Long-Standing Asymptomatic Inguinoscrotal Hernia

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Worst Case Scenarios! Complications Related to Hernial Disease

Incarceration, obstruction and strangulation are well recognized common complications of hernias. Several risk factors determine patients’ morbidity and mortality. Hernia surgery complications encompass infections, fascial dehiscence, recurrence, neuralgia, visceral injury, and mesh erosion or migration predetermined by many risk factors. The types and criteria for surgical site infections are defined by the extent of the infection. Whether the open or laparoscopic approaches are attempted, the rates of the respective complications depend on the approach. Post-operative hernias are appreciated because of their prevalence and complications. The criteria for enhanced recovery after surgery depend on whether patient is in the pre-operative, intra-operative or post-operative phase. Within the pediatric population, the risk of developing umbilical and inguinal is variable

A forgotten Reason for abdominal pain: Mesentric Panniculitis case report and review of literature

Background: Mesentric Panniculitis an inflammatory condition that usually present with vague abdominal symptoms such as pain and diarrhea. The ambiguity of the symptoms makes the diagnosis of MP a challenge. Case Report: a twenty five years old lady presented to the emergency room with vague abdominal complaints including pain and loss of appetite along with fever for the last two days. Workup for acute appendicitis was done including a CT scan which showed possible radiological signs of Mesentric Panniculitis

FINE NEEDLE ASPIRATION CYTOLOGY (FNAC) IN DIAGNOSIS OF TUMORAL CALCINOSIS, A REPORT OF THREE CASES

Introduction: Tumoral calcinosis (T.C.) is very rare and generally of unknown aetiology characterized by calcific deposits in the soft tissues. Commonly seen in the second decade of life (reported age range 15 months to 83 years). We are reporting 3 cases of T. C. who were initially diagnosed by FNAC. Two of the 3 cases were female siblings who were referred to us as possible cases of recurrent fibrosarcomas following surgical excision. Case reports:  (1) Two female siblings aged 17 and 14 years  complaining of large swelling in the upper   outer right thigh and the left outer upper thigh around the hip joints respectively. There was no limitation of movement. The masses recurred within a short period after total excision. Neither specimen was subjected to histopathology. Clinical examination showed two masses each approximately 30cm maximum diameter and 10 cm width. In addition the younger sister showed an additional mass 4.5 cm in the outer aspect of her right elbow. (2) 18 months old female child, unrelated to the above two cases, presented with an egg-sized mass in the mid-lateral aspect of her right thigh  cystic and mobile.There is a history of quinine injection in the same area. No positive family history of a similar condition. All three cases showed normocalcaemia and hyperphosphataemia with specks of calcification on x - ray and cysts in ultrasound. FNAC showed structureless gung , calcium granules and inflammatory cells including foreign body type multinucleated giant cells. Histopathology confirmed the diagnosis of T. C. Discussion: Described the three types of T. C. (familial, idiopathic, and that in patients of chronic renal failure on dialysis). The differential diagnoses were also discussed as well as lines of management such as Ca++ supplementation, phosphate restriction, acetazolamide, parathyroidectomy and the treatment of choice is total surgical excision. To our best knowledge this is the first time to report the use of fine needle aspiration cytology in the diagnosis of T. C. in Sudan.&nbsp

Ethical, legal and social aspects of the approach in Sudan

The global malaria situation, especially in Africa, and the problems frequently encountered in chemical control of vectors such as insecticide resistance, emphasize the urgency of research, development and implementation of new vector control technologies that are applicable at regional and local levels. The successful application of the sterile insect technique (SIT) for the control of the New World screwworm Cochliomyia hominivorax and several species of fruit flies has given impetus to the use of this method for suppression or elimination of malaria vectors in some areas of Africa including Northern State of Sudan. The research and development phase of the Northern State feasibility study has been started. Sudanese stakeholders are working side-by-side with the International Atomic Energy Agency in the activities of this important phase. Several ethical, legal and social issues associated with this approach arose during this phase of the project. They need to be seriously considered and handled with care. In this paper, these issues are described, and the current and proposed activities to overcome potential hurdles to ensure success of the project are listed

Field site selection: getting it right first time around

The selection of suitable field sites for integrated control of Anopheles mosquitoes using the sterile insect technique (SIT) requires consideration of the full gamut of factors facing most proposed control strategies, but four criteria identify an ideal site: 1) a single malaria vector, 2) an unstructured, relatively low density target population, 3) isolation of the target population and 4) actual or potential malaria incidence. Such a site can exist in a diverse range of situations or can be created. Two contrasting SIT field sites are examined here: the desert-flanked Dongola Reach of the Nile River in Northern State, Sudan, where malaria is endemic, and the island of La Reunion, where autochthonous malaria is rare but risk is persistent. The single malaria-transmitting vector at both sites is Anopheles arabiensis. In Sudan, the target area is a narrow 500 km corridor stretching from the rocky terrain at the Fourth Cataract - just above the new Merowe Dam, to the northernmost edge of the species range, close to Egypt. Vector distribution and temporal changes in density depend on the Nile level, ambient temperature and human activities. On La Reunion, the An. arabiensis population is coastal, limited and divided into three areas by altitude and exposure to the trade winds on the east coast. Mosquito vectors for other diseases are an issue at both sites, but of primary importance on La Reunion due to the recent chikungunya epidemic. The similarities and differences between these two sites in terms of suitability are discussed in the context of area-wide integrated vector management incorporating the SIT

TB or not TB! That’s the question

Twenty seven years old lady presented to the emergency department accompanied by family members with complaint of fluctuating consciousness and fever for the past three days. Upon further questioning the patient has been complaining from headache for two months, decreased appetite for the past month and had a travel history to Ethiopia five months ago. Family members were not sure about any history of weight loss, the patient took a one week course of antibiotics for tooth infection two weeks ago. Physical examination showed an ill looking, vitally stable lady on chest auscultation diffuse crackles heard bilaterally. Septic work up including CSF sample was ordered to rule-out meningitis chest X-ray was also ordered. Chest X ray result showed a clinical image specious of milliary TB (A) and results were confirmed by a positive acid fast stain of the CSF. Patient was taken to isolation and proper management was started with a final diagnosis of TB meningitis. A follow-up MRI showed few hyper-intense foci in deep white matter of left frontal lobe (B)

Occipital Meningoencephalocele case report and review of current literature

Abstract Background Meningoencephalocele is a rare congenital anomaly that is characterized by herniation of brain tissue through a defect in skull. Generally, it could be divided by anatomical location of defect to occipital and frontoethmoidal. The exact etiology of this condition is unknown but many theories have been postulated. The condition is usually seen at birth but can be identified prenatally. Case presentation A newborn was brought to the hospital after a normal non-complicated vaginal delivery done by the ambulance personnel. The newborn had a bulging mass on the posterior aspect of the head. Therefore, he was admitted and neurosurgical consultation was done for further evaluation. Currently the patient is following up in well baby clinic as well as the neurosurgery clinic for normal development and milestones acquisition. Conclusions This case presents the opportunity for junior healthcare professionals to learn about a group of congenital neurological disorder in the content of a rare case presentation

Two faces of the coin: Minireview for dissecting the role of reactive oxygen species in stem cell potency and lineage commitment

Reactive oxygen species (ROS) are produced as by-products of several intracellular metabolic pathways and are reduced to more stable molecules by several protective pathways. The presence of high levels of ROS can be associated with disturbance of cell function and could lead to apoptosis. The presence of ROS within the physiological range has many effects on several signalling pathways. In stem cells, this role can range between keeping the potency of the naive stem cells to differentiation towards a certain lineage. In addition, the level of certain ROS would change according to the differentiation stage. For example, the presence of ROS can be associated with increasing the proliferation of mesenchymal stem cells, decreasing the potency of embryonic stem cells and adding to the genomic stability of induced pluripotent stem cells. ROS can enhance the differentiation of stem cells into cardiomyocytes, adipocytes, endothelial cells, keratinocytes and neurons. In the meantime, ROS inhibits osteogenesis and enhances the differentiation of cartilage to the hypertrophic stage, which is associated with chondrocyte death. Thus, ROS may form a link between naïve stem cells in the body and the environment. In addition, monitoring of ROS levels in vitro may help in tissue regeneration studies. Keywords: Stem cells, Reactive oxygen species, Differentiation, Osteogenesis, Potenc