Orbital metastases of breast carcinoma.

SUMMARY: Orbital metastases, although rare, originate from systemic breast cancer in up to 35% of patients. Metastases more commonly arise from invasive lobular carcinomas than from invasive ductal carcinomas. Due to the diagnostic challenge of determining the primary site for the metastases, immunohistochemistry is essential. Clinical and radiological information are usually insufficient. This disease typically progresses quickly and has a poor prognosis. We report the case of a 55-year-old female who presented in 2017 with a left breast carcinoma and defaulted treatment during many different stages, then returned three years later with a right orbital mass which was confirmed to be a breast cancer metastasis on biopsy.

Amylase quantification in the terminal Ileum following formation of an Ileostomy.

Amylase is elevated in the foregut and has been used to confirm anastomotic integrity after pancreatic surgery. The physiological activity of pancreatic enzymes in the ileum has been studied in healthy volunteers but not quantitated with the simple and readily available amylase measurements employed with serum tests. We aim to quantitate the levels of amylase in the terminal ileum. This was a prospective, non-randomised, non-blinded, consecutive cohort study conducted at the Royal Brisbane and Women's Hospital. Consecutive patients undergoing routine surgery with an ileostomy were invited to participate in the study. Ileostomy effluent was collected and analysed daily for the first 5 post-operative days. This validation cohort included 8 males and 3 females, with a mean age of 49 years. Median daily amylase levels ranged from 4470 U/L to 23,000 U/L, with no specimens falling within the laboratory serum reference range of 40 to 130 U/L. Two specimens were not available on day one post-operative due to complete ileus. The sample size of 11 patients is small but was considered sufficient given that 55 effluent specimens were anticipated for analysis. Amylase levels remain highly elevated as the enzyme transits through the length of the small intestine and measured in the terminal ileum, and can be readily quantitated by the existing testing methodology routinely available.

Scaling-up services for psychosis, depression and epilepsy in sub-Saharan Africa and South Asia: development and application of a mental health systems planning tool (OneHealth).

BACKGROUND: Although financing represents a critical component of health system strengthening and also a defining concern of efforts to move towards universal health coverage, many countries lack the tools and capacity to plan effectively for service scale-up. As part of a multi-country collaborative study (the Emerald project), we set out to develop, test and apply a fully integrated health systems resource planning and health impact tool for mental, neurological and substance use (MNS) disorders. METHODS: A new module of the existing UN strategic planning OneHealth Tool was developed, which identifies health system resources required to scale-up a range of specified interventions for MNS disorders and also projects expected health gains at the population level. We conducted local capacity-building in its use, as well as stakeholder consultations, then tested and calibrated all model parameters, and applied the tool to three priority mental and neurological disorders (psychosis, depression and epilepsy) in six low- and middle-income countries. RESULTS: Resource needs for scaling-up mental health services to reach desired coverage goals are substantial compared with the current allocation of resources in the six represented countries but are not large in absolute terms. In four of the Emerald study countries (Ethiopia, India, Nepal and Uganda), the cost of delivering key interventions for psychosis, depression and epilepsy at existing treatment coverage is estimated at US$ 0.06-0.33 per capita of total population per year (in Nigeria and South Africa it is US$ 1.36-1.92). By comparison, the projected cost per capita at target levels of coverage approaches US$ 5 per capita in Nigeria and South Africa, and ranges from US$ 0.14-1.27 in the other four countries. Implementation of such a package of care at target levels of coverage is expected to yield between 291 and 947 healthy life years per one million populations, which represents a substantial health gain for the currently neglected and underserved sub-populations suffering from psychosis, depression and epilepsy. CONCLUSIONS: This newly developed and validated module of OneHealth tool can be used, especially within the context of integrated health planning at the national level, to generate contextualised estimates of the resource needs, costs and health impacts of scaled-up mental health service delivery.

Evaluating the impact of two training interventions to improve diagnosis and case-management of malaria and pneumonia in Uganda.

We present an age-structured mathematical model of malaria and pneumonia to study the effect of two capacity-building interventions: Integrated Management of Infectious Diseases (IMID) and On-site Support Services (OSS). IMID leads to a reduction in malaria prevalence by more than 2·4% across the [0,5), [5,14) and [14,50) age groups. IMID + OSS reduces it by more than 16·0% across all age groups. IMID decreases pneumonia prevalence by more than 3·0% across all age groups while IMID + OSS decreases it by more than 1·0% across all age groups. The number of malaria and pneumonia deaths is reduced by 7·8% by IMID across all age groups and IMID + OSS decreases this number by 30·5% across all age groups, which translates to saving a life of a child per month. Prevalence of malaria-pneumonia for the [0,5) age group is 0·52% at baseline, and IMID and IMID + OSS reduce it by 6·6% and 23·6%, respectively. There is no change in incidence of malaria or pneumonia disease episodes. The results also indicate that triaging of children contributes more than 50% to the effect of the interventions in reduction of deaths and a range of 14-91% in reduction of disease cases.

TIME Impact - a new user-friendly tuberculosis (TB) model to inform TB policy decisions.

Tuberculosis (TB) is the leading cause of death from infectious disease worldwide, predominantly affecting low- and middle-income countries (LMICs), where resources are limited. As such, countries need to be able to choose the most efficient interventions for their respective setting. Mathematical models can be valuable tools to inform rational policy decisions and improve resource allocation, but are often unavailable or inaccessible for LMICs, particularly in TB. We developed TIME Impact, a user-friendly TB model that enables local capacity building and strengthens country-specific policy discussions to inform support funding applications at the (sub-)national level (e.g. Ministry of Finance) or to international donors (e.g. the Global Fund to Fight AIDS, Tuberculosis and Malaria).TIME Impact is an epidemiological transmission model nested in TIME, a set of TB modelling tools available for free download within the widely-used Spectrum software. The TIME Impact model reflects key aspects of the natural history of TB, with additional structure for HIV/ART, drug resistance, treatment history and age. TIME Impact enables national TB programmes (NTPs) and other TB policymakers to better understand their own TB epidemic, plan their response, apply for funding and evaluate the implementation of the response.The explicit aim of TIME Impact's user-friendly interface is to enable training of local and international TB experts towards independent use. During application of TIME Impact, close involvement of the NTPs and other local partners also builds critical understanding of the modelling methods, assumptions and limitations inherent to modelling. This is essential to generate broad country-level ownership of the modelling data inputs and results. In turn, it stimulates discussions and a review of the current evidence and assumptions, strengthening the decision-making process in general.TIME Impact has been effectively applied in a variety of settings. In South Africa, it informed the first South African HIV and TB Investment Cases and successfully leveraged additional resources from the National Treasury at a time of austerity. In Ghana, a long-term TIME model-centred interaction with the NTP provided new insights into the local epidemiology and guided resource allocation decisions to improve impact.

Misconceptions about traumatic brain injuries among South African university students

Objective. To investigate the incidence and type of misconceptions about traumatic brain injuries (TBIs) harboured by university students. Method. A convenience sample of 705 university students were recruited and data were collected using an electronic survey. The link to the survey was sent via e-mail to all registered students at Stellenbosch University. The participants had to complete the Common Misconceptions about Traumatic Brain Injury (CM-TBI) questionnaire. Results. The findings of this study suggest that the students subscribe to misconceptions from each of the 7 categories of misconceptions about TBIs. The mean percentages of misconceptions about TBIs were calculated and the amnesia (mean 49.7) and unconsciousness (mean 46.1) categories were identified as the categories about which the respondents had the most misconceptions; while the mean percentages of misconceptions were lower for the categories of recovery (mean 27.6); rehabilitation (mean 26.56); prevention (mean 20.8); brain injury sequelae (mean 18.7) and brain damage (mean 8.4). Conclusion. Generally; these findings appear to be in keeping with previous literature; which suggests that misconceptions about TBIs are common among the general population. This study's identification of these misconceptions could help create awareness; provide a focus for information provision; and contribute to the development of educational intervention programmes tailored for the South African context

5-(Trifluoro-meth-oxy)isatin.

THE TITLE COMPOUND [SYSTEMATIC NAME: 5-(trifluoro-meth-oxy)-1H-indole-2,3-dione], C9H4F3NO3, crystallized with two mol-ecules in the asymmetric unit. Inter-molecular N-H⋯O hydrogen bonds link the mol-ecules to form layers parallel to the ab plane. In addition, π-π stacking inter-actions are observed with a centroid-centroid distance of 3.721 (1) Å. The near planarity of the two isatin ring systems is illustrated by by the maximum deviations of 0.023 (1) and 0.025 (1) Šfor the N atom in each case.

Gonadotrophin-independent precocious puberty in an eight-year-old boy due to ectopic human chorionic gonadotrophin from the central nervous system.

We present the case of an eight-year-old boy with advanced isosexual precocity associated with an elevated serum total-beta human chorionic gonadotrophin (HCG) and markedly elevated serum total testosterone. Radiological investigation discovered a lesion in the left thalamus and no peripheral tumour. Serum:cerebrospinal fluid (CSF) HCG ratio was approximately 1:1, consistent with a central nervous system source of HCG, with thalamic germinoma strongly suspected. Consent was not obtained for biopsy of the lesion. The patient underwent multiagent chemotherapy with return of serum HCG to normal. We discuss mechanisms of HCG-mediated sexual precocity in both boys and girls and the importance of CSF HCG.

Coping Responses as Predictors of Satisfaction with Life amongst a Group of Patients Diagnosed with Diabetes Mellitus

The purpose of this study was to investigate the extent to which coping responses could predict the level of life satisfaction experienced by patients suffering from diabetes mellitus. A non-experimental; cross-sectional design was adopted. The sample consisted of 154 individuals (62 Type I diabetics; 80 Type II diabetics; and 12 individuals for whom diagnostic information was not available) recruited from the outpatient diabetes clinic at a large state hospital. All participants completed the Coping Responses Inventory - Adult Version; as well as the Satisfaction with Life Scale. Initially; Pearson product-moment correlation coefficients were calculated to examine the relationship between the predictor variables (coping responses) and the criterion variable (satisfaction with life). Hierarchical regression analyses were conducted to determine the amount of variance in the satisfaction with life scores that was explained by coping responses. The combination of approach and avoidance coping subscales accounted for 33of the variance in the participants' satisfaction with life scores. However; upon further analysis; the avoidance coping subscales were found to account for 28of the variance in the sample's satisfaction with life. The cognitive avoidance subscale and the acceptance or resignation subscale were found to correlate negatively with satisfaction with life at the 1level of significance. It appears that approach coping responses do not predict the satisfaction with life experienced by individuals suffering from diabetes. However; avoidant coping responses; particularly cognitive avoidance and acceptance or resignation; are predictive of lower levels of satisfaction with life

Health-service utilization by pregnant women in the greater Mafikeng-Mmabatho district.

Since the implementation of free maternity services in South Africa from 1994, more maternity services were provided (SA, 1994: 73). These services are however inaccessible to many pregnant women in the rural areas, leading to sub-optimal antenatal health service utilization. Another problem that emerged, is deterioration in antenatal health service rendering throughout the country, as well as a lack of guidelines for the mobilization of pregnant women in order to promote optimal antenatal health service utilization (ANHSU) in the North West Province. The mentioned problems were the reasons for undertaking this research. The aims formulated for this research were: To determine the composition of the infrastructure of the antenatal health services and the efficacy of the antenatal health-service rendering in the greater Mafikeng-Mmabatho District; To undertake a survey of the ANHSU by pregnant women attending the mentioned services; To explore and describe the perceptions of these pregnant women regarding ANHSU; To formulate recommendations for antenatal health service providers working in the greater Mafikeng-Mmabatho District for the mobilization of pregnant women to promote optimal ANHSU. A qualitative survey design was followed within the context of the greater Mafikeng-Mmabatho District in the North West Province. Data-collection was managed through completion of structured questionnaires by chief professional nurses and puerperal women and by holding semi-structured interviews with puerperal women who were selected using non-probable, voluntary and purposive sampling. The findings that emerged were, that the composition of the infrastructure of the majority antenatal health services in the greater Mafikeng-Mmabatho District were insufficiently equipped indicating the provision of ineffective antenatal health service rendering. Pregnant women were utilizing the antenatal health services sub-optimally and the exploration and description of their ANHSU, revealed factors promoting and preventing utilization. Recommendations have been formulated for nursing education, nursing research and nursing practice with specific reference to the formulation of guidelines for antenatal health service providers to promote optimal ANHSU by pregnant women.

Two siblings with episodic ketoacidosis and decreased activity of succinyl-CoA:3-ketoacid CoA-transferase in cultured fibroblasts.

Succinyl-CoA:3-ketoacid CoA-transferase deficiency leads to a severe ketoacidosis presenting in infancy. We describe two siblings of African ancestry who presented with repeated episodes of ketoacidosis. Both had a positive test for salicylate in the absence of salicylate ingestion. Analysis of urine for organic acids revealed the presence of acetoacetate and 3-hydroxybutyrate. Succinyl-CoA:3-ketoacid CoA-transferase activities in cultured fibroblasts were 11% and 18% of control values.

Vertical tripod fixation (VTF) simplifies transscleral approaches.

Transscleral fixation of intraocular lenses (IOL) is an accepted procedure today. Following Malbran's initial approach, new techniques have been developed in various ophthalmic centers; many, however, are time-consuming and difficult, as reflected by complications, most commonly hyphema and IOL tilt. We present here a simple method of transscleral fixation, which was performed in 24 patients in our department. It involves fixating the IOL vertically, on a three-point configuration, using standard 10-0 prolene stitches. Performing it is easy and time-saving. VTF ensures a stable transscleral fixation of an IOL.

Procedures involving star-shaped capsulectomy for managing congenital cataracts in developing nations.

The management of congenital cataracts is still challenging, especially in developing nations, where surgical facilities are limited. Congenital cataracts were extracted from 22 patients (26 eyes): a procedure consisting of a star-shaped anterior capsulectomy and wash-out of lens material (STARWO) was performed in 16 of them (18 eyes) (group A); a procedure consisting of a star-shaped anterior capsulectomy, wash-out, anterior vitrectomy through the posterior capsulotomy, and repeated tearing of remnants of the anterior capsule (STARWAR) was performed in six patients (eight eyes) (group B). Intraocular lenses were implanted in both groups. In group A, secondary membranes (27.7%) developed in five eyes, postoperative uveitis in four (22.2%), and a late Elschnig pearl in 1 (5.5%). In group B, there was one case of secondary membrane formation (12.5%), and one of postoperative uveitis; neither required subsequent intervention. The inexpensive instrumentation used and the low rate of perioperative complications encountered in these patients make these two techniques attractive alternatives for managing congentital cataracts in developing nations.

[Diffuse corneal pigmentation--a new sign in neurofibromatosis].

Neurofibromatosis is an autosomal dominant disease affecting many organs. It is known for the characteristic pigmented skin spots and various neurofibromas. We present a 79-year old man who underwent elective cataract extraction. The surgery was complicated by the presence of diffuse, deep, intracorneal pigmentation. To our knowledge, this sign has not as yet been described in neurofibromatosis.

[Eye trauma in southern Africa].

The population of southern Africa living in South Africa, Swaziland, Lesotho and Mozambique is 50 million. Because of intertribal hostility, the particular family structure, and the widespread use of alcohol and cannabinoid drugs, violence is very common. Trauma results mainly from "cold" weapons, which are an essential part of the traditional accoutrements of the African male. 202 patients (31.86% of those who underwent eye surgery in 2 years) needed surgery for severe ocular trauma in Mbabane, Swaziland. In a similar period, 100 patients (19.49%) required similar surgery in Boksburg, South Africa.

Left paraduodenal hernia with acute abdominal symptoms. A case report.

A 22-year-old man with an incarcerated left paraduodenal hernia is described. Symptoms included nausea, vomiting, cramp-like abdominal pain and obstipation. A clinical diagnosis of mechanical small-intestinal obstruction was made on the history, examination, and abdominal radiographic findings. At laparotomy successful manual reduction was achieved, resection was not required and the patient made an uneventful recovery.