A Young Man in a Rural Breast Clinic

This article reports a case from Rwanda of muscular cysticercosis presenting as a painful “breast” lump in a young male patient. Sonographic evaluation revealed a hypoechoic mass deep to the breast tissue likely within the pectoralis muscle, rather than the breast. Subsequent excisional biopsy resulted in the diagnosis of cysticercosis

Causes and outcome of intracranial bleed in children presenting to emergency department of tertiary care hospital

Introduction: Intracranial (IC) bleed spontaneous and traumatic are important cause of morbidity and mortality in children. Objective: To determine the causes and outcome of children presenting to emergency department of a tertiary care hospital. Material and Method: The study was conducted at Emergency department (ED) of Aga Khan University from Jan 2009- Dec 2010.The charts of the patients with Intracranial bleeding were reviewed retrospectively. Data was collected on variables like age, gender, symptoms, clinical presentations CT scan findings, cause of bleeding and final disposition with outcome were recorded in a predesigned proforma. Data was entered and analyzed using SPSS version 19.0. Results: During the study period total 145 children presented to emergency department with suspected Intracranial Bleed. The mean age of presentation was 5.6 years ± 4.26 years with 27(18.6%) less than 1 year of age. Males were 100(69%) and females were 45(31%). The presenting complaints were headache (16.6%), altered level of consciousness (40.7%), seizures (29.7%), vomiting (51%) and fever (20.7%). Duration of symptoms was less than a week in 72.4% of patients. History of trauma was found in 104(71.7%), anemia 80(55.2%) and thrombocytopenia 11(7.6%). Ct scan showed extradural in 30.3% , parenchymal in 26.2% , subdural in 25.5% , cerebral edema in 71.7% and midline shift in 27.6%.Almost 32.4 % patients were shifted to operating room immediately .PICU admission was needed in 64.1% and 15.2% expired. Conclusion: Intracranial bleed is a common reason for Emergency department visits in children. Trauma is an important cause of intracranial bleeding in children. Keywords: bleeding, Emergency, Trauma, Childre

Prevalence of Premenstrual Syndrome In Females of Gujranwala Division And Its Associated Risk Factors

Introduction: Premenstrual syndrome (PMS) is characterized by cyclic reoccurrence of distressing somatic and psychological manifestations, during luteal phase of menstrual cycle. Present research work aims to investigate prevalence of PMS in females of Gujranwala division Pakistan and to explore various risk factors associated with this syndrome. Methods: The study included self-administered questionnaire, for diagnosis of PMS and PMDD. Participants were analysed for socio-demographic characteristics and menstrual history, serum cholesterol and haemoglobin levels of patients and control were measured. Results: In the present study, 56% females were screened positive for PMS while Prevalence PMDD was 18%. Most common physical symptoms of PMS were abdominal bloating (63.2%), muscle pain (71.73%), lack of energy (85.85%) and appetite change (79.15%) whereas major distressing psychological were Irritability (82.32%), anger (74.55%), depression (49%) and anxiety (63.2%). Prevalence of PMS was 22.6% in underweight, 50.1% in participants having normal weight, 15.5% in overweight individuals and 11.6% in obese. Anaemia (P = 0.00), fatigue (P = 0.00), dysmenorrhea (P = 0.00), family history of PMS (P = 0.00) and residential area (P = 0.047) were major risk factors for development of different symptoms of PMS. Conclusion: Statistically significant association was not confirmed between PMS, obesity and blood cholesterol level. PMS is a common menstrual disorder among reproductive females of Gujranwala division, Pakistan. Findings of the study revealed that anemic females were at risk to develop PMS symptoms

Breast Cancer Prevalence Among Patients Referred for Ultrasound-Guided Biopsy at Kenyatta National Hospital, Kenya

Purpose: To establish the prevalence of cancer in patients referred for breast ultrasound-guided biopsy at Kenyatta National Hospital, Nairobi, Kenya. Methods and Materials: A total number of 115 patients were included after approval from the local ethical review committee. The patients were referred by clinicians for ultrasound-guided biopsy for palpable breast lesions confirmed by imaging as solid masses. Detailed ultrasound examination per American College of Radiology (ACR) guidelines was performed before core biopsy or fine needle aspiration (FNA). Histological diagnosis was made and prevalence of cancer analyzed. Results: Of the 115 patients, final histology was available for 112 lesions; two cases could not be traced and one was inconclusive. Females accounted for 96.5% of cases; median age 28 years (range of 15-79 years). Median age of patients with cancer was 48 years (range 28-79 years). Cancer was diagnosed in 28 (25%) specimens, the remaining 84 revealing benign histology, with 74/84 (88%) fibroadenomas. There were 32/112 patients aged > 40 years (28.6%), of which 22 (78.6%) had cancer (p Conclusion: Most breast masses in our cohort (75%) were benign. Patients with a breast lump, especially young ones, need not assume it is cancer until thorough clinical and imaging evaluation has been done to characterize lesions and biopsy performed when indicated. Of the 25% of patients with cancers in this study, almost 79% were > 40 years of age; younger women had benign lesions, mostly fibroadenomas.</p

Risk factors, causative organisms and sensitivity patterns of infective keratitis in a tertiary care hospital in Rawalpindi

Objective: To determine the risk factors, causative organisms, sensitivity patterns and treatment outcomes of infective corneal ulcers. Methods: The is a prospective cohort study carried out from January 2018 to December 2019 at the Department of Ophthalmology, Fauji Foundation Hospital (FFH) Rawalpindi. A total of 65 eyes of 65 patients of corneal ulcer meeting the inclusion criteria were evaluated and corneal scrapes were sent for microbiological assessment.  Variables studied were age, gender, risk factors, onset and duration of symptoms, best corrected visual acuity (BCVA), treatment and complications. Results: Out of 65 eyes of 65 patients, 40 (61.5%) were females and 25 (38.4%) were males. Most common local risk factor was ocular surgery (29.2%) followed by ocular trauma (23.1%). Diabetes was present in 44.6% of the cases. Culture results after corneal scrapings were positive for 39 (60%) of the total samples, while 26 (40%) had no growth. Bacterial growth was present in 51.3% of eyes, fungal in 28.2% while 20.5% of the eyes were infected with polymicrobial organisms. Most common pathogens were Pseudomonas (25.6%) that were most sensitive to ciprofloxacin. By the end of the follow-up period 40 cases (61.5%) showed improvement. Conclusion: This study concluded that isolated Pseudomonas was the most common pathogen. Prompt diagnosis with culture sensitivity tests are very much needed in developing countries to avoid blindness due to keratitis. Keywords: Infective keratitis, risk factors, corneal ulcer, culture sensitivity

Recurrence of breast carcinoma as Paget disease of the skin at a prior core needle biopsy site: Case report and review of the literature

Introduction: Core needle biopsy has become the preferred method of diagnosing breast carcinomas prior to definitive surgery. The possibility of displacing tumor cells into the needle track is a concern. Presentation of case: A 38 year old woman was diagnosed with right breast ductal carcinoma in situ (DCIS) with microinvasion by core needle biopsy. Bilateral skin sparing mastectomies with immediate autologous reconstruction were performed. One and a half years later the patient noted erythema and a scaling crust on the skin of the right breast that progressed over several months. Punch biopsy revealed Paget disease restricted to the epidermis. Subsequent comparison to initial clinical photographs confirmed the cancer was associated with the skin puncture site of the needle biopsy. The patient underwent complete excision with skin grafting and remains free of disease three years later. Discussion: Only 13 cases of needle track recurrences have been reported. The majority presented as invasive carcinoma forming a subcutaneous mass. In the current case, detection was delayed due to not initially noting that a skin lesion was at the puncture site of the original needle biopsy. This is the only case of recurrence as tumor limited to the epidermis. Conclusion: Although recurrence in a needle track occurs very infrequently, clinicians should be aware of this phenomenon and investigate any changes, particularly when occurring at a needle biopsy site. Recording the skin puncture site can aid in early detection of recurrences. Recognition of a recurrence is important for prompt treatment and optimal prognosis

Skin Nodules as a First Presentation of Synchronous Bilateral Invasive Lobular Breast Carcinoma: A Case Report

The most common cause of skin metastases in adult women is primary breast carcinoma, which comprises about 70% of cases [1]. Skin metastases have non-specific clinical appearances, making it challenging to differentiate them from other benign conditions [1]. We present a case of a 52-year-old female with type II diabetes and a three-month history of refractory skin lesions who did not respond to anti-inflammatory treatment. The patient subsequently complained of a right breast lump, evaluation of which led to the diagnosis of bilateral synchronous invasive lobular carcinoma

Persistent inter-observer variability of breast density assessment using BI-RADS® 5th edition guidelines

Due to most states' legislation, mammographic density categorization has potentially far-reaching implications, but remains subjective based on BIRADS® guidelines. We aimed to determine 1) effect of BI-RADS® 5th edition (5th-ed) vs 4th-edition (4th-ed) guidelines on reader agreement regarding density assessment; 2) 5th-ed vs 4th-ed density distribution, and visual vs quantitative assessment agreement; 3) agreement between experienced vs less experienced readers. In a retrospective review, six breast imaging radiologists (BIR) (23–30 years' experience) visually assessed density of 200 screening mammograms performed September 2012–January 2013 using 5th-ed guidelines. Results were compared to 2016 data of the same readers evaluating the same mammograms using 4th-ed guidelines after a training module. 5th-ed density categorization by seven junior BIR (1–5 years' experience) was compared to eight experienced BIR. Nelson et al.'s kappas (κm, κw), Fleiss' κF, and Cohen's κ were calculated. Quantitative density using Volpara was compared with reader assessments. Inter-reader weighted agreement using 5th-ed is moderately strong, 0.73 (κw, s.e. = 0.01), similar to 4th-ed, 0.71 (κw, s.e. = 0.03). Intra-reader Cohen's κ is 0.23–0.34, similar to 4th-ed. Binary not-dense vs dense categorization, using 5th-ed results in higher dense categorization vs 4th-ed (p < 0.001). 5th-ed density distribution results in higher numbers in categories B/C vs 4th-ed (p < 0.001). Distribution for 5th-ed does not differ based on reader experience (p = 0.09). Reader vs quantitative weighted agreement is similar (5th-ed, Cohen's κ = 0.76–0.85; 4th-ed, Cohen's κ = 0.68–0.83). There is persistent subjectivity of visually assessed mammographic density using 5th-ed guidelines; experience does not correlate with better inter-reader agreement. •Mammographic density inter-reader agreement remains variable and persistently subjective.•Using BI-RADS® 5th edition compared to the 4th edition, breast imagers assess more mammograms as dense.•No difference in breast density distribution is observed based on experience level