Psychosocial and quality-of-life factors associated with depigmentation therapy for vitiligo

BACKGROUND

There is a paucity of data examining the psychosocial factors relevant to depigmentation therapy, an irreversible treatment for vitiligo. This study explores patients' perspective and experience while undergoing depigmentation therapy and quality-of-life effects of such therapy.

METHODS

An online instrument assessing the impact of depigmentation therapy on various psychosocial variables and including the validated Dermatology Life Quality Index (DLQI) were administered to two groups of participants with vitiligo: (1) those who are currently undergoing or have completed depigmentation therapy and (2) those with vitiligo who have not undergone depigmentation therapy but had considered it. Data were collected on psychosocial factors such as length of time until depigmentation therapy was offered, duration, financial burden, level of satisfaction, impact on life activities, and challenges faced during and after depigmentation therapy. DLQI scores were also measured.

RESULTS

Thirty-five vitiligo patients who did not undergo depigmentation and 42 patients who did undergo depigmentation therapy were included in the study. Baseline characteristics were comparable between groups. Mean DLQI was higher for patients who did not undergo depigmentation than for those who underwent depigmentation (10.2 versus 5.3, p = 0.002), indicating worse quality-of-life in those not depigmenting. Patients who underwent depigmentation reported significantly less discomfort in various social situations after undergoing depigmentation therapy compared to how they felt before undergoing therapy and reported significantly less discomfort in these situations than patients who did not undergo depigmentation therapy.

CONCLUSIONS

Despite potential challenges, depigmentation therapy appears to augment quality-of-life across various domains in individuals with vitiligo.

Improving Diagnostic Accuracy in Skin of Color Using an Educational Module

Dermatologic disparities disproportionately affect patients with skin of color (SOC). This study evaluated the effectiveness of a focused educational module for improving diagnostic accuracy and confidence in the treatment of patients with SOC among interprofessional health care providers. An SOC educational module involving a pretest, 15-minute lecture, immediate posttest, and 3-month posttest was created. One hundred participants completed the pretest and immediate posttest; 36 of them also completed the 3-month post-test. Our results suggest that a focused educational module may provide long-term improvements in diagnostic accuracy and confidence for conditions presenting in patients with SOC.

Psychosocial Considerations in the Management of Vitiligo

Vitiligo is a depigmenting skin disease that can carry significant psychosocial impact. Health care providers play a crucial role in shaping patients' understanding of their condition, approach to treatment, and coping mechanisms. In this article, we review the psychosocial aspects of vitiligo management, including the debate over the "disease-ification" of vitiligo, its effects on quality of life and mental health, and methods to holistically assist affected individuals beyond just treatment of the vitiligo itself.

Telocytes in Cutaneous Biology: A Reappraisal

The telocytes (TCs) are novel interstitial cells that have been overlooked for a long time due to their histologic similarity to other stromal cells. TCs can be separated from the stromal cells based on their distinct immunohistochemical, ultrastructural, and molecular features. Functionally, TCs are involved in the tissue renewal, mechanical support, and immune modulation. These cells are also involved in the signal transduction either through their direct interactions with the neighboring cells or through the paracrine signaling via extracellular vesicles. TCs are damaged in several inflammatory and fibrotic conditions such as ulcerative colitis, Crohn's disease, hepatic fibrosis, psoriasis, and systemic sclerosis. The transplantation of TCs in the damaged tissue can promote tissue regeneration. Therefore, enhancing tissue TCs either by their transplantation or by promoting their survival and growth using novel medications represents novel therapeutic strategy in the future. In this review, we addressed several aspects of TCs including their origin, distribution, morphologic features, and functions. We also discussed their involvement of the cutaneous TCs in the development various pathologic conditions.

How to Advise Medical Students Interested in Dermatology: A Survey of Academic Dermatology Mentors

Dermatology residency programs are among the most competitive residencies of medical specialties. To navigate this competitive process, students seek advice from dermatology mentors who provide a range of responses depending on their experience or preferences. To consolidate this range of advice, we surveyed members of the Association of Professors of Dermatology (APD) on their responses to common questions from medical students regarding quantity of program applications, research gap year, internship year, letters of intent, away rotations, letters of recommendation (LORs), and the new Electronic Residency Application Service (ERAS) supplemental application. Although recommendations given to students remain individualized, our study describes the range of advice received and details the differences between mentor advice and common student practices throughout the application cycle. We hope these data will help mentors in advising students as well as inform organizations seeking to create standards and official recommendations regarding aspects of the application process.

The indelible marks on dermatology: Impacts of COVID-19 on dermatology residency Match using the Texas STAR database

With changes to interview format and away rotations, the COVID-19 pandemic has reshaped the residency application process. In this retrospective cohort study of data from the nationwide Texas Seeking Transparency in Applications to Residency (STAR) survey, we sought to understand how the pandemic has affected applicants in the 2021 dermatology Match. We compared applicants in the post-COVID-19 Match year (2021) with those in pre-COVID-19 Match years (2018-2020) regarding match rates, interview costs, residency geographic connections, and number of interviews attended. A total of 439 dermatology applicants who completed the Texas STAR survey were included. There was no difference in percentage of applicants with a geographic connection to their matched program (43.88% vs 47.20%). Compared with prior cycles, applicants in the 2021 Match had a higher percentage of interview offers (96% vs 90%, P < .0001), and more applicants attended 16 or more interviews (P = .0489). Applicants in the 2021 Match reported an average savings of $5,000 compared with prior cycles. Virtual interviews offer savings for applicants but may encourage interview hoarding. Though applicants did not perform away rotations, there was no increase in geographic connection for matched applicants. Stakeholders should consider these data when evaluating the pros and cons of virtual interviewing postpandemic.

Characterization of Antimicrobial Resistance Genes of Pasteurella multocida Isolated from Diseased Chickens in Egypt

 In this study, the prevalence of Pasteurella multocida in diseased chickens, capsular genotyping, antimicrobial resistance patterns and some resistance genes were determined. Lungs, liver and spleen samples were collected from 250 diseased chickens from layers and broiler flocks from El-Gharbia and Kafr El-Sheikh governorates in Egypt for isolation of P. multocida in the period from June 2018 to December 2019. Confirmatory identification was done by using PCR for capsular type A antigen. P. multocida was isolated from 3.6 % of the diseased chicken. Six isolates of P. multocida that examined for detection of capsular type A showed positive results. Antimicrobial resistance patterns were evaluated for all isolates against twenty antimicrobial agents and the results showed 100% resistance totrimethoprim/sulfamethazole, oxacillin and nitrofurantion. Also, strains expressed highly resistant to penicillin, chloramphenicol, rifampicin and ampicillin \sulbactam, while they were sensitive to norfloxacin, clindamycin, cephalexin and cefotaxime. The antimicrobial resistance genes were detected by using PCR and the results showed  that all isolates harbored  β-lactam-resistantgene BlaROB-1 (100%), followed by sulfonamide resistant gene  sul1 (50%), tetracycline-resistant gene tetH (33.3%) and trimethoprim-resistant dihydrofolate reductase dfrA (16.6%).

Clinical and Haematological Findings in Dengue Fever

From 2000 onwards dengue fever has been occurring at regular intervals in Bangladesh. Ultrasonography is a useful diagnostic procedure. This study was done, keeping this background in mind. Objective of this study was to identify the role of ultrasonography as a useful tool in early diagnosis of dengue haemorrhagic fever. This was a cross-sectional descriptive type of observational study. Results of ultrasonography, haematogy an immunology were observed in 2004 and 2019 in 32 patients on each occasion. In 2004 out of 32 patients 29 had positive ultrsonographic findings supported by corresponding haematological and immunological findings. In 2019 ultrsonography was done in three out of thirty two patients, all three had had positive ultra sonographic findings which were supported by haematological and immunological findings. Dengue fever has serious complications like plasma leakage which manifest in the form of ascites, pleural effusion, thick gallbladder wall etc. If such complications can be detected at an early stage many lives can be saved.

Removal of iron, zinc, and nickel-ions using nano bentonite and its applications on power station wastewater

Removal of high concentrations of toxic heavy metals from wastewater is very important within the environmental field because heavy metals pollution a serious environmental problem due to them being nonbiodegradable. This study shed some light on the use of Nano bentonite as an adsorbent for the elimination of Iron, Zinc, and Nickel ions from wastewater, and the optimum conditions were evaluated to find out thermodynamic and kinetic parameters and equilibrium adsorption models have been applied. The results showed that adsorption percentage increases with increasing temperature, speed of rotation, and volume of solution, but decreases with adsorbent dose and initial concentration increase. The adsorption process has fit pseudo-second-order kinetic model Langmuir and Freundlich adsorption isotherm models were applied to analyze adsorption data and both were found to apply to these adsorption processes. Thermodynamic parameters e.g., ΔG^o, ΔS^o, and ΔH^o of the adsorption process were found to be endothermic. Finally, the Nano bentonite was observed to be more powerful for the removal of Fe (III), Zn (II), and Ni (II) at the same experimental conditions.

The utility of teledermatology in the evaluation of skin lesions

INTRODUCTION

Past studies have shown mixed results about the accuracy of store-and-forward (SAF) teledermatology in the evaluation of skin lesions. The objective of this study is to determine the accuracy of SAF teledermatology in the diagnosis of skin lesions and biopsy decision compared to in-person clinical evaluation.

METHODS

Histories and photographs of skin lesions gathered at clinic visits were sent as SAF consults to teledermatologists, whose diagnoses and biopsy decisions were recorded and compared statistically to the clinic data.Results and Discussion: We enrolled 206 patients with 308 lesions in the study. The study population was composed of 50% males (n = 104), and most patients were white (n = 179, 87%) and not Hispanic/Latino (n = 167, 81%). There was good concordance for biopsy decision between the clinic dermatologist (CD) and teledermatologist (TD) (Cohen's kappa (κ) = 0.51), which did not significantly differ when melanocytic lesions were excluded (κ = 0.54). The sensitivity and specificity of teledermatology based on biopsy decision was 0.71 and 0.85, respectively. Overall concordance in first diagnosis between the CD and TD was good (κ = 0.60). While there was no difference between CD and TD in proportion of correct diagnoses compared to histopathology, two skin cancers presentations were missed by TD. Study limitations included sample size, enrolment bias and differing amounts of teledermatologist case experience. Teledermatology has good concordance in diagnosis and biopsy decision when compared to clinic dermatology. Teledermatology may be utilized in the evaluation of skin lesions to expand access to dermatologic care.

Thymoquinone and curcumin modify inducible nitric oxide synthase, caspase 3, and thioredoxin immunohistochemical expression in acetaminophen hepatotoxicity

BACKGROUND

Acetaminophen (APAP) hepatotoxicity is characterised by an extensive oxidative stress due to depletion of glutathione (GSH), which results in massive lipid peroxidation and subsequent liver injury. The current paradigm suggests that mitochondria are the main source of reactive oxygen species (ROS), which impair mitochondrial function and are responsible for cell signalling resulting in cell death. This study was designed to compare the potential impact of thymoquinone (THQ), and/or curcumin (CURC) on liver injury induced by APAP toxicity in rats.

MATERIALS AND METHODS

Serum levels of alanine transaminase, aspartate transaminase, total bilirubin, and total protein were measured. In addition, liver nitric oxide (NO), malondialdehyde, reduced glutathione (GSH), and superoxide dismutase (SOD) were estimated. Moreover, these biochemical parameters were confirmed by histopathological and immunohistochemical investigations for the expression of thioredoxin, iNOS and caspase 3.

RESULTS

Acetaminophen toxicity elevated most of the above-mentioned parameters but decreased GSH, SOD, and total protein levels. Histologically, liver sections demonstrated liver injury characterised by hepatocellular necrosis with nuclear pyknosis, karyorrhexis and karyolysis. Immunohistochemical study revealed increased expression of iNOS and caspase 3 proteins, while the thioredoxin protein expression was decreased.

CONCLUSIONS

Treatment with the THQ and CURC regulated the biochemical and histopathological alterations induced by APAP toxicity. It was concluded that the combination strategy of THQ and CURC might be considered as a potential antidote in combating liver injury induced by APAP with minimal side effects.

Disseminated Syringomas of the Upper Extremities in a Young Woman

Syringomas are benign, eccrine sweat gland tumors frequently found on the eyelids and neck in post-pubescent women and may present in healthy individuals or be associated with various medical comorbidities. We present a case of an otherwise healthy 19-year-old female with an abrupt onset of disseminated syringomas on the bilateral forearms and dorsal hands. Eruptive acral syringomas have not been previously reported in adolescents, and this diagnosis should be considered in patients presenting with a papular eruption on the hands and forearms.

Therapeutic interventions to lessen the psychosocial effect of vitiligo in children: A review

Vitiligo commonly affects children, with half of affected individuals experiencing disease onset before the age of 20. Because childhood is a time of advancement in social and psychological development, understanding the extent of the effect of the disease and means of alleviation is crucial. Vitiligo has been shown to decrease children's quality of life, with greater distress in children with highly visible lesions and darker skin tones. This article reviews the literature regarding interventions that have been analyzed in children. Studies evaluating the effect of camouflage, cognitive behavioral therapy, psychological self-help tools, and support groups on the psychosocial aspects of vitiligo were included. The review highlights the ongoing need for studies to better understand the modalities described in this article, as well as others, such as skin dyes, bleaching creams, medical tattooing; week-long camps that cater to children with chronic skin disease; and biofeedback, that might have a role in preventing the psychosocial sequelae of childhood vitiligo.

Silver nanoparticles enhance the larvicidal toxicity of Photorhabdus and Xenorhabdus bacterial toxins: an approach to control the filarial vector, Culex pipiens

Mosquito-control is still based mostly on chemical insecticides which are toxic and cause environmental deprivation. This study investigates synthesizing silver bio-nanoparticles (AgNPs) from nematode-symbiotic bacterial toxin complexes as an alternative larvicidal bioinsecticide agent against Culex pipiens larvae. Five species/strains of nematode-symbiotic bacteria, Xenorhabdus indica, Xenorhabdus spp., Photorhabdus luminescens laumondii HP88, Photorhabdus luminescens akhurstii HRM1 and Photorhabdus luminescens akhurstii HS1 were used. AgNPs were characterized by scanning electron microscopy and x-ray diffraction analysis. Larvae were initially exposed to descending concentrations (300, 150, 75, 37.5 and 18.75 µg/ml) of each of the five bacterial toxins (as positive controls) or to the bio-AgNPs synthesized from the same bacterial toxins (200, 100, 50, 25, 12.5, 6.25, 3.12 and 1.5 µg/ml) for 48 hours. Results of toxicity bioassays showed that mortality of treated larvae was concentration-dependent, toxins from X. indica, P. luminescens laumondii HP88 and P. luminescens akhurstii HS1 showed LC₅₀ of 29, 28 and 2002 µg/ml, respectively. While, toxins from P. luminescens akhurstii HRM1 and Xenorhabdus sp. showed LC₅₀ of 199, 318 µg/ml, respectively. Bio-AgNPs synthesized from, X. indica or Xenorhabdus sp. toxins have significantly increased their larvicidal activities (LC₅₀ of 1.6, 3.7 µg/ml ) at 48h post-treatment. Moreover, bio-AgNPs synthesized from P. luminescens laumondii HP88, P. luminescens akhurstii HRM1 or P. luminescens akhurstii HS1 toxins significantly increased their larvicidal activities (LC₅₀ of 2.1, 1.5, 13.9 µg/ml, respectively) at 48h post treatment. In conclusion, the highest larval toxicity was observed when larvae were treated with bio-AgNPs synthesized from P. luminescens akhurstii HRM1 and X. indica, followed by P. luminescens laumondii HP88 and Xenorhabdus sp. Subsequently, data of the present study suggest these bio-AgNPs toxin complexes as potentially effective bio-control candidates in the battle against mosquito. However, testing other types of bio-synthesized nanomaterials, and their synergistic combinations against different mosquito species still under investigation.

Cutaneous Rosai-Dorfman Disease

A 48-year-old Hispanic man presented with a nodule on the right cheek. The lesion had started as a papule 4 months previously that had slowly enlarged and then plateaued at its present size. The nodule was asymptomatic, and the patient denied bleeding, draining, or preceding trauma. Review of systems was negative for fevers, weight loss, night sweats, lymphadenopathy, or other skin findings. Past medical history was significant only for type 2 diabetes mellitus, hyperlipidemia, and hypertension.

Peste des petits ruminants infection in domestic ruminants in Sudan

The existence of peste des petits ruminants (PPR) in domestic ruminants and camels in Sudan during 2008-2012 was investigated. Lung tissues and serum samples were randomly collected from sheep, goats, cattle, and camels at different areas of Sudan. A total of 12,384 serum samples were collected from clinically healthy 7413 sheep, 1988 camels, 1501 cattle, 1459 goats, and 23 gazelles at different areas in the Sudan. They were examined for PPR antibodies using competitive ELISA (cELISA). The overall detected seroprevalence of PPR in tested sera was 49.4%; seroprevalence values within species were 67.1, 48.2, 25.8, 2.1, and 21.7% in sheep, goat, cattle, camels, and gazelles, respectively. The highest seroprevalence (68.1%) was observed in sera collected from Darfur states, then the central states (54.3%). A total of 1276 lung tissue samples (623 sheep, 324 cattle, 220 camels, and 109 goats) were collected. The majority of lung samples were collected from clinically healthy animals that showed lesions on PM in slaughterhouses (95%) and during PPR outbreaks; samples were tested for PPR antigen using immunocapture ELISA (IcELISA). PPR antigen was detected in 233 out of the 1276 tested samples (18.3%). Positive results were observed in samples collected from clinically healthy and diseased animals. The observed prevalence values in each species were 33.6, 21.1, 15.4, and 12.3% in camel, goat, sheep, and cattle, respectively. PPR antigen was detected in samples from different areas; however, the highest prevalence (63.9%) was found in samples collected from the eastern states, then Khartoum state (28%). Trials for virus isolation were done in different cell cultures. Out of 30 IcELISA-positive samples inoculated in primary bovine and ovine kidney cells, Vero cells, the PPR virus was successfully isolated from 15 (eight sheep, five camels, and two goats) samples in the three cell culture types. Using RT-PCR, PPRV nucleic acid was detected in all 25 IcELISA-positive tested samples.

Adrenal medulla of AS/AGU rats: a histological and immunohistochemical study

BACKGROUND

The outcome of the autograft therapy for Parkinson's disease including autologous cells from adrenal medulla was disappointing. This could be attributed to the pathological process in Parkinson's disease affecting cells of the adrenal medulla. This study was performed to investigate the histopathological changes in the adrenal medulla of AS/AGU rat, a model of Parkinson's disease, in comparison with Albino Swiss (AS) rats.

MATERIALS AND METHODS

A total of 24 male AS rats were divided into four groups, each of 6 animals: AS W1 - AS rats aged 1 week; AS adult - AS adult rats; AS/ /AGU W1 - AS/AGU rats aged 1 week; and AS/AGU adult - AS/AGU adult rats. The rats were sacrificed and the adrenal glands were dissected and processed for histological staining with haematoxylin and eosin and periodic acid Schiff and for immunohistochemical staining for S100 protein, ubiquitin and tyrosine hydroxylase.

RESULTS

The histological investigation of the adrenal medulla of AS/AGU rats showed vascular congestion, inflammatory cellular infiltration, pyknotic nuclei, necrotic chromaffin cells and medullary inclusion bodies. The immunohistochemical investigation of AS/AGU rats showed a statistically significant decrease in the expression of S100 protein, ubiquitin and tyrosine hydroxylase compared to AS rats.

CONCLUSIONS

The histological and immunohistological changes in the adrenal medulla could explain the failure of outcome of adrenal autograft therapy in Parkinson's disease.

Immunohistochemical study of sustentacular cells in adrenal medulla of neonatal and adult rats using an antibody against S-100 protein

BACKGROUND

This study was performed to investigate the light microscopic features of sustentacular cells in adrenal medulla in neonatal and adult male albino rats using an antibody against S-100 protein. S-100 expression in sustentacular cells is considered a reliable cell marker for this type of cells.

MATERIALS AND METHODS

Twenty-four male albino rats were allocated into two groups, neonatal group (1 week old, 12 rats) and adult group (3 months old, 12 rats). Paraffin sections of the adrenal glands were immunostained for the expression of S-100 protein.

RESULTS

The results demonstrated differences in distribution, arrangement and structure of sustentacular cells in adrenal medulla in neonatal and adult rats. All sustentacular cells of adrenal medulla in all animals showed intense immunoreactivity for S-100 protein in their nuclei, perikarya, and cytoplasmic processes. Most of S-100 immunopositive sustentacular cells in adrenal medulla of neonatal rats are few, dispersed, small in size, and oval in shape with thin short bipolar cytoplasmic processes. These cells in adult rats are more numerous, larger in size, and stellate in shape with numerous slender, longer branched cytoplasmic processes.

CONCLUSIONS

This study indicated that adrenal medullary sustentacular cells showed obvious morphological postnatal changes with aging suggesting structural and functional maturation.

[Rates of prostate-specific antigen testing for early detection of prostate cancer: a first comparison of German results with current international data]

OBJECTIVE

Measurement of prostate-specific antigen (PSA) is not only used as a screening instrument by urologists, but also by general practitioners and internal specialists (GP-IS). Until now, there are neither data on the approach of German GP-IS in practicing this nor have data been classified in the context of available international literature on this topic.

MATERIALS AND METHODS

Between May and December 2012, a questionnaire containing 16 items was sent to 600 GP-IS in Brandenburg and Berlin. The response rate was 65% (392/600). Six indicator questions (IQ1-6) were selected and results were set in the context of available international data. The quality of present studies was evaluated by the Harden criteria.

RESULTS

Of the 392 responding physicians, 317 (81%) declared that they would use PSA testing for early detection of PCA (IQ1) and, thus, formed the study group. Of these GP-IS, 38% consider an age between 41 and 50 years as suitable for testing begin (IQ2), while 53% and 14% of the GP-IS perform early detection until the age of 80 and 90 years, respectively (IQ3). A rigid PSA cut-off of 4 ng/ml is considered to be reasonable by 47% of the involved GP-IS, whereas 16% prefer an age-adjusted PSA cut-off (IQ4). Patients with pathological PSA levels were immediately referred to a board-certified urologist by 69% of the GP-IS. On the other hand, 10% first would independently control elevated PSA levels themselves after 3-12 months (IQ5). Furthermore, 14% of the interviewed physicians consider a decrease of PCA-specific mortality by PSA screening as being proven (IQ6). Knowledge regarding PCA diagnostics is mainly based on continuous medical education for GP-IS (33%), personal contact with urologists (6%), and guideline studies (4%). While 53% indicated more than one education source, 4% did not obtain any PCA-specific training. The results provided by this questionnaire evaluating response of German GP-IS to six selected indicator questions fit well into the international context; however, further studies with sufficient methodical quality are required.

CONCLUSIONS

Despite current findings and controversial recommendations of the two large PCA screening studies on this issue, German GP-IS still frequently use PCA screening by PSA measurement. Primary strategies of early detection as well as follow-up after assessment of pathologically elevated PSA levels poorly follow international recommendations. Thus, an intensification of specific education is justified.

A review of cutaneous drug eruptions

Cutaneous drug eruptions can range from an asymptomatic rash to a life-threatening emergency. Because of the high frequency, morbidity, and potential mortality associated with drug eruptions, patients with possible drug reactions should promptly be recognized, worked up, and treated. Drug reactions are common in the elderly population due to age-related alterations in metabolism, excretion of medications, and polypharmacy. This review discusses the epidemiology, pathogenesis, clinical presentation, diagnosis, and management of drug eruptions that providers commonly encounter in the care of the geriatric population. An algorithm for an approach to patients with a suspected drug eruption is presented.

Health-related quality of life and its determinants in HIV patients with post herpetic neuralgia

BACKGROUND

Postherpetic neuralgia is a neuralgia caused by the varicella zoster virus. Its natural history involves slow resolution of the pain syndrome. A subgroup of patients may develop severe, long-lasting pain that does not respond to medical therapy. It also accounts for 11-15% of all referrals to pain clinics but little is known about the quality of life of patients with this condition in our locality Nigeria.

METHOD

Fifty three Post herpetic Neuralgia patients aged between 25 and 56 years (mean = 37.47 +/- 8.29 years) receiving antiretroviral therapy/treatment at the University of Maiduguri Teaching Hospital, Maiduguri, Nigeria participated in this study. The short-form 36 (SF-36) generic health-related Quality of Life questionnaire was used to assess the QoL. Spearman rank correlation procedure was used to evaluate the relationship of HRQoL outcomes with medical and socio-demographic factor.

RESULT

Physical functioning), Role limitations due to physical health (LPH), Role limitations due to emotional problems (LEP), Social functioning (SF), General health perceptions (GH) scores were below average (35.59 +/- 19.85, 34.28 +/- 33.16, 33.70 +/- 23.26, 49.07 +/- 17.04, 44.09 +/- 9.72 respectively) while Emotional well being/Mental health (EM) was above average (50.13 +/- 11.56). An average (moderate) symptom scale score was Energy/Fatigue (EF) (51.32 +/- 12.87) while Bodily pain (BP) was severe (31.09 +/- 20.46). Age and sex had no significant influence on any of the functional and symptom scale scores as well as the overall QOL. Inverse relationship was observed between age and each of the LPH, LEP, SF, GH, overall QoL and the entire symptom scales. The overall QoL and each of the symptom scale scores were significantly related (P > 0.05). The functional scale score PF, RPH, REP EM and GH were significantly related to overall QoL while SF was not significantly related (P > 0.01).

CONCLUSION

This study has shown that the overall QoL of PHN in HIV positive patients undergoing adjuvant therapy is below average. The predictor factors of the overall QoL of this group of patients have been brought to light. These patients would require ways to improve the QoL, there is the need for health care provider to address the factors uncovered by this study. Four of the determinant factors (PF, LP, BP and EF) are issues that fall within the corridor of physical therapy. Physical therapist should arise to address these significant aspects of the management this group of patients.

Flock dynamics of desert Barki sheep in relation to age structure

Reproduction data of 8689 ewe records spread over 40 years (from 1960 to 2000) representing 2952 breeding Barki ewes were used in this study. The flock belonged to the Desert Research Center in Egypt. Flock dynamics of nine age groups (2-10 yrs) were assessed. Two parameters were used to evaluate flock dynamics, net reproduction rate (R(o)) (number of ewe- lambs reaching joining age and produced by each ewe during its lifetime in the flock) and intrinsic rate of increase (r(m)) (flock growth when no resource is limiting). Age of ewe had a highly significant (P < 0.01) effect on number of ewes lambing per ewe joined (E(PJ)), number of lambs born per ewe joined (L(BJ)), number of lambs weaned per ewe joined (L(WJ)) and number of ewe lambs reaching joining age per ewe joined (L(EJ.J)). All estimates tended to increase with dams age up to four years and decreased thereafter. The results of R(o) and r(m) showed that the studied flock must consist of 5 age groups to maintain its size and replace itself. It may be recommended to cull the breeding ewe at the age of 6 years to accelerate genetic improvement.

Staphylococcus aureus isolated from a horse in a sudden death condition in Kassala state, eastern Sudan

In this study, Staphylococcus aureus was isolated from a draught horse presented to Kassala Veterinary Research Laboratory (KVRL) for investigation and diagnosis. The affected animal was previously treated with Gentamycin and Tetracycline before submitted to this laboratory, but the animal was not cure. Thereafter, the animal was attended to the laboratory; it was suffering from inguinal abscess and some clinical signs. Clinical and laboratory examinations were carried out however, the animal was suddenly fallen and died immediately. Then post-mortem, bacteriological and histopathological examinations were done. S. aureus was isolated as pure culture from the lungs and peritoneum of the necropsied animal. This isolate showed highly sensitivity to Erythromycin and Clindamycin and it was resistant to Penicillin, Cloxacillin, Cefotaxime, Co-Trimoxazole, Cephalexin and Tetracycline. It was concluded from this study, the shock resulted from S. aureus was the causative agent of the death in this case.

Patterns of lipid changes among type 2 diabetes patients in Sudan

This study investigated the patterns and determinants of lipid disorders among a group of 250 type 2 adult diabetic patients and 60 age- and sex-matched healthy controls in Sudan. Demographic and clinical data, body mass index and waist circumference, and fasting blood samples were taken to estimate the glucose and lipid profile. The mean duration of diabetes was 9.4 years and 46.0% of patients had poor glycaemic control. Compared to controls we detected a statistically significant increase in triglycerides level and a decrease in HDL-C levels. Other lipid values showed a slight increase compared to controls. There was a statistically significant association of triglycerides and HDL-C with increasing age, female sex, obesity, physical inactivity and poor glycaemic control of diabetes.

Towards sustainable delivery of health services in Afghanistan: options for the future

Disruption caused by decades of war and civil strife in Afghanistan has led many international and national nongovernmental organizations (NGOs) to assume responsibility for the delivery of health services through contracts with donor agencies. Recently the Afghan Government has pursued the policy of contracting for a basic package of health services (BPHS) supported by funds from three major donors - the World Bank, the United States Agency for International Development (USAID) and the European Commission. With the gradual strengthening of the public health ministry, options for the future include pursuing the contracting option or increasing public provision of health services. Should contracting with NGOs be pursued, a clear strategy is required that includes developing accreditation instruments, better contracting mechanisms and a system for monitoring and evaluating the entire process. Should the government opt for an increasing role, problems to be solved include securing the transition to public provision, obtaining guarantees that appropriate financing will be provided and reconfiguration of the public health delivery system. Large-scale contracting with the private for-profit sector cannot be recommended at this stage, although this option could be explored via subcontracting by larger NGOs or small-scale trial contracts initiated by the public health ministry. Irrespective of the option chosen, an important challenge remaining is the recalcitrant problem of high out-of-pocket payments. Sustainable delivery of health services in Afghanistan can only be achieved with a clear national strategy in which all stakeholders have roles to play in the financing, regulation and delivery of services.

Use of the Internet by Sudanese doctors and medical students

Patterns of use of the Internet were investigated by a questionnaire survey of 102 hospital doctors and 123 medical students in Khartoum, Sudan, in January 2005. More doctors (84.3%) had used the Internet than had students (78.9%). Half of consultants (55.0%) used the Internet daily, compared with only 18.2% of junior doctors. Many consultants and junior doctors rated their abilities as poor (60.0% and53.1%). One-third of students (33.3%) used the Internet only for personal and not for academic purposes. Barriers to greater use of the Internet by doctors included: time constraints (80.2%), poor skills (54.6%), no access to full texts of journal articles (53.4%), difficulty in verifying the quality of information (47.6%) and high costs (41.8%). Students faced similar barriers but also listed poor knowledge of the English language.

Managing herpes zoster in immunocompromised patients

Herpes zoster infections are more common and often more complicated in immunocompromised patients. The key clinical objective in these patients is to reduce the incidence of cutaneous and visceral dissemination that can lead to life-threatening complications. This is best achieved with prompt antiviral therapy, which should be instituted in all immunosuppressed zoster patients if presentation occurs within 1 week of rash onset or any time before full crusting of lesions. For localized disease, most patients can be treated with oral valaciclovir, famciclovir or aciclovir, with close outpatient follow-up. Intravenous aciclovir therapy is reserved for those with disseminated varicella zoster virus infection, ophthalmic involvement, very severe immunosuppression or the inability to take oral medications. Foscarnet is the drug of choice to treat aciclovir-resistant herpes zoster. Appropriate analgesic therapy should be combined with early antiviral treatment to reduce the incidence and severity of acute zoster pain and post-herpetic neuralgia.

Expression of cyclooxygenase-2 and 12-lipoxygenase in human breast cancer and their relationship with HER-2/neu and hormonal receptors: impact on prognosis and therapy

BACKGROUND

A number of studies have shown over-expression of cox-2 in breast cancer. Also it has been recorded that human breast cancer expresses high level of cox-2 and 12-lipoxygenase which may be beneficial in future therapy plan for those patients.

AIMS

The present study aims to examine the level of transcripts of cox-2 and 12-lipoxygenase in Egyptian breast cancer patients and to compare between the expressions of both enzymes and TNM staging, hormone receptors status (including estrogen and progesterone) and HER2/neu expression.

MATERIALS AND METHODS

Total cellular RNA was extracted from 64 frozen tissue samples of breast carcinoma and their corresponding normal adjacent tissues. Cox-2 and 12-lipooxygenase expressions were detected using RT-PCR. Hormonal receptors as well as HER2/neu were detected immuno-histochemically for each patient.

RESULTS

About 47 and 62.5% of carcinoma samples showed over-expression of cox-2 and 12-lipooxygenase respectively as compared to their corresponding normal tissues. The results revealed that cox-2 significantly associated with TNM staging (P = 0.0047) and hormonal receptors status (P = 0.0201). The relationship between cox-2 and HER2/neu expression was close to a significant value (P = 0.0747). 12-lipooxygenase showed only significant association with TNM staging (P = 0.0076). Neither hormonal receptors nor HER2/neu showed significant association with this enzyme.

CONCLUSION

Elevated levels of cox-2 and 12-lipoxygenase expression were detected in human breast cancer. Also, the results revealed that cox-2 and 12-lipooxygenase mRNA expressions are associated with TNM staging in human breast cancer. Furthermore, there is an inverse association between cox-2 expression and hormonal receptor status. This observation may drive us to the possible role of those two enzymes in determining the plan of therapy of breast cancer patients.

Towards sustainable delivery of health services in Afghanistan: options for the future

Disruption caused by decades of war and civil strife in Afghanistan has led many international and national nongovernmental organizations (NGOs) to assume responsibility for the delivery of health services through contracts with donor agencies. Recently the Afghan Government has pursued the policy of contracting for a basic package of health services (BPHS) supported by funds from three major donors-the World Bank, the United States Agency for International Development (USAID) and the European Commission. With the gradual strengthening of the public health ministry, options for the future include pursuing the contracting option or increasing public provision of health services. Should contracting with NGOs be pursued, a clear strategy is required that includes developing accreditation instruments, better contracting mechanisms and a system for monitoring and evaluating the entire process. Should the government opt for an increasing role, problems to be solved include securing the transition to public provision, optining guarantees that appropriate financing will be provided and reconfiguration of the public health delivery system. Large-scale contracting with the private for-profit sector cannot be recommended at this stage, although this option could be explored via subcontracting by larger NGOs or small-scale trial contracts initiated by the public health ministry. Irrespective of the option chosen, an important challenge remaining is the recalcitrant problem of high out-of-pocket payments. Sustainable delivery of health services in Afghanistan can only be achieved with a clear national strategy in which all stakeholders have roles to play in the financing, regulation and delivery of services.

Deficiencies in medical prescriptions in a Sudanese hospital

We determined the quality of medical prescription in Ribat University Hospital, Khartoum through detecting errors in doctors' prescriptions. We randomly selected 1000 medical prescriptions and checked them for completeness and legibility. The total number of doctors responsible for writing the prescriptions was 46. The patient's full name was written on only 18.8% of prescriptions and that of the doctor on only 6.7%. In only 19.5% of prescriptions were drugs prescribed by their generic names, 59.7% lacked the quantity of the drug, 25.7% lacked the duration of treatment and 15.8% were difficult to read. The quality of drug prescriptions written by our hospital doctors is seriously deficient.

Attitudes towards euthanasia among final-year Khartoum University medical students

To investigate the attitudes of final-year medical students at Khartoum University towards euthanasia an anonymous questionnaire was answered by 141 students. Most were familiar with the concept of euthanasia. The majority, 108 (76.6%) opposed euthanasia and their reasons included religious beliefs, belief that euthanasia was unethical and fear of misuse. The supporters of euthanasia (23.4%) stated reasons such as preventing the suffering of patients and respecting their autonomy and dignity. More students who described themselves as strongly religious were opponents of euthanasia (83/87, 95.4%) than those who were moderately religious (25/54, 46.3%).

Human Papillomaviruses and Genital Disease

Human papillomavirus (HPV) infection is causally related to several benign and malignant diseases of the anogenital tract. In this article the authors detail the epidemiology, methods of transmission and risk factors, pathogenesis, and oncogenesis of HPV, and describe clinical manifestations and current treatments. Special attention is given to condyloma acuminatum and non-cervical anogenital intraepithelial neoplasia. The authors conclude with the latest information on prophylactic vaccine development and prospects for future control of HPV-related disease.

History of disorders of thyroid dysfunction

The first description of thyroid diseases as they are known today was that of Graves disease by Caleb Parry in 1786, but the pathogenesis of thyroid disease was not discovered until 1882-86. Thyroidectomy for hyperthyroidism was first performed in 1880, and antithyroid drugs and radioiodine therapy were developed in the early 1940s. Thomas Curling first described hyopothyroidism (myxoedema) in 1850 and the cause and suitable treatment were established after 1883. This paper reviews the main landmarks in the history of thyroid disease, supplemented by a brief discussion of the historically relevant scientific aspects of the thyroid gland, and the evolution of endocrinology as a formal discipline.

A study of domestic violence among women attending a medical centre in Sudan

To investigate domestic violence in the Sudanese family, we studied 394 literate, married women attending the Arda Medical Centre, Omdurman, from October 2001 to February 2002. Through self-administered questionnaires, the women provided data on sociodemographic characteristics and abuse by the husband. Abuse was reported by 164 women (41.6%), who suffered 525 violent episodes in the previous year, classified into controlling behaviour (194), threatening behaviour (169) and physical violence (162). Frequency of violent episodes varied from 1 (25%) to > 6 (20.7%). Violence during pregnancy was reported by 27 women (16.5%). Provoking events included suspicion of illicit relations, talking back and inadequate home care. Common reactions reported by the women included staying quiet, crying and resistance.