Giant pilomatrix carcinoma of the scalp with intracranial extension: A case report.

Key Clinical Message: A very rare skin cancer. Malignant variant of pilomatricoma. It is unique because of its highly aggressive behavior. Responds poorly to chemotherapy and radiotherapy. Treated with a wide surgical excision with safe margins. Abstract: Pilomatrix carcinoma is uncommon and locally aggressive tumor of the hair follicle matrix. It is a malignant variant of pilomatricoma. If left untreated for a long time may attain massive size and has the potential for distant spread. Only few cases with brain extension have been reported in the literature. Diagnosis of these tumors is established by histopathology. Although pilomatrixoma and pilomatrix carcinoma are well-recognized lesions, clinically they are frequently misdiagnosed as other skin conditions. The tumors respond poorly to chemotherapy and radiotherapy. Thus, recommended treatment is a wide surgical excision with safe margins. Herein, we report the case of a 39-year-old African woman with pilomatrix carcinoma of the scalp eroding the skull bone with intracranial extension.

Spatial accessibility to basic public health services in South Sudan.

At independence in 2011, South Sudan's health sector was almost non-existent. The first national health strategic plan aimed to achieve an integrated health facility network that would mean that 70% of the population were within 5 km of a health service provider. Publically available data on functioning and closed health facilities, population distribution, road networks, land use and elevation were used to compute the fraction of the population within 1 hour walking distance of the nearest public health facility offering curative services. This metric was summarised for each of the 78 counties in South Sudan and compared with simpler metrics of the proportion of the population within 5 km of a health facility. In 2016, it is estimated that there were 1747 public health facilities, out of which 294 were non-functional in part due to the on-going civil conflict. Access to a service provider was poor with only 25.7% of the population living within one-hour walking time to a facility and 28.6% of the population within 5 km. These metrics, when applied sub-nationally, identified the same high priority, most vulnerable counties. Simple metrics based upon population distribution and location of facilities might be as valuable as more complex models of health access, where attribute data on travel routes are imperfect or incomplete and sparse. Disparities exist in South Sudan among counties and those with the poorest health access should be targeted for priority expansion of clinical services.

Lymphatic filariasis among the Ezza people of Ebonyi State, eastern Nigeria.

A total of 1,243 Ezza people living in 10 communities of Ebonyi State, eastern Nigeria were examined between July 2002-January 2003 for lymphatic filariasis. This is the first time a filariasis survey due to Wuchereria bancrofti has been carried out in this state. Of the 1,243 persons examined, 210 (16.9 %) had W. bancrofti microfilariae. Infection varied significantly among communities and ages (p < 0.05) but not sex-related (p > 0.05). The Ezza people are predominantly farmers and professional hired labourers. There was a close association between microfilaria rate and microfilaria -density in various age groups (r = 0.812; p < 0.01). Microfilaria density is an important measure in the epidemiology, treatment and control of human filarisis in this endemic foci. Clinical signs and symptoms of the disease include elephantiasis, hydrocoele, dermatitis and periodic fever. Clinical symptoms without microfilaraemia and microfilaraemia without clinical symptoms were also observed. Of 1,603 mosquitoes dissected, Anopheles gambiae, An. funestus and Culex quinquefasciatus showed infectivity rates of 6.3 %, 5.1 % and 6.0 % respectively. The affected persons and other key informants are unaware of the cause of the disease and attributed it to witchcraft, violation of taboo, bad water and food. Intervention strategies to be integrated into the on-going Community-Directed Treatment with Ivermectin (CDTI) project are discussed.

Control of endemic dracunculiasis in Ebonyi state, south-eastern Nigeria.

A field study was carried out in Ozibo and the Ebonyi local government area of Ebonyi state, south-eastern Nigeria to determine the effectiveness of several intervention strategies in the control of endemic dracunculiasis in that area. During the initial study prior to the application of such measures, 14,421 subjects were examined. A total of 8,688 (60.2%) persons had either Dracunculus ulcers or emergent worms. Sex-related prevalence rates were 56.1% and 63.9% for males and females respectively. Age specific prevalence rates increased with age in males, whereas highest infection rates were found in females younger than 20 years. Twenty-eight months after the introduction of intervention strategies the prevalence rate fell by 85.1% to 9% (males: by 88.2% to 6.6%, females: by 83.0% to 10.8%). Reduction rates of more than 90% were observed in males aged 10 to 19 and in females aged 0 to 9 years. Intervention measures included systematic pond treatment, distribution or replacement of filters, intensive health education, provision of hand-dug wells, regular bore-hole installation/rehabilitation as well as active case detection, containment, management, and prompt reporting. Active involvement of the endemic communities, governments and the Global 2000 staff regarding the control efforts is a necessity towards the final eradication of the disease in the near future. The relationship between some of these intervention strategies and community development are highlighted.

[Adjuvant therapy of colon cancer stage C MAC. Adverse effects and efficacy in the Department of Oncology, Soroka Medical Center in the years 1991-1994].

The National Institutes of Health (NIH) held a consensus conference which recommended 5-FU and levamisole as adjuvant chemotherapy for colon cancer MAC (Modified Astler Coller) stage C. From 1991-1994, 37 such patients diagnosed here were treated with 5-FU (intravenous dose of 450/mg/m2/d for 5 days and from day 29, once a week for 48 weeks) and oral levamisole (50 mg 3 times/d. for 3 days, every 2 weeks for a year), as suggested by NIH guidelines. 16 patients were males and 21 were females, mean age was 62 years and median 64. Cancer locations were: right colon (in 16, 43%), left colon (19, 51%), multiple colon primaries (2, 1%). 25 (68%) had 1-3 positive lymph nodes and 12 (32%) had 4 or more positive lymph nodes. Only 20 (54%) finished treatment as prescribed. In the others, 1 or both drugs caused side-effects for which the drugs had to be stopped. 6 patients relapsed while on treatment. The most common side-effects were diarrhea, stomatitis and bone marrow suppression. 3 were hospitalized due to neutropenic fever. 5-year actuarial survival of all patients was 61%; 5-year relapse-free survival was 61%; 5-year relapse-free survival of right versus left colon was 41% and 82%, respectively (p < 0.01). There was no significant difference in 5-year survival of those with 1-3 positive lymph nodes as compared to those with 4 or more (62% and 56%, respectively). 5-year survival in those who finished or did not finish treatment (excluding those who stopped treatment because of progressive disease) was 83% and 70%, respectively (NS). The 5-year survival of our series was similar to that of patients treated similarly elsewhere. The 5-FU and levamisole treatment was not tolerated well by our study population. It has recently been replaced in our service by a 5-FU and leucovorin regimen given for 6 months.