Visceral leishmaniasis in Lebanon a report of four cases: case series and review.

INTRODUCTION: Leishmaniasis comprises a complex of vector-borne diseases, caused by more than 20 species of the protozoan genus Leishmania, and ranging from localized skin ulcers to lethal systemic disease. It is endemic in Asia, Africa, the Americas, and the Mediterranean region. In the Middle East countries like Syria reports high incidence of the disease. In addition to the endemicity of the region for leishmaniasis, the Middle East has seen a great deal of human migration either for earning of livelihood or due to political upheaval in the region. Cutaneous form can be disfiguring but visceral form can be lethal. METHODOLOGY: In this article we report the clinical presentation of 4 cases of visceral leishmaniasis; 3 cases were pediatrics and one immunosuppressed adult patient all of them were from Syria from different regions. The diagnosis was made by bone marrow aspirate; PCR was made for 2 of them and was positive for leishmania infantum. All of them were treated with Amphotericn B lipid formulation (ABELCET) with complete response (definite cure). RESULTS: We report in this article 4 cases of visceral leishmaniasis treated with amphotericin B lipid complex (Abelcet) following the guidelines with complete remission. CONCLUSION: Visceral leishmaniasis is a serious disease and if not treated can lead to death. Lebanon is not known to be endemic for leishmania but since the war the ministry of health reported an outbreak of leishmania and mainly cutaneous leishmania. Here we present 4 cases of visceral leishmania and a review of the latest guidelines on the treatment modalities and protocols.

[Rapidly progressing quadriparesis secondary to licorice (souss) intoxication]. / Tétraparésie rapidement progressive par intoxication à la réglisse (souss).

INTRODUCTION: Regular consumption of licorice based beverages can provoke pseudohyperaldosteronism with hypokalemia but can rarely lead to severe muscle weakness. CASE REPORT: A 62-year-old man was admitted for a one-week history of progressive weakness of the four limbs. Blood work revealed severe hypokalemia that was due to primary pseudo-hyperaldosteronism secondary to licorice intoxication. He became normal after correction of the electrolytes disturbances. DISCUSSION & CONCLUSION: In an area where a liquorice-based beverage (souss), is frequently and sometimes excessively consumed, pseudo-hyperaldosteronism secondary to licorice toxicity should be thought of in front of any muscle weakness accompanied by hypokalemia. A rapid correction of electrolytes disturbances leads to rapid improvement.

A neonatal screening in Lebanon: Results of five years' experience.

BACKGROUND: Neonatal screening programs for common disorders like phenylketonuria, congenital hypothyroidism, and glucose-6-phosphate dehydrogenase (G6PD) deficiency are not fully established at the national level in Lebanon. Screening for the above disorders was carried out for newborns delivered at the American University of Beirut Medical Center over a period of five years. SUBJECTS AND METHODS: Blood specimens collected 2-3 days after birth were applied to neonatal screening blood collection cards. A total of 9117 newborns were screened using phenylalanine, thyroid-stimulating hormone, and G6PD activity measurements on blood spots. RESULTS: One case of phenylketonuria and another of hyperphenylalaninemia were detected. We also detected 5 cases of permanent type of congenital hypothyroidism, giving an incidence of 5:9117 (1:1823). The age range at initiation of hormonal replacement therapy was 9-46 days. The overall incidence of G6PD was 106:9117 (1:86 or 1.16%), of which 84 had complete deficiency (1:109 or 0.92%), and 22 with intermediate activity. CONCLUSION: The incidence of these disorders found in this Lebanese sub-population warrants consideration of a comprehensive nationwide neonatal screening program.

Tuberculous epididymo-orchitis following intravesical BCG for superficial bladder cancer.

A seventy-two-year-old man with transitional cell carcinoma of the bladder received intravesical Bacillus Calmette-Guérin (BCG) following which he developed left testicular pain and swelling that partially resolved with conservative treatment. Six months later a second course of BCG was given for recurrent disease. Ten months later, he developed left testicular swelling and severe induration along with a draining scrotal sinus. Tuberculous orchitis was suspected and a left orchiectomy was performed. Pathology showed caseating granulomatous orchitis and epididymitis with numerous acid fast bacilli on Ziehl-Neelson stain. The patient received a six-month course of antituberculous therapy. This case highlights a rare but serious complication of intravesical BCG.

Antígeno prostático específico e descriçäo de novos marcadores para o câncer de próstata / Prostate-specific antigen and new related markers for prostate cancer

Näo obstante o antígeno prostático específico (PSA), ou calicreína 3 humana, seja o mais valioso instrumento disponível para o diagnóstico e a administraçäo do câncer de próstata, da maneira como é atualmente utilizado ele näo é sensível ou específico o suficiente para permitir o diagnóstico precoce ou o estadiamento da doença. Diversos conceitos novos vêm sendo introduzidos com a finalidade de otimizar o uso clínico das dosagens do PSA, mas todos apresentam suas desvantagens. As formas moleculares do PSA, especialmento do PSA livre, parece ser útil na detecçäo do câncer de próstata em concentraçöes que väo de 4-10 µg/l. Novas técnicas moleculares, como a reaçäo em cadeia da polimerase transcriptase reversa para a detecçäo de quantidades mínimas do RNA mensageiro do PSA e o antígeno prostático membrana-específico säo promissores para o prognóstico e possivelmente para o estadiamento precoce do câncer prostático. Por outro lado, a calicreína 2 humana, uma protease sérica estreitamente relaciomnada ao PSA e que também é produzida predominantemente pela próstata, pode ser um novo marcador adjuvante do câncer prostático. Quanto às suas funçöes biológicas, o PSA já näo pode ser considerado uma molécula específica da próstata, associada principalmente à liquefaçäo do sêmen, tendo em vista seu possível papel de indicador prognóstico no câncer de mama feminina. A funçäo biológica do PSA em tecidos normais e em tumores pode ser muito mais complexa do que se tem acreditado até o momento e exige investigaçöes posteriores