Autoimmune hemolytic anemia may be associated with lymphoproliferative diseases like Hodgkin's or non-Hodgkin's lymphoma, however the occurrence is uncommon. An association of other autoimmune diseases with lymphoproliferative diseases is also possible. We report a case of non-Hodgkin's lymphoma presented first with autoimmune hemolytic anemia. A 40 year old female presented with fever, pain in abdomen and dyspnea. She was icteric and had mild splenomegaly. Blood investigation revealed serum positive direct antiglobulin test hemolytic anemia. Bone marrow trephine biopsy showed presence of non-Hodgkin's lymphoma.
Actinomycosis is an endogenous infection caused by gram positive bacteria with filamentous appearance, of the genus Actinomyces, of which the most common pathogen is Actinomyces israelii. Tonsillar actinomycosis is usually a bilateral feature. Although actinomycosis can be detected in the tonsils comparatively frequently, there are only few reports regarding unilateral tonsillar hypertrophy due to actinomycosis. To our knowledge, only six cases of unilateral tonsillar hypertrophy caused by actinomyces infection have been reported until now. Four of them were masquerading as a tumor, and two as pendulous masses attached to the tonsils. We herein report a case of unilateral actinomycosis masquerading as a tonsillar neoplasm in an 18 year old boy.
A "Collodion baby" is a relatively rare and transient condition in which a newborn is encased in a yellow, thick, shiny, tight, parchment-like membrane; called a 'collodion membrane'. This condition usually precedes the development of one of the various types of ichthyosis- a disorder of cornification. To date, approximately 270 cases of collodion babies have been reported since the disorder was originally described. We report a unique case of a one day old male neonate who presented to our hospital with the presence of this disorder. The discussion covers the clinical aspects and significance of this rare entity.
Squamous cell carcinoma is an invasive type of ocular surface squamous neoplasia which is a term introduced for premalignant and malignant epithelial lesions from conjunctiva and cornea. Treatment outcome of ocular surface squamous neoplasia (OSSN) depends on its type and stage, which is confirmed by histopathological examination. Invasive type of OSSN as squamous cell carcinoma needs combined treatment to reduce its recurrence. We present a case of a 45 year old female patient with positive HIV status, presenting to our outpatient clinic with a progressive limbal mass. She underwent combined treatment modality with total excision along with cryo-application and topical mitomycin-C drops with no evidence of recurrence on follow-up for a year. Emphasis on various adjunctive therapies along with the surgical approach is also discussed.
Prostate cancer is notorious for its atypical presentation. However, spread to the cervical spine is uncommon. We herein describe the findings in a 57-year-old African American gentleman, who presented with neck pain and right-sided weakness. Examination revealed neck tenderness with numbness in the distribution of C6 region on right side. An MRI of the neck imaged a 3.4cm extradural soft tissue mass in the C6 region extending into the spinal-canal, causing spinal cord compression. At this point, differential diagnosis included: metastatic cancer vs. chronic granulomatous vs. primary CNS lesion. Management included high dose intravenous steroids and mass resection with cervical-spine fusion. The prostate specific antigen (PSA) was 1815 ng/mL (normal less than 4 ng/mL) with a repeat value of 1666 ng/mL, and the pathology findings confirmed the mass to be metastatic prostate carcinoma. This case illustrates an unusual presentation of metastatic prostate cancer, lytic in nature, presenting as cord compression, and sparing the bone and lymph nodes in the cervical region. Metastatic lesions of prostate cancer to the bone are most often blastic rather than lytic in nature . Cervical involvement is seen in only 5% of cases. Regardless of this atypical presentation, early diagnosis of cord compression is of utmost importance because neurologic status upon presentation has important prognostic value. It is important to consider prostate cancer metastasis in any compressive neuropathy, or findings of an atypical mass affecting the cervical spine.
Lessons learnt from umbilical cord accidents: are these stillbirths preventable?
Umbilical cord accidents (UCA) refer to a group of conditions, where the umbilical cord vessels undergo sudden compression, compromising the blood flow to the fetus. UCA are associated with still birth and are often considered to be an etiology of sudden antenatal death syndrome. Herein, we report three cases of UCA, which reported late to us, resulting in fetal demise.
Intussusception in adults is an infrequent cause of intestinal obstruction; preoperative diagnosis is difficult as symptoms can be intermittent and long standing. This relatively rare entity differs from the childhood form in its etiology, presentation and treatment. We present two cases of ileo-colic intussusception in adults, with a clinical presentation that mimicked complicated appendicitis. These cases remind us that both ileal tumors and intussusception must be included in the diagnosis of lower abdominal pain.
Good research is the crux of an article. A well written article with good scientific content and good reporting makes it reach out to a large audience. The technical aspects of an article, however, are as important, and more so in today's world of electronic publications and databases. It is interesting that good articles may actually not be retrieved by the very audience that may need them, because some technical aspect was either not accurate or not given the attention to detail that was warranted. It is getting increasingly important for authors and editors to learn more about the technical aspects of an article to ensure that 'every article has its reader'. This article aims to address these issues. It explains some of the common technical elements, the importance of accuracy and the right choices of terms, not only to ensure that they conform to prescribed publishing standards, but also for better retrieval through electronic bibliographical databases.
Introduction: Many doctors use Personal Digital Assistants (PDAs) in their personal lives, but a few of them are integrating these devices into their clinical practice. Studies in different countries have explored the extent to which medical practitioners use PDAs, but little work has been done on this subject in Ghana. Methodology: This was a cross-sectional study, sampling a total of 103 participants (67 medical students and 36 house officers) from Korle-Bu Teaching Hospital (KBTH), Accra, Ghana. A custom-designed anonymous questionnaire with 31 questions was developed to assess the trend of PDA use. Results: 65.7% of medical students and 72.2% of house officers in KBTH owned PDAs. 40.9% of medicals students and 42.3% of house officers, use their PDAs before, during or after patient encounters. 61.5% of house officers and 40.9% of medical students indicated that their use of PDAs influence their clinical decision making and 69.2% of house officers and 15.9% of medical students indicated that their use of PDAs helped them avoid drug interactions when prescribing for patients. Analysis tests revealed no relationships between age group, gender and level of IT knowledge with PDA use. Conclusion: Results of this study showed that most medical students and house officers in KBTH used PDAs which made an impact on clinical decision making and patient treatment.
In the early decades of the 20th century it was established that some non neuro-endocrine malignant tumors and their metastasis, were secreting substances with biologic properties and causing clinical syndromes similar to the ones caused by naturally occurring hormones. The most known syndromes are caused by substances mimicking the biologic properties of ACTH, erythropoietin, insulin and PTH. Many theories have been postulated in an attempt to explain the synthesis process of hormone mimetic substances. Ectopic secretion of ACTH syndrome comprises 10%-20% of all cases presenting with Cushing's syndrome. The clinical picture manifests in a variable way. The increased plasma levels of cortisol in these cases, cause symptoms distinct from the ones of true Cushing's syndrome. In general these patients have an ominous prognosis. Survival is limited to 6-12 months and is attributed to hypercortisolemia that is known to increase the risk of metastasis. Hypercalcemia syndrome from ectopic secretion of hypercalcemic factors is a severe complication of cancer patients with an incidence of 5-10%. Increased serum calcium is caused either by the osteolytic metastasis of malignant tumors or by their secretions. The clinical picture caused is similar to the findings of primary hyperparathyroidism. Treatment options in case of acute and severe hypercalcemia in patients with malignancy are limited. The endocrine syndromes produced by non-endocrine tumors not only affect patient's quality of life but also occasionally cause severe complications and can disrupt surgical or medical treatment of the primary tumor. Searching for the occurrence of such syndromes demands a high index of suspicion. This paper brings the spotlight back to the clinical syndromes of hypercortisolemia and hypercalcemia caused by ectopic ACTH and hypercalcemic factors respectively, re-iterating the need for early diagnosis and prompt management in such cases.
Introduction: About 80% of type 2 diabetes mellitus is either preventable or controllable by changing diet, increasing physical activity and improving lifestyle. This research study investigated the role of the brisk walking and yogic exercises on fasting blood glucose levels among adult males with type 2 diabetes mellitus. Methodology: 20 male diabetic patients were enrolled in the study and randomly allocated into two interventional groups. Study participants in group 1 underwent brisk walking intervention and study participants in group 2 underwent yoga intervention for 60 minutes daily between 6 AM to 7 AM for 15 consecutive days. The fasting blood glucose levels of study participants were measured using a calibrated glucometer. Results: Significant reduction (p<0.05) in fasting blood glucose level of participants has been seen in both groups on the 15th day of intervention from its baseline value. Conclusion: The findings conclude that yogic exercises and brisk walking have enhanced the blood glucose lowering capacity among diabetic patients with pharmacological treatment and may be practiced as an adjuvant therapy for type 2 diabetic populations to reduce or prevent long-term complications.