Epithelial-myoepithelial carcinoma (EMC) is an unusual malignant salivary gland tumor. Little is known about the clinical and biological behavior of EMC. There is no consensus for its treatment. It is considered as a low grade malignant tumor. Whatever, it presents a potential of local recurrence and possibility of metastases. We report a 76-year-old patient who presented an epithelial-myoepithelial carcinoma of parotid gland, treated successfully with wide local resection and adjuvant radiotherapy with no signs of recurrence for 3 years.
CASE REPORT | June 16, 2020
Abdominal Tuberculosis Presenting with an Indiscernible Abdominal Complaint: A Case Report
Abdominal tuberculosis accounts for 11% of patients of extra-pulmonary tuberculosis. It is also the sixth most common form of extra-pulmonary tuberculosis. Abdominal tuberculosis that presents without pulmonary or general signs/symptoms of tuberculosis is rare events that occur only in 1.2% of the disease. It can result in an intestinal obstruction; however, it is a rare cause of intestinal obstruction that is usually overlooked or misdiagnosed. We report a 17-year-old female patient who’s not known to have any medical illness presented with acute abdominal pain due to small bowel obstruction with no significant effect on bowel habit. Imaging showed free fluid in the abdomen and small bowel obstruction. The patient was managed surgically with adhesiolysis and started anti-microbial therapy. The report describes the diagnostic challenges that abdominal tuberculosis can presents with, especially in patients without accompanying pulmonary or general tuberculosis signs/symptoms. Such a presentation can be a challenge to diagnosed and usually are mistaken with other differential diagnoses. Therefore, clinicians - especially in areas that are endemic with Tuberculosis - need to consider such rare diagnoses and have a high suspicion of tuberculosis in such a presentation.
CASE REPORT | June 18, 2020
Kayser Fleischer Ring - A Strong Clinical Indicator of Neuro-Wilson's Disease
Ashok Rathi, Nidhi Singh, R. S. Chauhan, J. P. Chugh
Wilson’s disease is a hereditary disorder of copper metabolism which is characterized by neuropsychiatric and hepatic manifestations as well as appearance of Kayser-Fleischer ring. A male presenting with features of gradually progressive dysphagia, dysarthria, dystonia, abdominal discomfort and difficulty in maintaining balance, was referred for ophthalmic evaluation for any neuro-wilson manifestation. Patient had BCVA of 6/6 both eyes with anterior and posterior segment revealing no significant findings. Slit lamp biomicroscopic examination revealed a yellowish-brown deposits of Kayser Fleischer (KF) Ring following which diagnostic tests for Wilson Disease (WD) were carried out and treated for the same. The dense KF ring conveys that it has been a long-standing disease and a definite indicator of Neuro-wilson disease. This case report emphasize on the significance of early identification of KF ring and its neurological relevance.
CASE REPORT | June 24, 2020
Presumed Central Serous Chorioretinopathy in 9 Years Old Boy
A 9-year-old male attended our clinic with the blurred vision in his right eye, for one day duration. No past history of systemic or ocular illnesses except for recurrent tonsillitis. On ocular examination; his left eye (OS) visual acuity (VA) was 6/6, and the right eye (OD) VA was 6/9.5 which corrected to 6/9 with +0.75 diopter sphere. Fundus examination revealed normal optic nerve and a serous detachment in the posterior pole, nearly about the disc size. The optical coherence tomography angiography (OCTA) showed neurosensory retinal detachment with subretinal fluid. The family was not able to perform the fundus fluorescein angiography (FFA) due to the financial crisis in the region. Given this background, the diagnosis of idiopathic central chorioretinopathy had given. The clinical course was monitored without any treatments and spontaneous remission achieved within six months Figure 1, 2 and 3.
ORIGINAL RESEARCH ARTICLE | June 14, 2020
Risk-Minimization Measures in the EU: Review of Two Year Period Safety Referral Procedures
The current study aims to research, systemize and analyze the qualitative characteristics of pharmacovigilance referral procedures which took place in the EU for two years period 2017-2018. For the purpose of the study PRAC decisions and minutes for all procedures which started and completed within 2017-2018 were extracted and systemized. The systemization was made based on several criteria including legal basis of procedure, scope, proposed risk-minimization measures. The results from the study showed that the PRAC’s recommendations are most frequently focused on narrowing patient population and therapeutic indications and enhancing safety monitoring during medicines’ use. National competent authorities play major role both as initiators of referrals and national safety monitors. The conducted analysis shows that conducting PRAC safety referral procedure is a complex and dynamic process where real-life clinical data is valuable source of information. The suggested risk-minimization steps are mainly focused on enforcement of measures already existing in the risk-management plan of the products. They also require a constant follow-up monitoring for efficacy. National competent authorities are leading participants in organizing the work and composing the agenda of the committee.
REVIEW ARTICLE | June 14, 2020
Traditional Knowledge of Medicinal Herbs of Gondia District for Beauty Care: An Ethno-Botanical Survey
Traditionnal herbal drugs have recently been receiving all over the world. The forest region of Gondia district is harbours plenty of medicinal plants along with other flora and fauna. The ethnic communities mostly depend upon herbal medicines for healing their ailments. The study was done through structural questionnaires in consultation with the tribal practitioners. Herbs and spices have been used in maintaining and enhancing human beauty since time immemorial. Indian women have long used herbs for skin care and natural oils to perfume their bodies. Not too long ago, elaborate herbal beauty treatments were carried out in the royal places of India to heighten sensual appeal and maintain general hygiene.
ORIGINAL RESEARCH ARTICLE | June 26, 2020
Evaluation of the Practice of Thromboprophylaxis in Urological Surgery
Abdeslam Elkartouti, Mohamed Lezrek, Moulay Ahmed Hachimi
The objective of our work is to assess the practice of thromboprophylaxis in urological surgery in relation to international recommendations and to propose corrective measures. This is a prospective observational study of the practice of thromboprophylaxis in urological surgery. Carried out over a period of ten weeks. Data collection was carried out on files developed in consultation; the analysis of the results made it possible to include only the files subject to thromboprophylaxis and the comparison of these results with data from the literature to judge the conformity of the decisions of thromboprophylaxis compared to the specific recommendations. Among the 40 cases collected, one case was excluded because they relate to curative thromboprophylaxis. Compliance with the decision whether or not to initiate thromboprophylaxis concerned only 29 patients out of 39, ie decision compliance of 74.35%. Analysis of the overall thromboembolic risk showed that this risk was high in 35% of the cases. The duration of thromboprophylaxis was the judgment criterion, the compliance of which was only 63.6 3%. These results show the interest of this kind of study in order to update our protocols in accordance with the recommendations with regard to thromboprophylactic prevention, it is highly desirable to sensitize health professionals to the importance of respecting the prescription period for better patient management.
ORIGINAL RESEARCH ARTICLE | June 26, 2020
Evaluation of Antibiotic Prescriptions in the Emergency Department
Abdeslam Elkartouti, Sidi Mohamed Hannafi, Moulay Ahmed Hachimi
The objective of this study is to assess the prescription of antibiotic therapy in the emergency department, which is an overview of our hospital training and to reflect on the development of corrective measures. A working group was responsible for developing the methodology. The data collection was prospectively for each patient, this data relating to the characteristics of the patients (age, sex), the reasons for emergency consultations, the data concerning the patient field, the elements of the clinical and paraclinical examination and prescribed antibiotic treatments and analysis of these data. This study included 542 patients consulting for different reasons; including 347 men (64%) against 195 women (36%); of which 90 patients benefited from the prescription of antibiotic therapy, is 16.60% of the patients included. Antibiotic therapy prescribed in the emergency room was justified in 86 patients (95.55%); the choice of the molecule was in accordance with the recommendations in 53 patients (58.88%) and the prescribed dosage was in accordance with the recommendations in 73 patients (81.11%). The quality of the choice of probabilistic antibiotic therapy conditions the patient's prognosis. To reduce this risk, the emergency physician must base his decision on probabilistic reasoning and reassess the treatment based on the antibiogram and systematically use the antibiotic therapy protocols recommended by learned societies which must be adapted to the local ecology; to ensure the proper use of antibiotics.
Commotio retinae or Berlin’s edema is an acute traumatic maculopathy complicating blunt eye trauma. It is characterized by a transient retinal opacification affecting particularly the macular area. Its functional evolution is very variable, ranging from complete recovery to profound visual deficits with an acute and permanent visual loss. We report two cases of Commotio retinae (Berlin’s edema) occurring after blunt ocular trauma of different severity and we emphasize the interest of OCT in the diagnosis, monitoring and prognostic evaluation of traumatic maculopathy.
CASE REPORT | June 30, 2020
Exudative Age-Related Macular Degeneration: A Case Report and Review of the Literature
Age-related macular degeneration (AMD) is a progressive degenerative retinal disease with particular damage in the macular area. It is the most common cause of blindness in developed countries mainly affecting the elderly. The exudative or wet form represents the most severe form with rapid progression despite therapeutic progress. It is characterized by the development of choroidal neovessels, crossing the retinal pigment epithelium and developing below the macular area. We report a clinical case of exudative AMD complicated by macular edema and serous retinal detachment, diagnosed in a 70-year-old patient with cardiovascular risk factors and presenting reduced visual acuity with central scotoma. Through this case we study the risk factors, the diagnostic and therapeutic procedure of exudative AMD with a review of the literature.
ORIGINAL RESEARCH ARTICLE | June 30, 2020
Characteristics of Ocular Behçet Disease: A Retrospective Study
Introduction: Behçet disease is a systemic inflammatory disease characterized by intraocular inflammation, oral and genital ulcers, skin lesions and many other visceral disorders. It is particularly prevalent in the countries of the Mediterranean basin and in the Middle East. The objective of our work is to describe clinical, therapeutic and prognostic characteristics of ocular Behçet disease. Methods: We present a retrospective study of 14 patients with ocular Behçet disease, diagnosed according to the International Study Group of Behçet disease criteria. All patients underwent a complete ophthalmologic examination, Fluorescein Angiography and Optical Coherence Tomography OCT. Results: The average age is 32.5 years, ranging from 17 to 64 years. A male predominance was noted. Visual acuity was > 1/10 in 8 patients, between 1/10 and 5/10 in 4 patients and > 5/10 in 2 patients. Ophthalmological examination revealed an anterior non-granulomatous uveitis in 8 patients, with hypopyon in 2 patients and with acute hypertonia in 2 others, an intermediate uveitis with hyalitis in 2 patients, a retinal vasculitis with periphlebitis in 3 patients, a branch retinal venous occlusion in 1 patient; a macular edema in 2 patients and a papillary edema in 3 patients. Fluorescein Angiography objectified vasculitis with white sheathing end tortuous vessels in 3 cases, peripheral retinal ischemia in 1 patient and papillitis with late diffusion in 3 cases. Macular OCT showed cystoid macular edema in 2 cases. Therapeutic management consisted of topical corticotherapy with mydriatics in isolated anterior inflammation. A bolus of Solumedrol at a dose of 10 mg / kg / day during 3 followed by an oral relay at 1 mg / kg / day with progressive degression, was indicated in 8 cases. Retinal photocoagulation was performed in one patient. The evolution was marked by a regression of inflammatory signs with final visual acuity ≤ 1/10 in 4 patients. Two cases were complicated by extended posterior synechiae with acute ocular hypertonia that required a Yag laser iridotomy after inflammation control. Conclusion: Blindness remains the most serious complication of ocular Behçet disease. The prognosis depends on the precocity of treatment and requires a strong collaboration between ophthalmologists and internists.
ORIGINAL RESEARCH ARTICLE | June 30, 2020
Antidiabetic, Antihyperlipidaemic and Protective effects on Kidney and Liver functions by leaf extracts of Eriosema psoraleoides G. Lam (Leguminosae)
Eriosema psoraleoides is a plant used in ethnomedicine in the South East of Nigeria to manage conditions related to diabetes. The present research work is aimed at investigating the antidiabetic potentials of the leaves of this plant. The plant was collected in Nsukka, Nigeria, and authenticated by a taxonomist. Phytochemical screening was carried out on the leaves of the plant using standard procedures. The acute toxicity was tested using the Lorke’s method. Extraction was carried out successively with n-hexane, ethylacetate and 80% aq. Methanol, by maceration. In vivo tests were carried out on alloxan-induced diabetic male Wistar rats, using these three extracts for 14 days. Glibenclamide, 4mg/kg body weight was used as positive control. Statistical analysis was carried out using standard error of the mean and student’s t-test. Blood glucose measurements were done with a glucometer. Phytochemical results showed the presence of tannins, flavonoids, steroids, anthraquinones, and reducing sugars. In the toxicity test no deaths were recorded even at 5000mg/kg body weight of the rats. In the acute antidiabetic test no significant reduction in blood glucose levels were recorded for any of the extracts in the first 180 minutes on day 1. In the chronic test, the n-hexane and ethylacetate extracts demonstrated significant (p<0.05) reductions in blood glucose levels up to 77.5%, and 75.3%, on the 14th day, respectively, compared to 79.3% for Glibenclamide. The biochemical results show the plant has antihyperlipidaemic, hepatic and renal protective effects. Our results tend to justify the use of this plant in ethnomedicine.
Scholars Middle East Publishers
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