been reductions in maternal and under-5 child mortality, overall rates are barely above secular trends and neonatal mortality has not reduced much. Progress in addressing basic determinants, such as poverty, undernutrition, safe water, and sound sanitary conditions as well as female education, is unsatisfactory and, not surprisingly, population growth hampers economic growth and development across the country. The devolution of health to the provinces has created challenges as well as opportunities for action. This paper presents a range of actions needed for change within the health and social sectors, including primary care, social determinants, strategies to reach the unreached, and accountability

Histiocyt ic sarcoma of the flax cerebri with Distant metastasis

Histiocytic Sarcoma is an extremely rare CNS tumor and to the best of authors\u27 knowledge, the extra-axial CNS histiocytic Sarcoma involving FalxCerebriin the humans has not been described earlier in the literature.We report an unusual case of22 year old male who presented to the Civil Hospital with symptoms of chronic headache and bilateral lower limb weakness. His MRI Brain showed an aggressive heterogeneously enhancing extraaxialfalxtumor with trans-calvarial invasion seen on interim CT scan and demonstration of distant metastases after resection and craniectomy. The immune-histochemical analysis was strongly positive CD68 and S-100 signifying Histiocytic Sarcoma

Bi li COVID-19 mogla biti hemoglobinopatija?

The world is struggling to deal with the corona pandemic. Effective therapies are still awaited due to the lack of understanding of the pathophysiological mechanism of the disease. Bearing recent research and clinical observations in mind, the authors propose a novel physiological mechanism of COVID-19 and explain development of COVID-19 related acute respiratory distress syndrome (ARDS) secondary to COVID-19 related hemoglobinopathy. It is a consistent observation that the radiological picture of COVID-19 related ARDS bears more resemblance to high altitude pulmonary edema (HAPE) than typical ARDS. There has been great controversy regarding this proposed similarity. The main argument from those objecting to this comparison is that the etiology is hypoxia in case of HAPE and inflammation in COVID-19 related ARDS. We propose that considering the recent bioinformatics prediction models, COVID-19 might first infect red blood cells via CD147 and cause hemoglobin damage. The resulting hypoxemia may cause pulmonary hypoxic vasoconstriction leading to HAPE-like lung lesions. The now introduced alveolar hypoxia further exaggerates hemoglobinopathy hypoxemia leading to a vicious cycle. In this review, the authors recommend laboratory experiments to prove these hypotheses. The proposed physiological mechanism has significant therapeutic implications. If proven, the authors suggest the use of exchange transfusion as adjunct therapy and development of anti-CD147 drugs.Cijeli svijet se bori kako bi svladao pandemiju koronavirusa. Patofiziološki mehanizam ove bolesti i dalje je nepoznat, što znači da se učinkoviti lijekovi tek očekuju. Vodeći računa o novijim istraživanjima i kliničkim zapažanjima, autori predlažu novi fiziološki mehanizam bolesti COVID-19 i objašnjavaju razvoj sindroma akutnog respiracijskog distresa (ARDS) nakon hemoglobinopatije povezane s COVID-19. Dosljedno se bilježi da radiološka slika hemoglobinopatije povezane s COVID-19 ima više sličnosti s visinskim plućnim edemom (HAPE) negoli s tipičnim ARDS. Ova sličnost izaziva velika proturječja. Glavni argument onih koji se protive ovoj usporedbi jest da je etiologija kod HAPE hipoksija, a kod ARDS povezanog s COVID-19 je to upala. Mi pretpostavljamo da bi, uzimajući u obzir novije bioinformatičke modele predviđanja, COVID-19 mogao najprije zaraziti eritrocite putem CD147 i uzrokovati oštećenje hemoglobina. Tako nastala hipoksemija može uzrokovati plućnu hipoksičnu vazokonstrikciju, što onda dovodi do oštećenja pluća sličnih HAPE. Tako uvedena alveolarna hipoksija dalje pogoršava hipoksemiju hemoglobinopatije i stvara se začarani krug. U ovom pregledu autori preporučuju laboratorijske eksperimente kako bi se dokazale ove hipoteze. Predloženi fiziološki mehanizam ima značajne terapijske implikacije. Ako se dokaže, autori predlažu primjenu izmjenske transfuzije kao dopunske terapije i razvoj lijekova protiv CD147

RISK FACTORS OF SCABIES IN PATIENTS ATTENDING AT TERTIARY CARE HOSPITAL

Objective: The objective is to find the risk factors among the patients attending department of medicine, OPD of  Bahawal Victoria Hospital, Bahawalpur. Study design: Descriptive cross-sectional study Place and Duration of study: Department of Medicine, OPD Bahawal Victoria Hospital, Bahawalpur. From 1st March to 25th September 2017. Materials and Methods: It is a descriptive cross-sectional study. Study was performed in Department of Medicine, OPD Bahawal Victoria Hospital, Bahawalpur. People with scabies seeking care in Department of Medicine Bahawal Victoria Hospital, Bahawalpur, were selected for the study. Convenient type of sampling technique was used to calculate the sample size. Total number of 1082 patients of both male & female gender and of all ages suffering from scabies was included in the study. Subjects were assessed by gender, age, their residence (rural or urban), marital status, status of education, monthly income, itching, body part of itching, time of itching (day or night) and other things like sharing of clothes, sharing of towels, oral hygiene, washing hands, close contact with pets etc. Data was analyzed using SPSS computer software version 23. Results: Overall, there were 100% (n=1082) scabies patients were included, in this study, both genders. Itching was presented in 90.1% (n=975) patients, while 57.1% (n=618) patients were also having red lesions. Regarding the part of body involved in itching, 36.5% (n=395) and 67.5% (n=730) patients experienced itching on face & nipples, 44.4% (n=480), 76.9% (n=832), 63.7% (n=689) and 85.6% (n=926) patients experienced itching on web spaces, soles, wrist and around umbilicus respectively. 38.1% (n=412) patients experienced it in axilla and 66.6% (n=721) on palms, while 56.7% (n=614) patients experienced itching on genitalia. Out of 1082 patients, 91.7% (n=992) patients were having these symptoms at day time, 4.7% (n=51) at night time, while 3.6% (n=39) having these symptoms at both day & night time. Conclusion: According to our research scabies is more common among males due to more exposure of males to the external environment. People with weak immune systems and the elderly are more at risk of developing scabies. Scabies is more common among rural communities because of low standard of quality of life and poor health education. Keywords: Risk Factors, Scabies, itching, skin lesion