Epidemiology,Pathology and Treatment of Cutaneous Leishmaniasis in Taif Region of Saudi Arabia

Background

Cutaneous leishmaniasis is an annoying and disfiguring disease affecting around 1,500,000 individuals globally. There are endemic pockets of this disease in Taif region. In some patients, lesion often weeps and leads to scar formation. The study was conducted to see the efficacy of fluconazole and itraconazole in the patients of cutaneous leishmaniasis and the effect of these drugs on liver enzymes and kidney markers.

Methods

Positivity of Leishmania was recorded by microscopic examinations of smears. Specific diagnosis for Leishmania major and L. tropica was made with the help of nested polymerase chain reaction. Fluconazole was given at the rate of 200mg/day while itraconazole was given at 150mg/day for six weeks. AST, ALT, creatinine and urea were estimated during medication.

Results

Leishmania major and L. tropica were the species responsible for cutaneous leishmaniasis in Taif region. 81% patients had single lesions, mostly on face followed by hands and legs. 15% of the lesions had bacterial contamination. In terms of efficacy, fluconazole gave slightly better results compared to itraconazole. After 6 weeks of medications, slightly elevated values were recorded for liver enzymes and creatinine.

Conclusion

Transmission of leishmaniasis in Taif region is probably because of poor coverage of residual insecticides spraying at hiding places in pile-ups of rocks and abandoned houses from where sand flies visit nearby houses and cattle sheds during night. Fluconazole and itraconazole may be used for the treatment of cutaneous leishmaniasis with good recovery rate and fewer side effects.     

Epidemiology of permanent childhood hearing loss in Glasgow, 1985-1994

This retrospective study was undertaken to document the epidemiology of permanent childhood hearing impairment (PCHI) in Glasgow and to make some assessment of the current practice to identify these children before universal neonatal hearing screening (UNHS) is implemented. Subjects were those with bilateral permanent hearing impairments of at least 40 dB in the better hearing ear, born between 1985 and 1994, in Greater Glasgow. The subjects were identified and data extracted from the Educational Audiology database. The case records at the Royal Hospital for Sick Children were also reviewed to identify possible aetiology groups. The prevalence rate of all permanent hearing impairments was 1.23 per thousand live births. Eleven percent of all hearing impairments were acquired or progressive. There was no significant effect of sex on aetiology (X2 = 6.509, df = 6, p, = 1), age at identification of hearing impairment and hearing aid provision (Kruskal Wallis, p = 0.484 and 0.782 respectively). For those identified as congenitally hearing impaired, the median ages at diagnosis of hearing impairment and hearing aid provision were 18 months and 31 months respectively. Age at diagnosis of hearing impairment and hearing aid provision were unaffected by aetiology of hearing impairment (Kruskal Wallis, p = 0.782 and p = 0.484 respectively). The prevalence rate of PCHI and the ages at identification and intervention in Glasgow are typical of the rest of the UK. Audiological surveillance measures are falling well below the standard of care expected today and the introduction of UNHS is likely to improve outcomes as long as the additional health and educational resources are in place to deal with the earlier identification of these children.     

Non-responders to hepatitis B vaccination: a review

Hepatitis B virus (HBV) infection is a major public health issue throughout the world and vaccination of those at risk is the main method of containment. Of healthy vaccinees, 5-10% fail to mount an adequate antibody response. The antibody levels of an unknown further fraction of vaccinees fall considerably over time rendering them at a potential risk of infection. The scope of this article is to review the factors that might influence the immune response to HBV vaccination, to review the methods used to overcome the problem of poor response and to discuss what possible guidelines are available or needed in treating these vaccinees.     

Isolated lipoma of filum terminale in adults: MRI findings and clinical correlation

Introduction: Fat within the filum terminale is frequently seen on routine magnetic resonance imaging (MRI) of the lumbosacral spine (LSS), with prevalence of 1–5%. The objective of this study was to determine the prevalence and MRI features of isolated lipoma of filum terminale (LFT) in adult population and its correlation with the patient clinical presentations. Methods: Prospective analysis of all lumbosacral MRI performed at King Abdullah University Hospital during a 21‐month period. A total of 37 patients with LFT were included. Patients were divided into two groups. Group A patients have neurological deficit manifested by either motor, sensory or sphincter abnormality. Group B patients have normal neurological examination. Clinical findings were correlated with: A: thickness of LFT, B: length of LFT, C: distance of LFT from conus medullaris (CM), D: age of the patient. Results: The prevalence of isolated LFT in our study was 3.2%. There was no significant correlation between the thickness or length of LFT and the presence of neurological deficit. The distance of LFT from CM was also not correlated with the patient clinical presentation. No significant difference in the age between the two groups. Conclusion: LFT in adult likely represent an incidental finding on routine lumbosacral MRI. Special attention for LFT in children is mandatory as it may indicate clinical tethering in otherwise normal appearing LSS.     

Clinical Value of Immunohistochemically Detected Lymphovascular Space Invasion in Early Stage Cervical Carcinoma

Background  This study investigates the clinical significance of lymphovascular space invasion (LVSI) as detected by hematoxylin and eosin (LVSI-H&E) and immunohistochemistry (LVSI-IHC) in early stage cervical carcinoma. Methods  Single representative sections from 97 patients with early stage squamous cell cervical cancer were immunostained with pancytokeratin and CD31 endothelial cell marker antibodies. The H&E sections and their corresponding immunostained sections were reexamined to identify LVSI. Associations between LVSI with clinicopathological factors were sought. Results  Overall, LVSI was present in 29 (29.9%) and absent in 68 (70.1%) by IHC, as compared with 18 cases (18.6%) and 79 cases (81.4%), respectively, by H&E. Statistical analysis revealed a significant association between LVSI-H&E and nodal metastasis (P = .004). Follow-up data were available for 76 patients. The median follow-up period was 64 months. During follow-up, 7 of 24 patients with recurrent disease had evidence of LVSI-H&E as opposed to 3 of 52 cases with no recurrence. There was a significant association between tumor recurrence and LVSI-H&E (P = .009). The 5-year recurrence-free survival was 30% for the group with LVSI-H&E compared with 73% without. There was a significant difference in the recurrence-free survival between the two groups (P = .002). In contrast LVSI-IHC was found to be associated with no pathological factors, and survival analysis revealed no statistically significant association with recurrence or survival. Conclusion  LVSI-H&E in early stage cervical cancer remains an important predictive factor of recurrent disease and reduced disease-free interval. Immunohistochemically detected LVSI is a common event and seems to be of no clinical value.     

Posaconazole versus fluconazole or itraconazole for prevention of invasive fungal infections in patients undergoing intensive cytotoxic therapy for acute myeloid leukemia or myelodysplasia: a cost effectiveness analysis

Introduction  

Invasive fungal infections (IFI) remain a clinical concern in hematological patients with prolonged neutropenia because they are a major cause of morbidity and mortality. In a recent randomized trial, prophylaxis with posaconazole was associated with fewer IFI and related deaths relative to a fluconazole or itraconazole (Flu/Itra) control group (p < 0.001). In the current study, a cost effectiveness analysis was conducted to estimate the economic value of posaconazole as an alternative to Flu/Itra when used to prevent IFI in this patient population.     

Morbidity related to concomitant adhesions in abdominal surgery

Background

We sought to assess the independent effect of concomitant adhesions (CAs) on patient outcome in abdominal surgery.

Materials and methods

Using the American College of Surgeons National Surgical Quality Improvement Program data, we created a uniform data set of all gastrectomies, enterectomies, hepatectomies, and pancreatectomies performed between 2007 and 2012 at our tertiary academic center. American College of Surgeons National Surgical Quality Improvement Program data were supplemented with additional variables (e.g., procedure complexity–relative value unit). The presence of CAs was detected using the Current Procedural Terminology codes for adhesiolysis (44005, 44180, 50715, 58660, and 58740). Cases where adhesiolysis was the primary procedure (e.g., bowel obstruction) were excluded. Multivariable logistic regression analyses were performed to assess the independent effect of CAs on 30-d morbidity and mortality, while controlling for age, comorbidities and the type/complexity/approach/emergency nature of surgery.

Results

Adhesiolysis was performed in 875 of 5940 operations (14.7%). Operations with CAs were longer (median duration 3.2 versus 2.7 h, P < 0.001), more complex (median relative value unit 37.5 versus 33.4, P < 0.001), performed in sicker patients (American Society for Anesthesiologists class ≥3 in 49.9% versus 41.2%, P < 0.001), and harbored higher risk for inadvertent enterotomies (3.0% versus 0.9%, P < 0.001). In multivariable analyses, CAs independently predicted higher morbidity (adjusted odds ratio [OR], 1.35; 95% confidence interval, 1.13–1.61, P = 0.001). Specifically, CAs independently correlated with superficial and deep or organ-space surgical site infections (OR = 1.42 (1.02–1.86), P = 0.036; OR = 1.47 (1.09–1.99), P = 0.013, respectively), and prolonged postoperative hospital stay (≥7 d, OR = 1.34 [1.11–1.61], P = 0.002). No difference in 30-d mortality was detected.

Conclusions

CAs significantly increase morbidity in abdominal surgery. Risk adjusting for the presence of adhesions is crucial in any efforts aimed at quality assessment and/or benchmarking of abdominal surgery.     

Developing digital tissue phantoms for hyperspectral imaging of ischemic wounds

Hyperspectral imaging has the potential to achieve high spatial resolution and high functional sensitivity for non-invasive assessment of tissue oxygenation. However, clinical acceptance of hyperspectral imaging in ischemic wound assessment is hampered by its poor reproducibility, low accuracy, and misinterpreted biology. These limitations are partially caused by the lack of a traceable calibration standard. We proposed a digital tissue phantom (DTP) platform for quantitative calibration and performance evaluation of spectral wound imaging devices. The technical feasibility of such a DTP platform was demonstrated by both in vitro and in vivo experiments. The in vitro DTPs were developed based on a liquid blood phantom model. The in vivo DTPs were developed based on a porcine ischemic skin flap model. The DTPs were projected by a Hyperspectral Image Projector (HIP) with high fidelity. A wide-gap 2nd derivative oxygenation algorithm was developed to reconstruct tissue functional parameters from hyperspectral measurements. In this study, we have demonstrated not only the technical feasibility of using DTPs for quantitative calibration, evaluation, and optimization of spectral imaging devices but also its potential for ischemic wound assessment in clinical practice.