Bone marrow invasion by aspergillus specie in a sickle cell trait patient with invasive aspergillosis: a fatal case in association with disseminated intravascular coagulation

Invasive aspergillosis has been predominantly associated with pulmonary infection, particularly amongst immunocompromised individuals. Extrapulmonary infections with Aspergillus specie have been reported rarely irrespective of immune status. Risk factors for invasive aspergillosis include prolonged and severe neutropenia, haematopoietic stem cell and solid organ transplantation, advanced AIDS, and chronic granulomatous disease. The most frequently involved specie is Aspergillus fumigatus that constitutes over 90% of cases, followed by Aspergillus flavus, usually associated with a primary skin infection. Haematogenous spread to the bone causing osteomyelitis is the commonest form of disseminated aspergillosis and a surprisingly high proportion of these patients have no immunosuppression. We present a rare case of bone marrow invasion by Aspergillusspp. in a 3-year-old patient with sickle cell trait and chronic Aspergillosis. Case report: A 3-year-old patient with sickle cell trait was brought to the paediatric unit with recurrent diarrhoea, abdominal distention, weight loss and persistent cough. The child was severely wasted with generalised peripheral lymphadenopathy. She had marked respiratory distress and hepatosplenomegaly but no demonstrable ascites. Haematologic examination revealed leukaemoid reaction (leukocyte count of 44.0 x 10 /L) with monocytosis (10%) and thrombocytopenia (platelet count of 97,000/mm ); no blast cells were seen on blood film. The bone marrow was hypercellular with a myeloid/erythroid ratio of 20:1, consistent with infection. Bone Marrow culture yielded Aspergillus spp. and other results of sepsis work up were negative. Conclusion: Cases of extrapulmonary invasive aspergillosis have been reported rarely in both immunocompetent and immunocompromised patients. Haematogenous spread to the bone is the commonest form of disseminated disease

Sonographic evaluation of the common bile duct size in normal adults at university of maiduguri teaching hospital, Nigeria

Despite ultrasound safety, affordability and its widespread use in evaluation of the diseases of biliary tree, paucity of literature on the sonographic measurements of the size of the normal adult common bile duct (CBD) in this environment exists. Objectives: To determine the normal adult diameter of the CBD in this environment using ultrasonography. Methods: This was a cross-sectional prospective study carried out at the University of Maiduguri Teaching Hospital between January to June, 2011. Results: There were 224(56%) females and 176(44%) males aged between18 and 87 years (Mean±SD, 36.88 ±16.97 years). The mean AP and transverse CBD diameters (±SD) were 3.68±0.82mm and 3.89±0.86mm, respectively. The average mean for the two measurements (± SD) was 3.78±0.84mm (range = 2.0 – 6.0 mm). The mean transverse diameter was slightly greater than AP diameter (p = 0.0004).The CBD diameter was strongly correlated with age (r = 2 0.798; p = 0.000; r = 0.629). The least squares regression slope of 0.039mm±0.001 (mean±SD) was obtained suggesting 0.039mm±0.001 increase in the CBD diameter per year. There was significant correlation between the CBD diameter with weight (r = 0.504; p = 0.000) and BMI (r = 0.454; p = 0.000). No significant difference between the mean CBD diameter in males and females (p= 0.084)was observed. Conclusion: The mean and range of CBD size in normal adult population were determined and significantly correlated with age, weight, and BMI

Formal Modeling and Analysis of the MAL-Associated Biological Regulatory Network: Insight into Cerebral Malaria

The discrete modeling formalism of René Thomas is a well known approach for the modeling and analysis of Biological Regulatory Networks (BRNs). This formalism uses a set of parameters which reflect the dynamics of the BRN under study. These parameters are initially unknown but may be deduced from the appropriately chosen observed dynamics of a BRN. The discrete model can be further enriched by using the model checking tool HyTech along with delay parameters. This paves the way to accurately analyse a BRN and to make predictions about critical trajectories which lead to a normal or diseased response. In this paper, we apply the formal discrete and hybrid (discrete and continuous) modeling approaches to characterize behavior of the BRN associated with MyD88-adapter-like (MAL) – a key protein involved with innate immune response to infections. In order to demonstrate the practical effectiveness of our current work, different trajectories and corresponding conditions that may lead to the development of cerebral malaria (CM) are identified. Our results suggest that the system converges towards hyperinflammation if Bruton's tyrosine kinase (BTK) remains constitutively active along with pre-existing high cytokine levels which may play an important role in CM pathogenesis