Epidermoid Cyst of the Ear Lobule in Adult.

An epidermoid cyst is one of the most common benign cysts of the skin. The cyst is filled with keratin flakes and its wall is composed of keratinized, stratified, squamous epithelium. Epidermoid cysts can occur anywhere on the body, usually along the lines of embryonic fusion and mostly on the face, scalp, neck, chest, and upper back. Around 80% of the epidermoid cysts are seen in ovaries and testicles whereas, in the head and neck, they account for only about 7% and 1.6% of epidermoid cysts are reported in the oral cavity. The condition can be congenital or acquired. Congenital causes are rare and may be caused by the entrapment of ectodermal elements intradermally or subcutaneously during embryogenesis. Acquired causes of an epidermoid cyst may result from traumatic or iatrogenic implantation of epithelial cells into the dermal layer or from obstruction of a pilosebaceous unit in the hair follicle. Surgical excision completes the treatment.

Effects of treatment with a microRNA mimic or inhibitor on the developmental competence, quality, epigenetic status and gene expression of buffalo (Bubalus bubalis) somatic cell nuclear transfer embryos.

Expression levels of 13 microRNAs (miRNAs) were compared between buffalo blastocysts produced by somatic cell nuclear transfer through hand-made cloning and IVF to improve cloning efficiency. Expression of miR-22, miR-145, miR-374a and miR-30c was higher, whereas that of miR-29b, miR-101, miR-302b, miR-34a, miR-21 and miR-25 was lower, in nuclear transferred (NT) than IVF embryos; the expression of miR-200b, miR-26a and miR-128 was similar between the two groups. Based on these, miR-145, which is involved in the regulation of pluripotency, was selected for further investigation of NT embryos. miR-145 expression was lowest at the 2-cell stage, increased through the 4-cell stage and was highest at the 8-cell or morula stage in a pattern that was similar between NT and IVF embryos. miR-145 expression was higher in NT than IVF embryos at all stages examined. Treatment of reconstructed embryos 1h after electrofusion with an inhibitor of miR-145 for 1h decreased the apoptotic index and increased the blastocyst rate, total cell number, ratio of cells in the inner cell mass to trophectoderm, global levels of acetylation of histone 3 at lysine 18 and expression of Krueppel-like factor 4 (KLF4), octamer-binding transcription factor 4 (OCT4) and SRY (sex determining region Y)-box 2 (SOX2) in blastocysts. Treatment with an miR-145 mimic had the opposite effects. In conclusion, treatment of NT embryos with an miR-145 inhibitor improves the developmental competence and quality, and increases histone acetylation and expression of pluripotency-related genes.

Amplitude of low-frequency fluctuation (ALFF) and fractional ALFF in migraine patients: a resting-state functional MRI study.

AIM: To evaluate the amplitude of low-frequency oscillations (LFOs) of the brain in migraine patients using amplitude of low-frequency fluctuation (ALFF) and fractional ALFF in the interictal period, in comparison to healthy controls (HCs). MATERIALS AND METHODS: A total of 54 subjects, including 30 migraineurs and 24 gender- and age-matched HCs completed the fMRI. All the data and ALFF, fALFF analyses were preprocessed with the Data Processing Assistant for Resting-State fMRI (DPARSF). All of the statistical analyses were performed using the REST software to explore the differences in ALFF and fALFF between migraine patients and HCs. RESULTS: In contrast to HCs, migraine patients showed significant ALFF increase in the left medulla and pons, the bilateral cerebellum posterior lobe and right insula. The regions showing decreased ALFF in migraine patients included the bilateral cerebellum posterior lobe, left cerebellum anterior lobe, bilateral orbital cortex, right middle frontal gyrus, bilateral occipital lobe, right fusiform gyrus, and bilateral postcentral gyrus. The fALFFs in migraine patients were significantly increased in the bilateral insular and left orbital cortex, but were decreased in the left occipital lobe and bilateral cerebellum posterior lobe. CONCLUSION: These ALFF and fALFF alterations in the brain regions of migraineurs are in keeping with the domains associated with pain and cognition. Such brain functional alteration may contribute to further understanding of migraine-related network imbalances demonstrated in previous studies.

Triple Assessment of a Palpable Parotid Lump in "One-Stop" Clinics.

Introduction: The National Institute of Clinical Excellence in the UK (NICE) recommended the use of "one-stop" clinics for the assessment and management of head and neck lumps like those established for breast lumps. "One-stop" clinics should follow a triple assessment protocol involving physical examination, radiological imaging and fine-needle aspiration cytology (FNAC). Methods: A retrospective analysis of 144 patients with suspected parotid tumours from 2005 to 2011 was done. Patients were assessed for individual modalities and compared against the final histological diagnosis. Statistical analysis was used for sensitivity and specificity, as well as positive and negative predictive values. All calculations were performed using SPSS version 16 (Statistical Packages for the Social Sciences, Chicago, IL). A p value of < 0.05 was considered to indicate statistical significance. Results: A total of 105 patients underwent all the three modalities. Out of them, 93 had imaging that was considered radiologically benign and 12 were reported to have a malignant lesion. Cytologically, 75 were found to have a benign tumour, 13 were malignant, and 17 were considered to be indeterminate. The most common benign neoplasm was pleomorphic adenoma followed by Warthin's tumour. The sensitivity and specificity of triple assessment were 96% (p value 0.878-0.984) and 73% (p value 0.42-0.904), respectively. The positive predictive value was 96% (p value 0.878-0.984) and negative predictive value came out to be 93% (p value 0.42-0.904). Conclusions: The overall accuracy of triple assessment was found to be 92%. This study concludes that triple assessment is a useful assessment tool to evaluate a patient with parotid lump. Supplementary Information: The online version contains supplementary material available at 10.1007/s12663-021-01590-5.

An unusual case of obstructive jaundice.

Tuberculosis of the pancreas is a rarity, reported in a handful of literature. We enumerate the case of a young girl with high fever, jaundice, and right hypochondrial pain, whose investigations revealed a mass at the head of the pancreas. FNAC from the mass astoundingly proclaimed tuberculosis.

Leptospirosis: An insight into community structure of small mammal's host in urban environment.

Leptospirosis is a zoonotic disease caused by bacteria of the genus Leptospira and most often acquired through contact with environments contaminated with leptospires shed in the urine of infected mammals. In urban environment, rodents are well-known as the main carriers of this bacteria, however there were no intensive study on the population structure of these animals, and how it associated with this disease. Hence, we use a case study from an outbreak in a residential area in Selangor, Malaysia, to investigate how community structure of small mammals, associated with the prevalence of Leptospira. One hundred cage traps were placed randomly in and around these houses in five phases with two months interval for a year. Community structures (species, sex, and age) were assigned for each individual, prior to screening for pathogenic Leptospira, using a partial lipL32 gene from the kidney samples. 185 small mammals from four species were captured, Rattus norvegicus (74.5%, N=138), R. rattus (20%, N=37), Tupaia glis (5%, N=9), and Suncus murinus (0.5%, N=1). From this number, 29 individuals were found PCR positive for pathogenic Leptospira (R. norvegicus, N=20; R. rattus, N=6; T. glis, N=2; S. murinus, N=1). The study shows that Leptospira occurrence in the small mammals were significantly correlated to age category and sampling phases, with Spearman Correlation (rs) p=0.02 and p=0.04 respectively. Adult individuals were significantly more prevalent with Leptospira infection, whereby March and June were found to associate with higher Leptospira prevalent among the small mammals, potentially coincide with low rainfall and relative humidity level. This information is important in designing a specific control method for rodents in Leptospira outbreak areas. In addition, intensive sampling and regular cleaning effort were found to significantly reduce the small mammal Leptospira reservoir, thus should be implemented in intervention strategies in the urban environment.

Treatment of buffalo (Bubalus bubalis) SCNT embryos with microRNA-21 mimic improves their quality and alters gene expression but does not affect their developmental competence.

Application of cloning technology on a wide scale is severely limited by the very low live birth rate obtained with cloned embryos. Embryo quality is an important factor which affects the conception and live birth rate of cloned embryos. microRNA-21 (miR-21) has been implicated in the regulation of apoptosis and the expression level of several important genes which control apoptosis. We examined the effects of treatment of reconstructed buffalo embryos, produced by Hand-made cloning, with miR-21 mimic on developmental competence, quality and gene expression of cloned embryos. Expression level of miR-21, which increased from 2-cell to 8-cell stage and then decreased at the blastocyst stage, showed a similar pattern in cloned and IVF embryos. It was lower in cloned than in IVF embryos at 2-, 4- and 8-cell (P < 0.001) and blastocyst (P < 0.05) stages but not at morula stage. Treatment of reconstructed embryos with miR-21 mimic for 1 h after 1 h of electrofusion, increased (P < 0.05) the total cell number (251.3 ±â€¯10.7 vs 181.5 ±â€¯2.13). Blastocysts produced from miR-21-treated reconstructed embryos had lower (P < 0.05) apoptotic index than controls and IVF blastocysts (2.01 ±â€¯0.17, 5.46 ±â€¯0.26 and 4.19 ±â€¯0.15, respectively). The treatment also improved the inner cell mass:trophectoderm cell number ratio of blastocysts than in controls (0.21 ±â€¯0.01 vs 0.11 ±â€¯0.003) to values observed in IVF blastocysts (0.20 ±â€¯0.008). However, miR-21 mimic treatment did not affect the blastocyst rate, which was similar for treatment, control and negative control groups (36.58 ±â€¯3.64, 36.58 ±â€¯3.64 and 32.2 ±â€¯2.86%, respectively). miR-21 mimic treatment increased (P < 0.01) the expression level of apoptosis- (BCL2 and PTEN), pluripotency- (OCT4 and SOX2) and development-related genes (GLUT1, FGF4 and P53), but not that of CASPASE3 than in untreated controls in blastocysts. These results suggest that treatment of reconstructed embryos with miR-21 mimic improves blastocyst quality, reduces apoptosis and alters gene expression without improving the blastocyst rate.

Case report: coronectomy of an impacted and submerged second deciduous molar.

Coronectomy is a widely-accepted technique available for the treatment of impacted wisdom teeth. The fundamental principle is to prevent trauma to the inferior dental nerve (IDN). Many publications have demonstrated its positive outcomes but there is no literature available regarding coronectomy of deciduous teeth. This case report highlights the complex approach to managing a severely infraoccluded 85 in the mixed dentition of a 10-year-old female. The report demonstrates and discusses the combined orthodontic and oral surgical approach to prevent damage to the IDN and to allow space for orthodontic movement. This case demonstrates how nerve sparing techniques in the mixed dentition are achievable.Clinical relevance statement When managing severely infraoccluded and impacted deciduous second molars, clinicians must be aware that the option of a coronectomy should be considered and may be the difference between sparing the nerve or causing permanent injury.Objective The reader should understand that coronectomy is a suitable treatment option in managing impacted deciduous teeth.

Dotting the Three I's for collaborative TB-HIV activities: evaluation of a pilot programme in Kathmandu, Nepal.

Setting: The three government tertiary care hospitals providing care for people living with the human immunodeficiency virus (PLHIV) in Kathmandu, Nepal. Objectives: To assess 1) the screening cascades for intensified case finding for tuberculosis (TB), 2) isoniazid preventive therapy (IPT), including demographic and clinical factors associated with treatment interruption, and 3) TB infection control (IC) in the health facilities. Design: A cross-sectional study of new PLHIV enrolled from January 2012 to December 2014. Results: Among 572 registered PLHIV, 91% were on antiretroviral therapy. Of those registered, 561 (98%) were screened for TB and 73 (13%) were diagnosed with TB (17 [25%] sputum smear-positive, 17 [25%] smear-negative and 35 [51%] extra-pulmonary). Among the 488 (87%) PLHIV without active TB, 157 (32%) were initiated on IPT, of whom 136 (87%) completed treatment and 17 (11%) interrupted treatment. Those who experienced adverse events were 12 times more likely to interrupt IPT. TB IC showed gaps in personal control measures and supporting structures and policies. Conclusion: The implementation of the Three I's for collaborative TB-HIV activities in pilot sites in Nepal was successful and should be scaled up.

Contexte : Les trois hôpitaux d'état de niveau tertiaire offrant des soins aux personnes vivant avec le virus de l'immunodéficience humaine (PVVIH) à Katmandou, Népal.Objectifs : Evaluer 1) les étapes du dépistage pour une recherche intensifiée de cas (ICF) de tuberculose (TB) ; 2) le traitement préventif par isoniazide (TPI), y compris les facteurs démographiques et cliniques associés à l'interruption du traitement ; et 3) la lutte contre l'infection tuberculeuse (IC) dans les structures de santé.Schéma : Etude transversale auprès des nouveaux PVVIH enrôlés entre janvier 2012 et décembre 2014.Résultats : Parmi 572 PVVIH enregistrés, 91% étaient sous traitement antirétroviral. Parmi les inscrits, 561 (98%) ont eu un dépistage de TB et 73 (13%) ont eu un diagnostic de TB (17 [25%] TB à frottis positif, 17 [25%] TB à frottis négatif et 35 [51%] TB extra-pulmonaire). Parmi les 488 (87%) PVVIH sans TB active, 157 (32%) ont été mis sous TPI, 136 (87%) d'entre eux l'ont achevé et 17 (11%) ont interrompu le traitement. Ceux qui ont eu des effets secondaires ont été 12 fois plus susceptibles d'interrompre le TPI. Les mesures de lutte contre l'infection TB connaissent des lacunes en termes de mesures de protection individuelle et des structures et des politiques de soutien.Conclusion : La mise en œuvre des Trois I pour des activités collaborative TB-VIH dans des sites pilotes au Népal s'est faite avec succès et devrait être étendue.

Marco de referencia: Los tres hospitales públicos de atención terciaria que prestan servicios a las personas aquejadas de infección por el virus de la inmunodeficiencia humana (PVVIH) en Katmandú, Nepal.Objetivos: Evaluar 1) el algoritmo de detección en la búsqueda intensiva de casos de tuberculosis (TB); 2) el tratamiento preventivo con isoniazida (TPI), incluidos los factores demográficos y clínicos que se asocian con su interrupción; y 3) el control de la infección (IC) tuberculosa en los establecimientos de salud.Método: Fue este un estudio transversal de los PVVIH recién inscritos en el programa de enero del 2012 a diciembre del 2014.Resultados: De 572 PVVIH inscritos, el 91% recibía tratamiento antirretrovírico. De los pacientes registrados, en 561 se practicó la detección sistemática de la TB (98%) y se diagnosticaron 73 casos de enfermedad activa (13%) (17 obtuvieron un resultado positivo de la baciloscopia del esputo [25%], 17 un resultado negativo [25%] y ocurrieron 35 casos de TB extrapulmonar [51%]). De los 488 PVVIH sin TB activa (87%), 157 iniciaron el TPI (32%), 136 de ellos lo completaron (87%) y 17 lo interrumpieron (11%). La probabilidad de interrumpir el TPI fue 12 veces mayor en los pacientes que presentaron reacciones adversas. Al evaluar las medidas de control de las infecciones se observaron deficiencias en las medidas personales, las estructuras auxiliares y en las normas.Conclusión: La ejecución de actividades conjuntas, los Tres I's, de atención de la TB-VIH en tres centros piloto en Nepal fue eficaz y sería muy útil ampliar su escala de aplicación.

Utility of gamma-glutamyl transpeptidase and mean corpuscular volume in alcoholic liver disease.

The present study was designed to establish the role of Gamma-glutamyl transpeptidase (gamma-GT) and mean corpuscular volume (MCV) in alcoholic liver disease (ALD). Serum gamma-GT, total and direct bilirubin, albumin, total protein, AST, ALT and ALP were assayed by standard methods in a clinical chemistry autoanalyser. MCV, Hb, PCV and RBC were measured by an automated cell counter. Activity of gamma-GT and MCV levels were significantly higher in the patients with ALD compared to controls. A gamma-GT level of > or = 25 U/l was found to be significantly associated with ALD. MCV level > or = 100 fl/l showed a significant association with ALD. An AST to ALT ratio > 1 was found in 92% of the patients. None of the patients showed an ALT level > or = 300 IU/l. The degree of AST elevation in the patients with ALD was higher (3.7 times) then ALT (3.2 times). A gamma-GT level > or = 25 IU/L and an MCV level > or = 100 fl/l stand as markers of heavy alcohol consumption in this study. An AST to ALT ratio > 1 was present in most of the patients with ALD. The degree of elevation of AST was higher than ALT in the patients with ALD.

Length of Stay of Orthopaedic Inpatients at a Teaching Hospital in Eastern Part of Nepal.

INTRODUCTION: This study aimed to analyze the average length of stay of all inpatients in the department of Orthopaedics and to compare the variations in hospital stay between age, gender, traumatic and non-traumatic co-morbidities and modality of payment. METHODS: This hospital based retrospective descriptive epidemiological study was based on patients discharged from a tertiary level health care center of eastern Nepal. Registry data of 1 year was used to calculate length of stay and analyze the variations. RESULTS: Average length of stay was 10.5 days. It was 10.7 days for males and 10.1 days for females. It was 10.12 days for patients paying themselves for their treatment whereas 14.98 days for patients receiving reimbursement (third party payment). CONCLUSIONS: Average length of stay was more in elderly and patients of trauma (longest in pelvis injury). It was 1.5 times longer for patients receiving reimbursement for treatment.

Leptospirosis: An insight into community structure of small mammal’s host in urban environment

@#Leptospirosis is a zoonotic disease caused by bacteria of the genus Leptospira and most often acquired through contact with environments contaminated with leptospires shed in the urine of infected mammals. In urban environment, rodents are well-known as the main carriers of this bacteria, however there were no intensive study on the population structure of these animals, and how it associated with this disease. Hence, we use a case study from an outbreak in a residential area in Selangor, Malaysia, to investigate how community structure of small mammals, associated with the prevalence of Leptospira. One hundred cage traps were placed randomly in and around these houses in five phases with two months interval for a year. Community structures (species, sex, and age) were assigned for each individual, prior to screening for pathogenic Leptospira, using a partial lipL32 gene from the kidney samples. 185 small mammals from four species were captured, Rattus norvegicus (74.5%, N=138), R. rattus (20%, N=37), Tupaia glis (5%, N=9), and Suncus murinus (0.5%, N=1). From this number, 29 individuals were found PCR positive for pathogenic Leptospira (R. norvegicus, N=20; R. rattus, N=6; T. glis, N=2; S. murinus, N=1). The study shows that Leptospira occurrence in the small mammals were significantly correlated to age category and sampling phases, with Spearman Correlation (rs) p=0.02 and p=0.04 respectively. Adult individuals were significantly more prevalent with Leptospira infection, whereby March and June were found to associate with higher Leptospira prevalent among the small mammals, potentially coincide with low rainfall and relative humidity level. This information is important in designing a specific control method for rodents in Leptospira outbreak areas. In addition, intensive sampling and regular cleaning effort were found to significantly reduce the small mammal Leptospira reservoir, thus should be implemented in intervention strategies in the urban environment.

A comparison of flow cytometry, bone marrow biopsy, and bone marrow aspirates in the detection of lymphoid infiltration in B cell disorders.

AIMS: To evaluate the diagnostic value of bone marrow aspirates, trephine biopsies (BMB), and flow cytometry (FC) in the assessment of bone marrow infiltration in chronic lymphoid disorders. METHODS: Investigations were carried out in 110 diagnostic and follow up specimens from B cell disorders, namely: chronic lymphocytic leukaemia (CLL; 65), non-Hodgkin's lymphoma (NHL; 39), and hairy cell leukaemia (HCL; 6). A selected panel of monoclonal antibodies was used both for FC and immunohistochemistry. RESULTS: In CLL there was agreement between the three investigations in 71% of samples and in 88% when only FC and BMB were compared. In nine of 65 samples, FC and BMB were positive, although the aspirate was reported as negative. Four BMB negative samples had minimal residual disease (MRD) detected by FC, whereas two samples were positive both on BMB and aspirate but showed no evidence of disease on FC. In NHL, there was agreement between the three investigations in 22 of 39 cases, and in 27 of 39 cases there was agreement between FC and BMB. In eight of 39 NHL cases, FC was negative but the BMB was either positive (five) or uncertain (three), whereas in three of 39, FC was positive but BMB was either negative (one) or uncertain (two). In three of five uncertain BMB, no clonal population was detected by the polymerase chain reaction, whereas in the remaining two cases the nodular aggregates disappeared on further sectioning. CONCLUSIONS: Both BMB and FC are better than bone marrow aspirates for the detection of infiltration in B cell disorders. FC might be slightly more sensitive than BMB to detect MRD in CLL, whereas BMB may be slightly better than FC in NHL.

Reticulate acropigmentation of Kitamura: first case reports from Nepal.

Two young Nepalese females, aged 34 and 17 years, presented with multiple small brown macules in a reticulate pattern on the distal extensor aspects of their limbs. The first patient's daughter also had similar lesions. The second patient had similar lesions on her eyelids and palmar pits as well. The clinical diagnosis of reticulate acropigmentation of Kitamura (RAK) was made in both the patients and was confirmed histopathologically. These are the first case reports of this condition from Nepal.

Lichen planus after HBV vaccination in a child: a case report from Nepal.

Vaccination against hepatitis B virus has rarely been associated with lichen planus. We report a case of this kind in a child from Nepal. A 12-year-old boy had developed generalized itchy violaceous papules and plaques six weeks after the second dose of hepatitis B virus vaccine. Serum HBsAg and HBeAb were negative, but HBsAb was positive. New crops of generalized, similar eruptions developed after the booster dose of vaccine. All the lesions resolved within three months of systemic steroid therapy. There was no recurrence after one year of follow up. Awareness of such an association is necessary, especially in children, because vaccination campaigns are increasing.

Clinico-haematological and management profile of aplastic anaemia--a first series of 18 cases from Nepal.

AIM OF STUDY: To study the prevalence, clinico-haematological and management profile of aplastic anaemia (AA) among severely anaemic patients treated at BP Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal. METHOD: A retrospective analysis of 18 cases of biopsy proven AA patients was done between September 1995 and August 1997. RESULTS: Over a period of 2 years, 140 patients with severe anaemia were admitted to our institution. Eighteen patients were diagnosed with AA. The ages of the AA patients ranged from 7 to 56 (median 15) years, with a male: female ratio of 1.23:1. Pallor, bleeding diathesis, weakness and fever were the most common presenting complaints. Blood counts showed pancytopenia in 16 cases. Bone biopsies of all the cases were hypoplastic. Sixteen cases were non-severe AA and the remaining 2 were severe. Of the 18 cases, 16 were idiopathic; 1 case each was associated with chloramphenicol toxicity and hepatitis B infection respectively. Most of the patients were treated with corticosteroids or androgens or a combination of both. Only six patients came for regular follow-up. CONCLUSION: The high (12.85%) prevalence of AA among patients admitted with severe anaemia in this hospital (which acts as a catchment area for the Eastern region) may not reflect the actual prevalence of the disease in the local community. However, a prospective study may delineate the causative factors peculiar to this region. The clinico-haematological profile is typical of the disease. However, the management profile is incomplete without a proper follow-up. This limitation may be overcome by providing free or subsidized treatment.

Hydatid cyst presenting as a breast lump.

We report a 33-year-old woman who presented with a breast lump which, on pathological examination, was found to be a hydatid cyst. There was no evidence of any coexistent lesion elsewhere. To our knowledge, this represents the first case of hydatid disease of the breast reported from Nepal.

Lymphatic leishmaniasis--first case report from Nepal.

We report a case of exclusive involvement of lymph node in leishmaniasis presenting as generalized lymphadenopathy. The diagnosis of lymphatic leishmaniasis was confirmed by the presence of Leishmania donovani body in fine needle aspiration cytology, positive direct agglutination test and anti-rK39 antibodies. The bone marrow aspiration was negative for Leishmania donovani body. This is the first case of lymphatic leishmaniasis reported from Nepal.

Congenital infantile fibrosarcoma of the upper extremity.

Congenital-infantile fibrosarcoma is an unusual childhood tumor that occurs mainly in children under 5 years of age. More than 300 cases have been reported in the literature so far, very few of them at birth. A distinction must be made between it and its adult counterpart because of differences in their clinical behaviour. We report here a case of congenital fibrosarcoma in a 4-day-old female infant.

Lymphangiectatic fibrolipomatous polyp of the palatine tonsil.

A rare benign polypoid tumor of the right palatine tonsil is described in a 23 year old male. It contained dilated lymphatic channels surrounded by fibrous tissue and foci of mature fat. The features of this lesion add support to the hypothesis that benign tumors of tonsil may be hamartomas of tonsil rather than true neoplasms. The differential diagnosis of polypoid lesions of the tonsil is discussed.