Agminated Halo Nevus: A Novel Presentation.

ABSTRACT: Halo nevus is a benign type of melanocytic nevi commonly found in children and manifests as a central pigmented part surrounded by a well-defined hypopigmented area. Halo nevi are commonly located on the trunk. The central nevus may show partial or complete regression, whereas the associated halo may persist or enlarge. The term 'agminated nevus' refers to a cluster of melanocytic nevi restricted to an area of the body and commonly reported with acquired melanocytic nevi, blue nevi, and Spitz nevi. To the best of our knowledge, agminated halo nevus has not been previously described. We hereby report 2 cases with clinical and histopathologic findings consistent with the diagnosis of agminated halo nevus.

Multifocal Cutaneous Granular Cell Tumor in Children: A Rare Entity.

ABSTRACT: Granular cell tumors (GCTs) are rare soft tissue tumors of Schwann cell origin that manifest as papulonodular lesions and occur mainly in adults. The diagnosis is usually confirmed by histopathology. Most of GCTs are benign, but some lesions may exhibit malignant criteria. This study is a retrospective case series including all children with histopathologically documented multiple GCTs who attended the dermatology department of the university hospitals between February 2008 and March 2021. The objective of our study was to raise awareness to this unrecognized and rare entity in such age group. The study included 9 patients (6 girls and 3 boys) with multiple GCTs. Their age ranged between 5 and 13 years. The lesions were skin-colored to light brown, firm, smooth-surfaced nodules. Most of the lesions were on the extremities, and their mean diameter was 160.5 mm2. None of the lesions exhibited any malignant criteria on histopathology. No extracutaneous or mucosal lesions were detected. Dermatologists should be aware of this rare condition in children because early recognition allows more conservative resection of the tumor and less invasive reconstruction of the defect. Our study highlights that multifocality does not necessarily indicate malignancy or other systemic comorbidities.

Giant spotted grouped pigmented nevus: A case report.

Spotted grouped pigmented nevus is a distinct form of non-giant congenital melanocytic nevi. Histopathologically, it tends to proliferate around the skin appendages. We report a case of a 10-year-old boy with clinical and pathological findings consistent with the diagnosis of spotted grouped pigmented nevus of more than 20 cm diameter, which is considered giant.

Hypopigmented mycosis fungoides in Egyptian patients.

Hypopigmented mycosis fungoides (HMF) is uncommon clinical variant that was commonly observed in dark-skinned individuals. We described the clinical characteristics, pathological features, immunohistochemical profile and prognosis of HMF in Egyptian patients. During the period from January 2004 to December 2011, we were able to diagnose and follow up 27 patients with HMF. The study included 18 males (66.7%) and 9 females (33.3%) with a mean age of 35.39 ±13.13 years. The duration ranged from 1 to 6 years with a mean of 3.26 ±1.7 years. The majority of patients were skin type IV (63%) and presented with multiple (88.9%), asymptomatic (74.1%), ill-defined (70.4%) and non-scaly (77.8%) lesions distributed on the trunk (81.5%). Histologically, epidermotropic lymphocytes were observed in 100%, basal alignment of lymphocytes in 81.5%, Pautrier's microabscesses in 29% and folliculotropism in 18.5%. Immunostaining showed predominance of epidermal CD8+ cells in 51.9% while in 29.6% CD4+ cells were predominant. Phototherapy was effective in 86.7% of patients with success rate 66.7% of narrow band (NB) ultraviolet-B and 80% of psoralen ultraviolet-A. HMF among Egyptians could be classified as non-aggressive epidermotropic cytotoxic CD8+ variant. It is common among middle age males with skin type IV and mostly well respond to phototherapy.

Syringomatous dermatitis: a myth or an existing entity?

Syringoma is rare disease that in classical variant occurs mainly on lower eyelids. In previously published researches, there is increasing evidence that eruptive syringomas must be discussed as an inflammatory dermal reaction pattern. And there was a proposal to change a name from eruptive syringoma to reactive syringomatous proliferation in appropriate cases. We conduct retrospective study on histopathological archived material to study the histopathological findings in cases of eruptive syringomas and correlate it with hypothesis that eruptive syringomas is not true adnexal neoplasms "de novo" but a hyperplastic response of the acrosyringium to an inflammatory process.According to obtained data and literature correlation, we can conclude that there is apparent diversity in eruptive syringomas. Part of cases can be calculated as neoplastic lesions arising "de novo," and another part as reactive syringomatous proliferation due to preceding cutaneous inflammatory process. Thus, term "eruptive syringoma" may be changed in appropriate cases to a "reactive syringomatous proliferation."Clinical variants of eruptive syringoma with evidence of underlying inflammatory process may be more responsive on types of treatments used for inflammatory disorders. Thus, more global clinicopathological correlative researches should be conducted and classification with terminology should be appropriately changed.

Epidemiological and clinicopathological analysis of basal cell carcinoma in Egyptian population: a 5-year retrospective multicenter study.

PURPOSE: Basal cell carcinoma (BCC) is the most diagnosed type of cancer accounting for 80% of all keratinocyte malignancies. However, the exact demographic properties and clinicopathological criteria for BCC in Egyptians are not clearly reported. Our aim is to report and analyze the epidemiological and clinicopathological features of BCC in Egyptians. METHODS: We retrospectively reviewed the medical records for patients diagnosed pathologically with BCC during the period from January 2017 to December 2021. Data were recruited from four dermatology centers with different geographical distributions. RESULTS: We registered 544 patients. Their age ranged between 22-91 years with a mean of 61.6 ± 13.2 years. Females showed younger age of onset. The mean duration of the tumor was 3.9 ± 3.8 years. The most common involved region was the head (79.4%), and about one third of patients (32.2%) had a giant lesion (> 5 cm). The most common clinical presentation was ulcerative lesions (44.9%). Pathologically, the nodular type represented the most common variant (50.4%). CONCLUSION: Our results proposed that the annual incidence of BCC is increasing among Egyptians. Ultraviolet radiation is considered a high-risk factor of BCC leading to a higher affection of the head region and more prevalence in men. This study also highlights some criteria of BCC in Egyptians such as the long duration of the tumor, the early onset in females, the higher percentage of giant types, and the predominance of nodular type. To our knowledge, this is the first report describing the characteristic features of BCC among Egyptians.

Evaluation of serum squamous cell carcinoma antigen as a novel biomarker for diagnosis of hepatocellular carcinoma in Egyptian patients.

BACKGROUND: Hepatocellular carcinoma (HCC) is the fifth most common malignancy in the world. In Egypt, HCC was reported to account for about 4.7% of chronic liver disease (CLD) patients. Squamous cell carcinoma antigen (SCCA) has been reported to be strongly expressed in HCC tissue hampering its extensive use in clinical practice. AIM: To evaluate the clinical usefulness of serum SCCA levels as a serological marker for early detection of HCC among high-risk patients compared to AFP. MATERIALS AND METHODS: The study comprised of three groups. Group A included 30 patients with CLD diagnosed based on clinical, laboratory, and ultrasonographical investigations; group B included 49 patients with HCC diagnostically confirmed by spiral CT, elevated alfafetoprotein (AFP), and/or liver biopsy; and group C, the control group, included 15 healthy subjects matched for age and sex. All groups were subjected to thorough history taking, full clinical examination, and laboratory investigations including liver functions, viral markers, and AFP and SCCA estimation using ELISA technique. RESULTS: This study revealed a highly significant difference between patients with HCC, CLD, and controls regarding serum SCCA levels (5.138 +/- 7.689, 1.133 +/- 0.516, and 0.787 +/- 0.432 ng/ml, respectively). SCCA level was persistently elevated in patients with HCC with normal AFP levels representing its useful role in early detection and follow-up of patients treated for HCC. The area under the curve (AUC) of SCCA was 0.869 (95% CI 0.783-0.929), the cut-off value was established at 1.5 ng/ml with sensitivity of 77.6% and specificity of 84.4%). The difference between AUC of SCCA and that of AFP was 0.09 which mounted statistical significance. CONCLUSIONS: SCCA could represent a useful tool as a marker for detection of HCC.

The contribution of nano-zinc to alleviate salinity stress on cotton plants.

To investigate the effect of nano-zinc fertilizer on growth, yield and mineral status of cotton plants grown under salt stress, a pot experiment was set up in the greenhouse of the National Research Centre. The treatments were as follows: (I) diluted seawater: 10% (S1), 20% (S2) and tap water as a control (S0), (II) 100 ppm (NZn1), 200 ppm (NZn2) nano-zinc and distilled water as a control (NZn0). Irrigation with 10 and 20% seawater decreased dry weight (DW) of leaves by 11.53 and 43.22%, while decreases in bolls were 15.50 and 71.65%, respectively. Except for root DW and top/root ratio, the measured growth parameters were increased as nano-zinc concentration increased. As for the interaction between treatments, the highest DW of stem, leaves and bolls resulted from the addition of NZn2 under normal condition, followed by NZn2 x S1 and the next was NZn2 x S2. The foliar application of 200 ppm nano-Zn led to mitigating the adverse effect of salinity and confirmed that diluted seawater could be used in the irrigation of cotton plant. However, phosphorus fertilizer should be added with nano-Zn application to avoid P/Zn imbalance. Some elements' status and their ratios were recorded.

Provision of care for chronic kidney disease by non-nephrologists in a developing nation: a national survey.

OBJECTIVES: The prevalence of chronic kidney disease (CKD) in developing countries has increased dramatically. This study aimed to explore the practice patterns of non-dialysis-dependent CKD care in an affluent developing country. SETTINGS: Primary and specialised healthcare facilities of public and private sectors in the United Arab Emirates. PARTICIPANTS: 159 non-nephrologist physicians practising in the United Arab Emirates. INTERVENTIONS: A 28-item online self-administered questionnaire based on CKD clinical practice guidelines. PRIMARY AND SECONDARY OUTCOME MEASURES: The physicians' approach to identifying and managing patients with CKD. RESULTS: The survey was completed by 159 non-nephrologists, of whom 135 reported having treated patients with CKD. Almost all the respondents screen patients with hypertension and diabetes for CKD, but one-third of them do not screen patients with cardiovascular disease and elderly patients for CKD. The use of accurate CKD screening tests (estimated glomerular filtration rate and albumin/creatinine ratio) was suboptimal (77% and 59% of physicians used the procedures, respectively). One-third of the physicians do not offer treatment with inhibitors of the renin-angiotensin system to patients with CKD, and only 66% offer antilipid treatment. In general, the primary healthcare physicians are more familiar than secondary healthcare physicians with the diagnosis and management of patients with CKD. CONCLUSIONS: We identified substantial physician-declared deficiencies in the practice of identifying and managing early CKD. Integration of quality CKD care within the healthcare system is required to face the increasing burden of CKD in the United Arab Emirates and possibly in other developing nations.

Non-typhoid Salmonella septicemia and visceral leishmaniasis in a renal transplant patient.

BACKGROUND: We report on a renal transplant patient with recurrent attacks of fever, in which Salmonella septicemia as well as visceral leishmaniasis were diagnosed. PATIENT: The patient was a 62-year-old man with diabetic nephropathy and a living related kidney transplantation. RESULTS: Nearly 2 years after the transplantation, the patient developed recurrent attacks of fever, which were initially diagnosed as non-typhoid salmonellosis and improved after treatment. Three months later, he had relapses of fever. As the patient developed pancytopenia, a bone marrow aspiration was done, showing Leishmania parasites. The patient responded well to treatment with sodium stibogluconate. CONCLUSIONS: A high index of suspicion, together with better diagnostic assays to detect visceral leishmaniasis, is warranted in the diagnostic work-up of any fever of unknown origin in immunocompromised patients, especially in endemic areas.

Status of imported malaria in a control zone of the United Arab Emirates bordering an area of unstable malaria.

A concerted malaria eradication programme in the United Arab Emirates has reduced local transmission to only a very few small foci in the country. The Al Ain district is now a consolidation zone. However, transmission across the undemarcated border with Oman continues. Malaria imported by the large immigrant work force from major disease endemic areas remains a large burden. An added threat is the appearance of chloroquine-resistant Plasmodium falciparum principally from Sudan and Pakistan but increasingly amongst Omani cases seen in the hospitals and clinics in Al Ain. The implications of re-introduction of malaria and the establishment of chloroquine resistance, particularly for non-immune residents and visitors, are emphasized.

PIP: In Al Ain District located in the Abu Dhabi Emirate of the United Arab Emirates (UAE), clinicians at the Al Ain General Hospital outpatient clinic conduct a medical examination of and take blood samples from all new immigrants applying for resident or work permits. All persons with malaria receive 600 mg chloroquine phosphate at the clinic (day 0) and a prescription for another 600 mg for day 1 and 300 mg on day 2. The malaria cases are to return to the clinic on day 3. Entomologists record mosquito larval counts at all field sides and conduct susceptibility tests in the laboratory. The malaria control program applies a larvicide on breeding sites and uses pyrethroids to eliminate adult flying insects. In 1981, local transmission of malaria ceased. During 1988-1991, 4.7-9.1% of the population was slide-positive for malaria. This incidence rate is high enough to introduce imported malaria into the local anopheline mosquito population, should malaria control activities be reduced. Pakistanis, UAE nationals, and Omanis comprise most malaria cases (36.3-56.6%, 12.8-21.9%, and 15.7-25.3%, respectively). The immigrants tend to visit their home countries, where they acquire malaria. All UAE nationals acquire it while on holiday in or traveling to endemic areas, especially Oman. In 1991, out of 1150 cases, the leading sources of malaria were clearly Pakistan (576) and Oman (526). Most slide-positive children are either Omanis or part of UAE families with relatives across the border in Oman. Plasmodium falciparum, mostly from Pakistan and Oman, is responsible for 69.5% of malaria cases. The Indian subcontinent is the source of most P. vivax cases. Beginning in 1987, the number of chloroquine-resistant P. falciparum cases increased from 9 to 302. The leading sources of resistant cases originate from Oman (160), Pakistan (100), and Sudan (26). All chloroquine-resistant cases except one responded to Fansidar. Factors that may disturb effective malaria control efforts in this new agriculture area are rapid development of water resources and the undemarcated border with Oman.

Cyclosporine in the treatment of lupus nephritis including two patients treated during pregnancy.

Although the combination of corticosteroids and intermittent pulse doses of cyclophosphamide has considerably improved the prognosis of lupus nephritis, there are still some unanswered questions about this regimen, in particular its use in pregnancy. As cyclosporine appeared to be effective in experimental models of lupus nephritis, some studies have been performed using this drug in patients with lupus nephritis. However, there was no mention of pregnancy in these patients. In view of the large experience with cyclosporine during pregnancy in renal transplant recipients and its established safety concerning teratogenicity, we decided to treat 5 young female patients having lupus nephritis with cyclosporine in combination with low-dose prednisone. Two of these patients were pregnant and both had successful delivery. During the follow-up period of 7-35 months there were no signs of flare-up of the lupus nephritis, except in one case where the patient accidentally discontinued the medication. In a second patient there was a slight increase of the serum creatinine level. Otherwise, the renal and immunological parameters improved or remained stable during the observation period. Hypertension developed in 3 cases. These preliminary results support the further evaluation of cyclosporine as an alternative to cyclophosphamide in the treatment of lupus nephritis, especially in young female patients with pregnancy or at high risk for pregnancy.

Preliminary arteriovenous fistula for free-flap reconstruction in the diabetic foot.

We present our experience at the American University of Beirut Medical Center with two diabetic patients suffering from large necrotic and infected foot ulcers. Both patients were ambulatory at the time of presentation despite their extensive wounds and were believed to have a useful limb with adequate protective sensation worth saving. Below-knee amputation was prevented in both cases by successful soft-tissue coverage of the ulcers using microvascular composite-tissue transfer a few days after performing a preliminary arteriovenous fistula with a long vein graft loop. The flap vessels were anastomosed end-to-end to the arterial and venous limbs of the divided arteriovenous loop. This reconstructive technique of difficult diabetic wounds of the lower extremity, though in two stages, may be safer than one long procedure in a high-risk patient. It is technically easier than long interpositional vein grafts at the same time as free-flap transfer or microvascular anastomoses with small and diseased vessels. It definitely provides more chance of success as larger vessels are used to supply the flap. It permits distension of the vein graft at normotensive physiologic pressures and allows testing the arterial anastomosis as well as the venous flow before final flap transfer. Above all, it allows extreme freedom in performing tension-free anastomoses away from the infected wound.

Saprolegniosis in salmonids and their eggs in Japan.

An epizootic of the fungal infection saprolegniosis that occurred in freshwater-cultured salmons and their eggs at some hatcheries in Hokkaido (Japan) was investigated. In almost all cases, the initial clinical sign was characterized by the growth of cotton-like mycelia on the fishs' body surface, especially the head, adipose fin, and caudal fin, but the mycelia were not visible to the naked eye in the internal organs. Thirty-three strains isolated from lesions were classified in the genus Saprolegnia according to their morphological and biological characteristics on hemp seed cultures at various temperatures. Fifteen of the strains were identified as Saprolegnia parasitica, 16 were identified as S. salmonis, and two were identified as S. australis.

Synthesis, anticonvulsant and antimicrobial activities of certain new furochromones.

Some new substituted thiazolidinones, thioimidazolidinones and thiazolines have been synthesized from N1-substituted N2-(4-hydroxy-7-methyl-5H-furo[3,2-g] [1]benzopyran-5-on-9-yl)thioureas and monochloroacetic acid or alpha-halocarbonyl compounds. Some representative examples were tested for their anticonvulsant and antimicrobial activities.

Effect of previous chloroquine intake on in vivo P. falciparum drug sensitivity.

Investigation of the in vivo response of P. falciparum malaria parasites to chloroquine was conducted during 1993/94 in Al-Ain District of Abu Dhabi Emirate, UAE. Sixty seven expatriates who developed falciparum malaria on their return from Pakistan, Oman and Sudan were recruited for the WHO in vivo tests. Of the 67 patients, eight were classified as having RII and RIII responses, while 59 remained aparasitaemic at the end of the seven-day WHO standard test. On continuation into the 28-day WHO extended test, a further 34 patients exhibited RI resistance. Resistance of parasites to chloroquine was confirmed by measurement of plasma chloroquine using High-Performance Liquid Chromatography. In all 67 patients, the level of chloroquine was well above the minimum therapeutic level. The outcome of the in vivo test in patients treated for the first time was significantly different from that in patients who were previously on chloroquine. Among patients treated for the first time, 36 out of 41 (88%) had a resistant response, whereas, among those previously on chloroquine only six out of 26 (23%) had a resistant response. The difference is probably due to the higher initial plasma level of chloroquine among patients who were previously on the drug. Curing more patients with higher plasma chloroquine implies that chloroquine shall continue to be useful, particularly if resistance is at the RI level. Appropriate higher therapeutic levels of chloroquine should be defined for such patients.

Early microvascular reconstruction of Gustilo type III-C lower extremity wound. Case report.

Current algorithms for lower limb injuries recommend amputation for most Gustilo type III-C injuries with a limb salvage index score of 6-8 or more. Recent improvements in the timing and technique of microvascular flaps with the reduction in bone healing time as a result of better fixation devices and early bone grafting make the option of limb salvage after such severe injuries a valid and acceptable therapeutic approach. We present a case of severe shot gun injury to the leg with a limb salvage index score of 9 that was successfully salvaged by vascular reconstruction followed three days later with a microvascular osteocutaneous scapular flap anastomosed to the divided limbs of a preliminary arteriovenous fistula that had been constructed at the time of the initial vascular repair. The patient was able to walk unaided one year after the injury.