Darier-Roussy Subcutaneous Sarcoidosis Masquerading as Multiple Abscesses: A Report of a Rare Case.

Sarcoidosis is an idiopathic multisystemic granulomatous disease that mainly affects the lungs. Darier-Roussy subcutaneous sarcoidosis is among the specific and least encountered skin manifestations of sarcoidosis. In this case study, we report how subcutaneous sarcoidosis could mimic multiple abscesses presentation and hinder reaching a definitive diagnosis. A 65-year-old female presented with five, multiple, deep-seated skin lesions on the forearm, chest, and scalp. The lesions showed redness and tenderness. The patient also experienced arthralgia in the right ankle. Laboratory workup of the patient showed a high erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and white blood cell (WBC) count. The patient was suspected to have multiple abscesses, which were managed with antibiotics with no response. Thus, a computed tomography (CT) scan of the chest was done and showed mediastinal lymphadenopathy. A biopsy was taken from one of the right forearm skin lesions, and it revealed characteristic features consistent with sarcoidosis. The patient was managed with hydroxychloroquine and a tapering dose of prednisone. Therefore, subcutaneous sarcoidosis should be included in the differential diagnosis of subcutaneous lumps.

Smart city energy efficient data privacy preservation protocol based on biometrics and fuzzy commitment scheme.

Advancements in cloud computing, flying ad-hoc networks, wireless sensor networks, artificial intelligence, big data, 5th generation mobile network and internet of things have led to the development of smart cities. Owing to their massive interconnectedness, high volumes of data are collected and exchanged over the public internet. Therefore, the exchanged messages are susceptible to numerous security and privacy threats across these open public channels. Although many security techniques have been designed to address this issue, most of them are still vulnerable to attacks while some deploy computationally extensive cryptographic operations such as bilinear pairings and blockchain. In this paper, we leverage on biometrics, error correction codes and fuzzy commitment schemes to develop a secure and energy efficient authentication scheme for the smart cities. This is informed by the fact that biometric data is cumbersome to reproduce and hence attacks such as side-channeling are thwarted. We formally analyze the security of our protocol using the Burrows-Abadi-Needham logic logic, which shows that our scheme achieves strong mutual authentication among the communicating entities. The semantic analysis of our protocol shows that it mitigates attacks such as de-synchronization, eavesdropping, session hijacking, forgery and side-channeling. In addition, its formal security analysis demonstrates that it is secure under the Canetti and Krawczyk attack model. In terms of performance, our scheme is shown to reduce the computation overheads by 20.7% and hence is the most efficient among the state-of-the-art protocols.

Refining the metabolisable energy value of field beans for turkeys.

1. This study examined the feeding value of ten UK grown field bean (Vicia faba L. var. minor) cultivar samples from the same harvest year on nitrogen corrected apparent metabolisable energy (AMEn) and nutrient retention coefficients when fed to young female turkeys.2. A balancer feed (BF) was formulated to contain 12.39 MJ/kg ME and 269 g/kg crude protein. Ten nutritionally complete, mash diets were prepared by mixing 200 g/kg of each ground field bean cultivar with 800 g/kg of the BF, totalling eleven diets. Diets were fed to female BUT Premium turkeys from 40 to 50 d of age. Each diet was fed to eight raised floor pens, housing two birds, following randomisation. The AMEn was determined by the total collection technique over the last 4 d of the study. Relationships were examined between AMEn, chemical composition and quality variables of the field bean samples.3. The overall determined AMEn value of the beans ranged from 7.72 MJ/kg DM to 9.87 MJ/kg DM, giving an average AMEn of 8.80 MJ/kg DM (P < 0.05). The soluble non-starch polysaccharide (NSP) content of the beans negatively correlated with their determined AMEn (r = -0.730; P < 0.05). Bean flour lightness-darkness degree (L*) correlated positively with the AMEn (r = -0.643; P < 0.05)4. A positive correlation was observed between the degree of yellowness-blueness of bean flour and condensed tannins content (r = 0.696; P < 0.05). Step-wise regression indicated that soluble NSP + L* of field beans provided explanatory variables suitable for estimating the AMEn value for turkeys (r2 = 0.737; P < 0.05).

The prevalence and impact of anemia in hospitalized older adults: A single center experience from Bahrain.

Objectives: This study reports the prevalence of anemia and investigates its associated correlates and outcomes among elderly hospitalized patients in a single hospital in Bahrain. Methods: A retrospective study was conducted on 227 consecutive elderly patients admitted under general internal medicine in the biggest tertiary hospital in Bahrain. Medical records were reviewed for all patients, including clinical characteristics, laboratory results, and outcomes. Results: Anemia was highly prevalent among hospitalized elderly patients (71.6%). Males were significantly more affected than females (p = 0.031). In terms of severity, the most common type was moderate anemia (56.1%); with regards to etiology, the most common type was anemia associated with chronic disease (48.1%). Anemia was as common as other comorbidities, including hypertension (71.4%) and diabetes mellitus (53.7%). When comparing anemic to non-anemic patients, the length of hospital stay was significantly longer (p < 0.001) and inversely correlated to the level of hemoglobin; furthermore, 1-year mortality was significantly higher (p < 0.001). When compared to those with mild anemia, patients with moderate/severe anemia were more likely to die (odds ratio [OR] = 2.2, 95% confidence interval [CI]: 1.27-4.92). Conclusion: The prevalence of anemia in our study was higher than previously reported. Even so, anemia receives minimal attention and is usually seen as a minor problem. Our results reiterate the need to recognize the high importance of anemia especially when diagnosing and treating older patients. This, in turn, could positively affect a number of outcomes such as mortality, length of stay, and the functional decline of admitted individuals.

Adult-Onset Acute Disseminated Encephalomyelitis Refractory to Steroids.

Acute disseminated encephalomyelitis (ADEM) is an immune-mediated phenomenon characterized by demyelination of the central nervous system that displays numerous manifestations. It predominantly presents in children with a mean age range of five to eight years. ADEM remains a diagnosis of exclusion based on clinical and radiographic progression. Thus, it poses a diagnostic challenge. ADEM has been shown to be very responsive to steroids and exchange therapy. Here, we present an unusual case of ADEM in a 50-year-old female patient who, despite receiving an entire course of IV methylprednisolone and other conventional treatment methods, did not respond to the treatment.

Variability of amino acid digestibility in different field bean cultivars for broilers.

1. The amino acid composition of 10 different UK-grown field bean cultivar samples from the same harvest year were determined.2. Diets included each bean sample at a level of 200 g/kg feed compared against a control diet formulated with only soyabean sources, whereby the beans replaced the soyabean meal, and were used to compare ileal amino acid digestibility. The amino acid digestibility coefficients for the bean samples were obtained via substitution method.3. The data showed that one field bean sample, cultivar Sultan, had a lower amino acid digestibility (P < 0.05) than that of the other nine . This sample had a higher tannin content that may have affected amino acid digestibility.

Variation in the chemical composition and the nutritive quality of different field bean UK-grown cultivar samples for broiler chicks.

1. The chemical composition and physical characteristics of 10 different UK-grown field bean cultivar samples from the same harvest year were determined.2. Diets included each bean sample at a level of 200 g/kg, and were used to compare broiler growth performance and determine N-corrected apparent metabolisable energy (AMEn) and nutrient utilisation. The AMEn and nutrient retention coefficients for the bean samples were obtained via the slope-ratio method. The relationships were examined between variation in nutritive value for broilers and the laboratory analysis of the bean samples.3. The data showed significant differences (P < 0.05) among the bean cultivar samples for feed conversion ratio, AMEn and dry matter retention (DMR) coefficients. Further analysis showed that the feeding quality of different field bean cultivar samples, measured as AMEn, was highly correlated to crude protein (CP) (P < 0.05) and colour (P < 0.001) of the samples. Thus, beans with higher CP and pale colour had superior feeding value for broilers.

Exogenous tannase improves feeding value of a diet containing field beans (Vicia faba) when fed to broilers.

A total of 72 male Ross 308 broilers were used in a study to investigate the effect of dietary tannase on apparent metabolisable energy (AME), coefficients of dry matter retention (DMR) and nitrogen retention (NR) and fat digestibility (FD) of a diet containing 300 g/kg field beans (Vicia faba). Growth performance variables and gastrointestinal tract development were also measured. Two treatments were used in this study: control (C) and C + 3400 tannase units (TU) per kg feed. Diets were formulated to be nutritionally adequate with the exception that the AME was lower than recommended (12.65 vs 12.97 MJ/kg, respectively). Inclusion of tannase increased AME by 0.4 MJ/kg DM. Tannase supplementation improved dietary DMR, NR and FD by 2.8%, 3.2% and 6.5%, respectively. Birds given tannase had 4.4% reduction in feed intake and 2.6% improvement in gain to feed ratio (P < 0.05). Compared to control diet, birds given tannase had reduced relative to body weight (%BW) proventriculus and gizzard and pancreas weights, 3.29% vs 3.09% and 0.47% vs 0.44%, respectively. The mechanisms of action of the studied enzyme require further elucidation.

Brain MRI features of merosin-negative congenital muscular dystrophy.

The purpose of this article is to report brain MRI findings of merosin-negative congenital muscular dystrophy (CMD) in two cases and to discuss its differentiation from other CMD subtypes. The cases were investigated by 1.5 Tesla MRI equipment using T1-weighted, T2-weighted, fluid-attenuated inversion recovery (FLAIR), 3D fast spoiled gradient recalled (SPGR) and post-contrast gadolinium enhanced sequences and the diagnosis was confirmed by muscle biopsy with immunohistochemical staining for merosin. Magnetic resonance imaging showed bilateral subcortical U-fibre white matter changes with periventricular sparing in the first case. Though this imaging finding is non-specific and could be seen in other white matter diseases like Canavan disease, the absence of other distinguishing MRI and clinical features of those conditions allowed a proper diagnosis. The second case showed diffuse subcortical and deep white matter involvement and cerebellar cysts. There was no brainstem involvement, polymicrogyria or cobblestone lissencephaly in both of our cases which allowed differentiation of merosin-negative CMD from other CMDs. Muscle biopsy in both these patients showed dystrophic changes with absent staining for merosin confirming the diagnosis. Merosin-negative CMD should be considered in the imaging differential diagnosis of white matter diseases. In a patient presenting with features of CMD, MRI can be of help in further differentiation of the various CMD subtypes.

Comparison of RANTES expression in Crohn's disease and ulcerative colitis: an aid in the differential diagnosis?

BACKGROUND: RANTES (regulated on activation, normal T cell expressed and secreted) expression is increased in inflammatory bowel disease (IBD). RANTES is produced at higher levels in granulomatous conditions, so increased RANTES expression can be expected in Crohn's disease compared with ulcerative colitis. AIM: To compare RANTES expression between intestinal biopsy specimens of patients with Crohn's disease and those with ulcerative colitis. MATERIALS AND METHODS: A prospective study of patients presenting with lower gastrointestinal symptoms at the Bahrain Specialist Hospital from July 2004 to April 2005 was carried out. Endoscopic colonic biopsy specimens were taken from every patient and subjected to (a) routine haematoxylin and eosin staining examination by light microscopy, (b) immunohistochemistry for examination of RANTES protein expression by light microscopy and (c) in situ hybridisation for examination of RANTES mRNA expression by light microscopy. RANTES expression was assessed and quantified. RESULTS: 58 patients were enrolled to the study. Of them, 40 had IBD (21 had Crohn's disease and 19 had ulcerative colitis), 15 were controls with normal colonic biopsy results or non-inflammatory lesions and 3 had colonic inflammatory lesions other than IBD. RANTES expression in lymphocytes or histiocytes was significantly higher (p = 0.04) in new patients with ulcerative colitis than in those with Crohn's disease analysed by immunohistochemistry (IHC). CONCLUSION: RANTES expression in lymphocytes or histiocytes is significantly higher in patients with ulcerative colitis than in those with Crohn's disease. Hence, RANTES IHC can be an effective method for distinguishing between biopsy specimens of patients with ulcerative colitis from those of patients with Crohn's disease, where routine histological features are indeterminate. RANTES IHC may prove to be a useful technique for identifying early or equivocal granulomas.

[Compliance of patients with chronic obstructive lung disease receiving oxygen therapy at home]. / Behandlingskomplians hos patienter med kronisk obstruktiv lungesygdom i behandling med ilt i hjemmet.

Twenty-nine patients with severe chronic obstructive pulmonary disease (COPD) on long-term oxygen therapy (LTOT) were prospectively studied for compliance with therapy. Seven patients (24%) used oxygen < 16 hours/day and their mean 24-hour pulse oximetry showed mild hypoxaemia. In addition, we found that eight patients (28%) were smokers. We suggest that the follow-up of these patients should focus on the daily duration of the use of oxygen and cessation of smoking to optimise the effect of this therapy.

Does the electrocardiographic presence of Q waves influence the survival of patients with acute myocardial infarction?

AIMS: To compare the outcome of short- and long-term survival of patients with Q wave vs non-Q wave myocardial infarction. METHODS: A total of 6676 patients with acute myocardial infarction were enrolled on the TRAndolapril Cardiac Evaluation (TRACE) register between 1990 and 1992. Medical history, electrocardiographic diagnosis of Q wave and non-Q wave myocardial infarction, echocardiographic estimation of left ventricular systolic function determined as wall motion index, infarct complications, and survival were documented. The factors influencing the postmyocardial infarction outcome of these patients were studied after 30 days and after 8 years of follow-up, respectively. RESULTS: Cox proportional-hazard models demonstrated that the electrocardiographic Q waves had significant influence on survival during the first 30 days [risk ratio 1.4 (95% confidence limits 1.2-1.7)] but no influence thereafter [1.0 (0.9-1.1)]. The result was the same in univariate and multivariate analyses. Subgroup analysis defined by age, sex, wall motion index, presence of congestive heart failure, diabetes mellitus, arterial hypertension, subsequent myocardial infarctions and use of thrombolytic therapy did not disclose importance of Q waves on mortality. CONCLUSION: The electrocardiographic presence of Q waves is associated with increased mortality during the initial 30 days after a myocardial infarction, but has no influence thereafter.

A case of merosin-negative congenital muscular dystrophy with extensive white matter abnormalities and electroencephalographic changes in a Syrian boy.

Congenital muscular dystrophies are a group of heterogeneous disorders inherited as an autosomal recessive disease. In the Caucasians they are most frequently encountered as the so-called "pure" or occidental form. Recently it has been found that the severity of concomitant white matter changes depends on the presence or absence of merosin, the laminin isoform, in the skeletal muscle. The authors present a 2-year-old Syrian boy with congenital muscular dystrophy which proved to be merosin (laminin alpha2) deficient and believe that this is the first case described from Syria. The clinical picture, biochemical findings, neurophysiological investigations, biopsy findings and extensive abnormalities of white matter on magnetic resonance imaging (MRI) found in this case are presented. Peculiar electroencephalographic (EEG) pattern with fast rhythms in occipito-temporal regions is emphasized.

Adequacy of oxygenation in a group of Danish patients with COPD on long-term oxygen therapy.

The aim of this study was to assess the adequacy of oxygenation in patients with chronic obstructive pulmonary disease (COPD) on long-term oxygen therapy (LTOT) in Copenhagen county. Twenty-six patients were enrolled and assessed prospectively by 24-h pulse oximetry. Patients comprised seven males and 19 females with a mean age of 69 +/- 5 yrs, arterial oxygen tension of 6.5 +/- 0.6 kPa, forced vital capacity of 1.47 L, forced expiratory volume in one second of 0.5 +/- 0.2 L (22 +/- 9% of predicted) and St. George's Respiratory Questionnaire total score of 61 +/- 14. The mean 24-h arterial oxygen saturation measured by pulse oximetry (Sp,O2) was within normal limits (94 +/- 1%), but mild hypoxaemia with a mean Sp,O2 of 89 +/- 4% and a total of 12 +/- 15 desaturation episodes per patient were observed, mostly during daily activities. Multiple regression analysis revealed no significant predictors for patient oxygenation. In summary, 24-h pulse oximetry showed adequate oxygenation in this group of COPD patients on LTOT, though mild hypoxaemia was present during some daily activities.

[Arterial puncture or pulse oximetry?]. / Arteriepunktur eller pulsoksimetri?

Arterial puncture is the general accepted standard method for monitoring oxygen therapy in critically ill patients, but this technique is painful for the patient, has the potential of complications, and does not provide immediate continuous data. Pulse oximetry is a non-invasive method used to measure arterial oxygen saturation with a clinically acceptable accuracy of +/- 2%. Despite some limitations, pulse oximetry is considered to be reliable in most cases in detecting hypoxaemia and monitoring oxygen therapy in stationary units. The pulse oximeter can reduce the number of arterial punctures, personnel's time consumption, and limit oxygen abuse. Furthermore the new transportable and hand-held pulse oximeters offer new possibilities for continuous 24 hour monitoring of oxygen saturation also out of hospitals. The pulse oximeter can optimize monitoring patients' oxygen saturation in the stationary units, however, arterial puncture will remain the most reliable method in the assessment of hypoxaemia and hypercapnia, especially in acute situations.

[Localized diffuse pulmonary AL-amyloidosis]. / Lokaliseret diffus pulmonal AL-amyloidose.

A 56 year-old woman was admitted due to exertional dyspnoea. Her chest x-ray and CT scanning showed widespread diffuse infiltrative changes in both lungs, associated with a pronounced decrease in diffusion capacity. Transbronchial biopsies showed primary (AL) amyloidosis. Systemic AL-amyloidosis was excluded and diagnosis of localised diffuse parenchymal pulmonary amyloidosis was established. Treatment with prednisolone and melphalan for one year has stabilised the condition. Lung transplantation will be considered in case of deterioration.

Infectious tenosynovitis in broilers and broiler breeders in Egypt.

Two infectious tenosynovitis-producing viruses were isolated from tendon sheaths and synovial fluids of 59 broilers and 15 broiler breeders obtained from different flocks in Egypt during June to October 1983. The viruses grew well on the chorioallantoic membrane of developing chicken embryos, produced small localized white pock lesions with oedematous swellings at the inoculation sites and death of most of the embryos 72 to 96 hours post-inoculation. They also induced cytopathic effect in chicken embryo rough, Vero and MS cell lines. The viruses were neutralized by reovirus S1133 antiserum, both in tissue culture and on the chorioallantoic membrane. Inoculation of the viruses into 2-day-old broiler chicks via the foot pad, intramuscular and oral routes reproduced the disease with the development of characteristic clinical, pathological and serological responses. The infection was transmitted to in-contact control chicks. This is the first report of the disease and of the isolation and identification of the causative virus in Eqypt.