Synchronous pancreatic and scrotal tuberculosis: Double jeopardy.

We describe a patient who presented with scrotal swelling followed by non-healing and discharging scrotal sinuses, following local trauma and was initially suspected to have an infected scrotal hematoma. An evaluation revealed it to be scrotal tuberculosis. He also complained of upper abdominal pain and on transabdominal ultrasonography was detected to have a mass in the head of the pancreas. Evaluation of the pancreatic mass revealed it to be pancreatic tuberculosis. Both lesions responded well to anti-tubercular therapy. This is an unusual case of two rare sites of extrapulmonary tuberculosis presenting simultaneously in the same individual. Care needs to be exercised while evaluating any non-healing ulcers or sinuses and mass lesions in countries endemic for tuberculosis as this disease can be a great masquerader.

Lack of heart rate variability during sleep-related apnea in patients with temporal lobe epilepsy (TLE)-an indirect marker of SUDEP?

PURPOSE: Apneas occurring during sleep may precipitate autonomic instability in epilepsy patients making them susceptible to sudden death (SUDEP). Literature on heart rate variability (HRV) during apnea among patients with temporal lobe epilepsy (TLE) is sparse. The aim of this study was to characterize the HRV during the peri-apneic period in patients with TLE and compare with HRV of matched healthy individuals during the overnight polysomnographic (PSG) recording. Further, the role of carbamazepine (CBZ) in modulating peri-apneic HRV in the above cohort was also assessed. METHODS: Twenty patients diagnosed to have TLE (drug naive (n = 10) or on CBZ monotherapy (n = 10)) were compared with ten healthy controls. In both patients and controls, the time domain, frequency domain, and non-linear HRV indices were analyzed for 2 min before and after apnea/hypopnea termination and compared using paired t test (p ≤ 0.05). Additionally, the changes in HRV parameters in the peri-apnea/hypopnea period were compared between the three groups using one-way ANOVA followed by post hoc comparison (p ≤ 0.05). RESULTS: The three study groups were age (p = 0.21) and gender (p = 0.27) matched. In controls (M/F = 5:5; mean age 24.3 ± 5.0 years), there were significant changes in standard deviation of RR interval (SDNN), low frequency (LF) component and long-term HRV (SD2) parameters in the peri-apnea/hypopneic period. Conversely, in drug-naive TLE (M/F = 6:4; mean age: 22.8 ± 4.1 years), all the HRV parameters, including non-linear measures were comparable in the pre- and post-apneic period. On the other hand, patients on CBZ (M/F = 6:4; mean age 20.5 ± 4.8 years) showed significant changes in low-frequency nu (LFnu) and high-frequency nu (HFnu) components in the peri-apnea/hypopneic period. Comparison of the changes in HRV parameters in the peri-apnea/hypopnea period in patients with TLE and controls showed significantly lower changes in drug-naive TLE patients in SDNN, LF, and SD2 as compared to controls. CONCLUSIONS: This study showed that there was a lack of apnea-mediated HRV changes in patients with drug-naive TLE. This might suggest a possible alteration in reflex baroreceptor activation in patients with TLE, predisposing them to SUDEP, and this may be worsened with CBZ.

Verrucous condyloma lata mimicking condyloma acuminata: An unusual presentation.

A 15-year-old boy from a child center presented with a three-month history of a growth in the perianal region. There was a history of repeated peno-anal sexual exposures. On examination there was a fleshy, hyperpigmented, verrucous plaque around the anal verge. The Venereal Disease Research Laboratory Test was reactive in a titer of 1 : 64. Lesional biopsy showed marked epidermal hyperplasia without koilocytes, with a dermal infiltrate composed of lymphocytes, plasma cells and histiocytes. Patient was treated with parenteral penicillin with complete healing of the plaque. This is a rare presentation of secondary syphilis showing condyloma lata resembling condyloma acuminata.

Cutaneous neonatal lupus erythematosus with unusual features.

A three month-old boy was brought by his mother with complaints of multiple reddish lesions on his trunk and face since birth. The patient had erythematous annular plaques with scaling on his extremities, palms and soles with periorbital erythema and edema giving the characteristic "eye mask" or "owl's eye" appearance. His mother did not have history of any illness. Hemogram, liver and renal function tests were within normal limits. A skin biopsy was suggestive of subacute cutaneous lupus erythematosus. Immunological work-up was positive for antinuclear antibodies (ANA) (1:40) with anti-Ro titers of 3.4 and 3.47 (>1.1 = clinically significant titre) in the mother and child respectively, although negative for anti-La antibodies. The child's electrocardiogram and 2D echocardiography were normal. We are presenting a case of anti-Ro-positive cutaneous lupus erythematosus with an uncommon skin manifestation.

Cutaneous malakoplakia in an HIV-positive patient.

Malakoplakia is an uncommon granulomatous infectious disease that is found primarily in the genitourinary tract, but may rarely involve the skin. We report a case of cutaneous malakoplakia in an HIV-positive patient diagnosed on the basis of Michaelis-Gutman bodies. The patient presented with ulcers, draining sinuses and tender papules and nodules mainly on perigenital area, buttocks and right thigh.

Prevalence of schistosomiasis mansoni in Tauorga town, north-west Libya.

Study was conducted in 9 localities of Tauorga town, which is situated North-West of Libya, with the objective of finding out the present trend of Schistosomiasis mansoni in general population and to plan suitable strategies for its prevention. 1544 people were selected by two stage cluster random sampling and the data was gathered by direct interview from the family members during home visit. Stool samples were collected and examined for Schistosoma mansoni eggs. The study revealed that the overall prevalence of schistosomiasis mansoni was 20.85%, which was varied between 1.78% and 55.58% in different localities. Significantly higher prevalence was observed in school age group (28.61%), in males (25.28%) and in localities situated within the area of 2 Km from the spring (55.58%).

Prevalence of dental caries in school children from a suburban area in Tripoli, Libya.

Seven hundred and twenty school children of primary school grades 5 and 6 in Hadba Sargia area in Tripoli were examined for dental caries. The mean DMFT index for the whole sample of children was 1.58. The DT component comprised 1.34 and MT component 0.21 of DMFT score, which made 42.22% and 13.33% of total children sample, respectively. The amount FT component was 0.03 (1.39%) of all children with DMFT examined. The number of children with at least one DMFT score was 410 (56.94%) of the total study sample. In children with poor oral hygiene, DMFT score was significantly higher (1.91) than in those with good oral hygiene (0.85) (P less than 0.01). Children whose mothers had low education exhibited a higher total DMFT score (1.85) than those whose mothers had high education (1.16).