Optical Coherence Tomography: Clinical Applications in Medical Practice 

Abdullah Al-Mujaini,* Upender K. Wali, Sitara Azeem 

Abstract

Optical Coherence Tomography (OCT) is a success story of scientific and technological co-operation between a physicist and a clinician. The concept of cross-sectional imaging revolutionalized the applicability of OCT in the medical profession. OCT is a non-contact, topographic, biomicroscopic device that provides high resolution, cross-sectional digital images of live biological tissues in vivo and in real time. OCT is based on the property of tissues to reflect and backscatter light involving low-coherence interferometry. The spatial resolution of as little as 3 microns or even less has allowed us to study tissues almost at a cellular level. Overall, OCT is an invaluable adjunct in the diagnosis and follow up of many diseases of both anterior and posterior segments of the eye, primarily or secondary to systemic diseases. The digitalization and advanced software has made it possible to store and retrieve huge patient data for patient services, clinical applications and academic research. OCT has revolutionized the sensitivity and specificity of diagnosis, follow up and response to treatment in almost all fields of clinical practice involving primary ocular pathologies and secondary ocular manifestations in systemic diseases like diabetes mellitus, hypertension, vascular and neurological diseases, thus benefitting non-ophthalmologists as well. Systemically, OCT is proving to be a helpful tool in substantiating early diagnosis in diseases like multiple sclerosis and drug induced retinopathies by detecting early changes in morphology of the retinal nerve fiber layer. 

Parasitic Infestation in Pediatric and Adolescent Appendicitis: A Local Experience 

Ossama M. Zakaria,^1* Hazem M. Zakaria,² Mohamed Yasser Daoud,¹ Hamed Al Wadaani,¹ Waleed Al Buali,³ Hamdan Al-Mohammed,³ Abdulrahman S. Al Mulhim,¹ Wafaa Zaki⁴ 

Abstract

Objective: The relationship between parasites and pediatric appendicitis is a highly debatable issue. This study aims to investigate the role of parasitic infestation in the etiology of acute pediatric appendicitis.

Methods: A retrospective study including 1600 pediatric and adolescent patients who had undergone surgical therapy for a diagnosis of acute appendicitis over a period of ten years from Jan 2001 to Dec 2010. Demographic data were retrieved including the patient's age, sex, clinical data, clinical presentations, laboratory investigations, operative data and pathological findings to identify the presence and type of parasites. Patients were divided into two groups according to the presence or absence of parasites in the appendix lumen. In group I (n: 88), parasitic infestation was observed, whereas in group II (n: 1502), no parasitic infestation was present.

Results: Parasites were present in 5.5% (88 patients), and of those 88 parasitic infestations, 45 (51.1%) were Enterobaisis, 8 (9.1%) were Schistosomiasis, 23 (26.1%) were Ascariasis, 7 (8%) Trichuriasis, and 5 (5.7%) were Teania Saginata. The percentage of patients with suppurative, gangrenous or perforated appendicitis was similar in both groups with no statistical significance, irrespective of the presence or absence of parasitic infestation.

Conclusion: The low prevalence of parasites among the appendectomy specimens did not support the notion that parasites were a major cause of appendicitis in pediatric patients.

Keywords: Appendicitis; Parasitic infestation; Enterobiasis; Al-Ahsa.

Clinical Characteristics and Causality of Eye Lid Laceration in Iran

Ali Tabatabaei,¹ Abolfazl Kasaei,¹ Mojgan Nikdel,¹ Saeed Shoar,^1* Sara Esmaeili,² Mostafa Mafi,¹ Mohammad Moradi,² Mohammadreza Mansouri,¹ Bahram Eshraghi,¹ Ziaeddin Tabatabaei¹

Abstract

Objective: The aim of this study was to assess the etiological characteristics and visual outcomes of ocular trauma with more attention to eyelid laceration.

Methods: In a cross-sectional study, 98 cases of isolated traumatic eyelid laceration were consecutively studied and its epidemiology, etiology and association with visual outcome were evaluated. The findings of this study could be used to develop healthcare related precautions and work place safety recommendations.

Results: Of the 98 patients included in the study, men exhibited a greater vulnerability and they were mostly aged around 29 years old. In terms of the place of trauma, 42 (42.8%) cases occurred in the street, 29 cases (29.6%) occurred at home, and 18 cases (18.4%) occurred at the workplace, while 5 cases (5.1%) happened in entertaining environments like parks. For 3 patients (3%), the incident took place at a public pathway, and in 1 patient (1%), the case occurred at school. As the most common cause of trauma, 41 patients (41.8%) had an object hit their eyes. In addition, assaults were a major cause of injury. The right eye and the upper lid were also the most common sites of injuries. Although no blindness occurred due to trauma causing eyelid laceration, the visual outcomes were correlated with severity of the incident defined based on the presence of open globe injuries.

Conclusion: This study could possibly highlight the risk factors of eyelid laceration and provide the healthcare community with the essential recommendations regarding the safety precautions in dangerous settings, including daily/routine work places.

Keywords: Eyelid laceration; Etiology; Epidemiology.

The Association Between Socioeconomic Status and Adult Mortality in Rural Kwazulu-Natal, South Africa

Christian Ashong Nikoi,¹ Clifford Odimegwu^2*

Abstract

Objective: To examine the association between socio-economic status and adult mortality in a rural South African community.

Methods: Longitudinal data of adults aged 15-64 yrs residing within the Demographic Surveillance Area [DSA] on 1^st January 2001 and followed up for seven years, was used. Out of the total 33,677 adults who met the inclusion criteria, 4,058 died during the seven years follow up period. Mortality rates were computed using Kaplan-Meier survival estimates expressed per 1000 person-year of observation (PYO). Household wealth index was constructed by the use of PCA, while the association was assessed using Cox proportional Hazard model controlling for potential confounders such as age, sex and marital status.

Results: The high group of the socioeconomic quintile had the highest mortality rate of 22.2 per 1000 PYO, 95% confidence interval (20.7 - 23.7). After adjusting for the potential confounders, the effect of socioeconomic status in the highest SES category was 0.10 times less likelihood of death compared to the lowest SES group (Hazard Ratio=0.90; p=0.042; 95% confidence interval [0.81 - 0.99]).

Conclusion: This study revealed that adult socioeconomic status is not significantly associated with adult mortality. Reducing the gap between the rich and the poor, though a worthwhile effort; might not be the most effective means of reducing adult mortality.

Keywords: Adult mortality; Longitudinal data; Demographic surveillance site; Africa; Cox.

Extreme Preterm Premature Rupture of Membranes: Risk Factors and Feto Maternal Outcomes

Nihal Al Riyami,^1* Intisar Al-Ruheili,² Fatma Al-Shezawi,² Murtadha Al-Khabori³

Abstract

Objectives: Preterm premature rupture of membranes (PPROM) is defined as a rupture of the amniotic membranes occurring before 37 weeks of gestation and before the onset of labor. Extreme PPROM occurs prior to 26 weeks gestation and contributes to an increased risk of prematurity, leading to maternal and fetal complications. This study aims to estimate the risk factors associated with various maternal complications and to determine the worst outcomes in Omani females with extreme PPROM.

Methods: A retrospective cohort study was conducted on 44 women with extreme PPROM, who delivered at Sultan Qaboos University Hospital (SQUH) from January 2006 to December 2011. Women with incomplete information, multiple gestations, or a preterm delivery resulting from medical intervention, as well as women who delivered elsewhere were excluded from the study.

Results: Forty-four women with extreme PPROM were included in our study. The results revealed the most important risk factor to be history of infection, which was noted in 24 study participants. The mean maternal age was 30 years. The mean gestational age at PPROM and at delivery were 20.7±3.2 (range: 16-26 weeks) and 29.7±7.6 weeks (range: 17-40 weeks), respectively. The maternal complications observed in this study included; infection which was seen in 20 (45%) patients, antepartum hemorrhage in 11 (25%) patients, and cesarean section which was required in 12 (27%) patients. There was no significant association between risk factors such as gestational age at delivery, parity, maternal age at PPROM, or maternal Body Mass Index (BMI) and cesarean section rate. Infection played a major role, both as a risk factor and in causing extreme PPROM, which in turn increased in 12 patients (27%). In the multivariable model for predicting the need for cesarean section (gestational age at delivery, parity, maternal age at PPROM in years and maternal BMI), none of the factors were statistically significant.

Conclusion: Overall, concurrent infection rate was high among patients presenting with extreme PPROM. None of the baseline maternal factors predicted the need for cesarean section. This is likely due to the small sample size; hence, larger prospective studies are needed to confirm these findings.

Keywords: Extreme; PPROM; Risk Factors; Maternal Outcomes.

Interleukin-10 Serum Levels after Vaccination with In Vivo Prepared Toxoplasma gondii  Excreted/Secreted Antigens

Seyed Hossein Abdollahi,¹ Fateme Ayoobi,² Hossein Khorramdelazad,¹ Gholamhossein Hassanshahi,¹  Behzad Nasiri Ahmadabadi,³ Mohammadtaghi Rezayati,⁵ Ali Ravary,⁴ Ali Shamsizadeh,² Mohammad Kazemi Arababadi^3*

Abstract

Objectives: Toxoplasma gondii is a worldwide prevalent zoonotic parasite which causes toxoplasmosis. An appropriate vaccine for animals could interrupt the circle between animals and humans. Our previous study showed that excreted/secreted antigens (E/SA), derived from the peritoneum of mice infected with T. gondii tachyzoites could be considered as a good candidate for animal vaccination. Interleukin-10 (IL-10) inhibits proliferation of B and T lymphocytes and induces homeostasis in immune system responses. However, since IL-10 has also been shown to suppress the killing of T. gondii by human macrophages, the aim of this study was to evaluate IL-10 serum levels after vaccination with T. gondii E/SA prepared in vivo.

Methods: T. gondii tachyzoites were inoculated in the peritoneum of mice and harvested E/SA were used as a vaccine, with and without adjuvant, in T. gondii infected and un-infected mice. IL-10 serum levels were evaluated using the ELISA technique.

Results: The data showed that although serum levels of IL-10 were not changed at the early phases, they were elevated at the end phases of vaccination with T. gondii E/SA.

Conclusion: Based on these and our previous results, it can be concluded that in vivo prepared T. gondii E/SA could be considered as a good candidate for animal vaccination.

Keywords: Toxoplasma gondii; Vaccination; IL-10; Excreted/secreted antigens.  

Prevalence of Extended-spectrum β-Lactamases-producing Escherichia coli  from Hospitals in Khartoum State, Sudan

Mutasim E. Ibrahim,^1* Naser E. Bilal,¹ Magzoub A. Magzoub,² Mohamed E. Hamid³

bstract

Objective: This study aimed to determine the prevalence and assess antimicrobial susceptibility of extended- spectrum β-lactamase-producing Escherichia coli isolated from clinical specimens of patients at hospitals in Khartoum State, Sudan.

Methods: During April to August 2011, a total of 232 E. coli isolates were collected from various clinical specimens of patients. Isolates were identified, tested for antimicrobial susceptibility and screened for ESBL production as per standard methods. The double-disk diffusion method was used to confirm ESBL production using antimicrobial disks of ceftazidime (30 μg), cefotaxime (30 μg), with or without clavulanic acid (10 μg). A zone difference of >5 mm between disks was considered indicative of ESBL production.

Results: Out of 232 E. coli isolates, 70 (30.2%) were found to be positive for ESBL by the applied phenotypic methods. ESBL-producing isolates yielded high resistance rates for trimethoprim-sulfamethoxazole (98.6%), tetracycline (88.6%), nalidixic acid (81.4%) and ciprofloxacin (81.4%). The highest antimicrobial activities of ESBL-producing isolates were observed for amikacin (95.7%), followed by tobramicin (74.3%) and nitrofurantoin (68.6%). Resistance to quinolones, aminoglycosides, trimethoprim-sulfamethoxazole, tetracycline, nitrofurantoin and chloramphenicol was higher in ESBL than non-ESBL isolates (p<0.05). The frequency of ESBL-producing isolates varied among hospitals (18.2% to 45.1%), although a high prevalence was recorded as 45.1% at Khartoum Teaching Hospital. Wound specimens were the most common source of ESBL-producing isolates. The proportion of ESBL-producing E. coli did not differ significantly between adults and children (31% vs. 27%).

Conclusion: The prevalence of ESBL-producing E. coli detected in this study is of great concern, which requires sound infection control measures including antimicrobial management and detection of ESBL-producing isolates.

Keywords: E. coli; Extended- spectrum β-lactamases; Susceptibility; Detection; Sudan.  

Side effects of Deferasirox Iron Chelation in Patients with Beta Thalassemia Major or Intermedia

Murtadha Al-Khabori,¹ Sunil Bhandari,² Mohammed Al-Huneini,¹ Khalil Al-Farsi,¹ Vinodh Panjwani,¹ Shahina Daar^3*

Abstract

Objectives: Chelating agents remain the mainstay in reducing the iron burden and extending patient survival in homozygous beta-thalassemia but adverse and toxic effects may increase with the institution and long term use of this essential therapy. This study aimed to estimate the incidence of deferasirox (DFX) side effects in patients with thalassemia major or intermedia.

Methods: A retrospective study of 72 patients (mean age: 20.3±0.9 yrs; 36 male, 36 female) with thalassemia major or intermedia treated at Sultan Qaboos University Hospital, Oman, was performed to assess the incidence of side effects related to deferasirox over a mean of 16.7 month follow-up period.

Results: Six patients experienced rashes and 6 had gastro-intestinal upset. DFX was discontinued in 18 patients for the following reasons: persistent progressive rise(s) in serum creatinine (7 patients; 40% mean serum creatinine rise from baseline), feeling unwell (2), severe diarrhea (1), pregnancy (1), death unrelated to chelator (2) and rise in serum transaminases (2). Three patients were reverted to desferoxamine and deferiprone combination therapy as DFX was no longer biochemically effective after 18 months of therapy. There was no correlation between baseline serum ferritin and serum creatinine or a rise in serum creatinine. Cardiac MRI T2* did not change with DFX therapy. However, there was an improvement in liver MRI T2* (p=0.013).

Conclusion: Renal side effects related to deferasirox appear to be higher than those reported in published clinical trials. Further larger studies are required to confirm these findings.

Keywords: Chelator; Kidney function; Thalassemia; Toxicity.

Diagnostic Usefulness of Tru-Cut Biopsy in the Diagnosis of Breast Lesions 

Ammar Rikabi* and Sufia Hussain

Abstract

Objective: To evaluate the usefulness of Tru-Cut biopsy (TCB) in the diagnosis of breast lesions.

Methods: An observational non-interventional cross-sectional review was performed of all TCB reports of a mass or lesion observed in patients admitted between January 2008 and December 2010, at King Khalid University Hospital, Riyadh, Saudi Arabia.

Results: A total of 275 trucut biopsies were performed during the study period. Histopathology showed 92 (33.5%) malignant lesions, 177 (64.3%) benign lesions and 6 (2.2%) suboptimal or suspicious lesions. Repeat trucut biopsies were done in 29 (16.4%) of the benign cases, 12 (13%) of the malignant cases, and for 6 inconclusive specimens which showed 4 of the 29 benign cases to be malignant lesions, and 5 of the 6 inconclusive cases were also malignant lesions. All 12 malignant cases that had repeat trucut biopsy had a confirmed diagnosis of malignancy. Trucut biospy had a sensitivity of 95.1%, specificity of 100%, positive predictive value of 100%, negative predictive value of 97.2%, and an overall diagnostic accuracy of 98.2%.

Conclusion: Trucut biopsy is an accurate alternative to fine needle aspiration cytology in the diagnosis of breast lesions with a high diagnostic accuracy of 98.2%.

Kocher Debre Semelaigne Syndrome: A Rare Case Report with Orofacial Manifestations

Sunil R. Panat,¹ Prakash Chandra Jha,^2* Sangamesh N. Chinnannavar,³ Ankkita Chakarvarty,² Ashish Aggarwal³ 

Abstract

Kocher Debre Semelaigne Syndrome is a rare syndrome with clinical manifestation of hypothyroidism associated with pseudomuscular hypertrophy. Very few cases have been reported on kocher-debre semelaigne syndrome in the literature with the incidence reported to be less than 10%. As per our knowledge; until now, only one case of oro-facial manifestations has been reported. Here we report one such case of Kocher debre semelaigne syndrome in an 11 year old boy, showing features of macroglossia, multiple impacted teeth, puffed lips and anterior open bite.

Keywords: Kocher Debre Semelaigne syndrome (KDSS); Myopathy; Hypothyroidism; Orofacial aspects.

Idiopathic Soft Tissue Calcification in an Extremity: A Case Report

Dinesh Dhar* and Thykkottathil P. Varghese 

Abstract

We report a case of a-15-days-old infant presenting with firm palpable thickening of the left leg soft tissues along with induration. Radiographs of the leg revealed generalized calcification of soft tissues. No obvious underlying cause could be identified for tissue calcification and hence termed as Idiopathic calcinois cutis. There are reports of this condition in Pediatric and Dermatology literature, but very few reports in orthopedic literature. The aim of this report is to highlight the pathogenesis, course and review of literature of this relatively uncommon condition which can easily be mistaken by Orthopedic or General Surgeons for infective bony of soft tissue infection.

Keywords: Soft tissue infection; Calcinosis; Calcification; Infant.

Chryseobacterium indologenes Meningitis in a Healthy Newborn: A Case Report

Mohamed A. Hendaus* and Khalid  Zahraldin

Abstract

Chryseobacterium indologenes is a rare cause of infection in infants. The majority of case reports belong to hospitalized infants with indwelling devices. We are presenting a rare case of Chryseobacterium indologenes meningitis in a healthy newborn with no neonatal intensive care unit admissions or indwelling devices. The pathogen is resistant to many antibiotics and the patient was successfully treated with cefepime. This is the first case of C. indolegenes meningitis presented in a newborn with no indwelling device, NICU or long-term broad spectrum antibiotics. The choice of antibiotics can be challenging since the pathogen may exhibit resistance to a number of antibiotics.

Keywords: Chryseobacterium indologenes; Meningitis 

Malignant Epithelioid Hemangioendothelioma: A Case Report

Khouloud Bouslama,* Fatma Houissa, Majd Ben Rejeb, Slim Bouzaidi, Leila Moualhi, Haifa Mekki, Radhouane Dabbeche, Mohamed Salem, Taoufik Najjar 

Abstract

Malignant epithelioid hemangioendothelioma (EH) is a rare tumor of vascular origin. We report a case of a woman who was found to have multiple hepatic masses in the right lobe of the liver on radiologic investigations, initially misdiagnosed as a metastatic carcinoma. The diagnosis of EH was made on histopathological study and confirmed by immunohistochemistry, which showed diffuse response for CD34 marker and no response to tissue CEA, HMB-45 or S-100 protein. Partial hepatectomy was made with good results.

Keywords: Epithelioid; Liver; Histopathology; Immunohistochemistry. 

Primary Well Differentiated Breast Liposarcoma with Divergent Cartilagenous Differentiation: A Case Report

Ammar Cherkess Al-Rikabi,¹* Mohamed Sharif El-Sharkawy,² Abdulaziz Al-Seif³

Abstract

Primary liposarcomas of the female and male breasts are very rare. Heterologous differentiation in adipocytic tumors is also an exceedingly rare phenomenon, which is occasionally reported in the literature. We describe the case of a 22 year-old female who presented with a relatively large left breast mass which was clinically diagnosed as a case of giant fibroadenoma, but histologically showed a well differentiated liposarcoma with evidence of extensive chondroid differentiation. The mammographic and radiological features are presented and correlated with the histopathological appearances together with literature review and comparison with similar reported cases.

Keywords: Breast sarcomas; Liposarcoma; Chondroid/cartilaginous differentiation; Dedifferentiated liposarcoma.

Symptomatic Hypocalcemia Associated with Zoledronic Acid Treatment for Osteoporosis: A Case Report

Abdulmohsen H. Al Elq

Abstract

Intravenous bisphosphonates are widely used in the management of solid tumors, metastatic bone disease, metabolic bone diseases and hypercalcemia of malignancies. Recently, yearly intravenous injections of zoledronic acid, one of the potent nitrogen-containing bisphosphonates, have also been approved for the prevention and treatment of osteoporosis. Although infrequently observed, asymptomatic hypocalcemia mainly due to intravenous bisphosphonates has been documented. Here we report a female patient who exhibited profound symptomatic hypocalcemia after receiving intravenous zoledronic acid as treatment of postmenopausal osteoporosis. The patient was not assessed for calcium status prior to the intravenous bisphosphonate therapy, and she was later found to have severe vitamin D deficiency. To our knowledge, this is the first patient with symptomatic hypocalcemia to be reported after zoledronic acid was approved for the management of osteoporosis. We highlight the importance of evaluating calcium and vitamin D levels before initiating intravenous bisphosphonate treatment, particularly in the presence of widespread vitamin D deficiency and the likelihood of future increases in the prescription of intravenous bisphosphonates.

Keywords: Bisphosphonates; Zoledronic acid; Adverse effects; Hypocalcemia.

Pulmonary Artery Narrowing: A Less Known Cause for Massive Hemoptysis

Ashu Seith Bhalla,^1* Pankaj Gupta,¹ Amar Mukund,¹ Sushil Kumar Kabra,² Arvind Kumar³ 

Abstract

Chronic pulmonary artery narrowing may result from diverse causes; congenital as well as acquired. The relative hypoperfusion of the lung results in hypertrophy of multiple systemic arteries. Such patients can present with recurrent hemoptysis from hypertrophied systemic arteries, most commonly bronchial arteries. These patients remain undiagnosed for a long time because of the lack of awareness of this entity. We present three cases of chronic pulmonary artery narrowing presenting with massive hemoptysis.

Keywords: Hemoptysis; Pulmonary artery narrowing; Tuberculosis.

Intra-Abdominal Lymphangiomatosis with Bone Marrow Involvement in a 7-Year Old Girl: A Case Report

Kourosh Goudarzi Pour,¹ Borhan Moradvaesi,¹ Maryam Nouri,^1* Maliheh Khoddami,² Farzenaeh Jadali²

Lymphangiomas are rare tumors. When they occur at different locations, they are referred to as lymphangiomatosis. Here we describe a case of lymphangiomatosis presenting with chronic diarrhea and failure to thrive. Etiology, clinical presentations and treatment options will be discussed.

Keywords: Lymphangiomatosis; Tumor; Parenchymal; Propranolol.

Knowledge and Practice of Standard Precautions and Awareness Regarding Post-Exposure Prophylaxis for HIV among Interns of a Medical College in West Bengal, India

Shuvankar Mukherjee,^1* Agnihotri Bhattacharyya,¹ Biswanath SharmaSarkar,² Dipendra N. Goswami,¹ Santanu Ghosh,³ Amrita Samanta³

Abstract

Objectives: To assess the knowledge of interns on standard precautions and post-exposure prophylaxis for HIV, and identify the gap between knowledge and practice relating to standard precautions, as well as determining the perceived barriers against adherence to standard precautions.

Methods: The study was conducted on 130 interns of 2010-11 batch from a government-run medical college in Kolkata, India. All participants completed a self-administered questionnaire with items relating to basic components of standard precautions and post-exposure prophylaxis for HIV. The questionnaire also included open ended questions relating to reasons for non-adherence to the practice of standard precautions along with additional space for specific comments, if any.

Results: Poor adherence in the use of personal protective equipment, hand washing, safe handling and disposal of needles and sharp objects were found to be among the practices for which the interns expressed correct knowledge. While the main reasons for non-adherence were found to be clumsiness in handling needles, wearing gloves, feeling uncomfortable when wearing aprons, impracticality of regular hand-washing and non-availability of equipment. Although the majority of the respondents (84.6%) expressed awareness of washing sites of injured with soap and water, approximately 32.3% did not know that antiseptics could cause more damage. Also, only 63.8% expressed awareness of reporting any incidence of occupational exposure, while knowledge on post-exposure prophylaxis regimens was generally found to be poor.

Conclusion: The considerable gap between knowledge and practice of standard precautions and inadequate knowledge of post-exposure prophylaxis emphasizes the need for continuous onsite training of interns with supportive supervision and monitoring of their activities.

Keywords: Standard Precautions; Adherence; Post-exposure prophylaxis; HIV.