Medical thoracoscopy with cryobiopsy as diagnostic tool for pleural metastatic in cutaneous squamous cell carcinoma: a rare case report.

Introduction: Distance metastasis of cutaneous squamous cell carcinoma (cSCC) to pleural is rarely reported, and meets difficulties in diagnosing due to quality of pleural biopsy sample. This case presented a novel technique by using cryobiopsy to obtain adequate sample and was first conducted in our hospital. Case presentation: A 62-years-old man admitted to hospital with dyspnoea due to massive right pleural effusion. Lung multi-sliced computed tomography showed right lung pleural effusion with compression atelectasis as well as collapse of medial lobe and upper lobe, multiple solitary nodules on mediastinal, costal antero-posterior and right diaphragm pleural part. Medical thoracoscopy was performed to obtain pleural samples by using cryobiopsy and forceps biopsy. Pathological analysis with Immunohistochemistry (IHC) revealed metastatic squamous cell carcinoma. Discussion: Recurrence rate of cSCC remains high even after treatment, with worse prognosis. Distant metastasis to pleural is rarely reported. Clinical approach for malignant pleural effusion by using medical thoracoscopy has 80% sensitivity with minimal complication. Pleural cryobiopsy is a novel technique used for obtaining sample from pleural biopsy with significant larger size of the specimen, less crush artefacts, fragmented and better tissue integrity, although the diagnostic yield and bleeding severity between cryobiopsy and conventional forceps biopsy are not significant. Conclusion: Medical thoracoscopy with cryobiopsy should be considered as a preferrable diagnostic tool for obtaining better sample specimen, especially for pleural metastatic.

Schistosomiasis model with treatment, habitat modification and biological control.

Schistosomiasis is a parasitic disease caused by Schistosoma worm infection. Some species of snails can serve as the intermediate hosts for the parasite. Numerous interventions have been performed to repress the snail population. One of them is the use of molluscicide. Nevertheless, it is debated that molluscicide intervention has negative impacts on the ecosystem. To investigate the impact of more environmentally friendly interventions, we develop a schistosomiasis model with treatment, habitat modification and biological control. The biological control agent examined in our model is a snail predator. Moreover, to investigate the impact of snail habitat modification, we assume that the snail population grows logistically. We show that all solutions of our model are non-negative and bounded. We also study the existence and stability conditions of equilibrium points. The basic reproduction numbers are determined using the next-generation operator. Linearization combined with the Routh-Hurwitz criterion is used to prove the local stability condition of disease-free equilibrium points. Bifurcation theory is applied to investigate the local stability condition of the endemic equilibrium points. To examine the global behavior of our model, we use asymptotically autonomous system theory and construct a Lyapunov function. We perform several numerical simulations to validate and support our deductive results. Our results show that early treatment can reduce the basic reproduction number and schistosomiasis cases. In addition, modifying snail habitat and releasing the snail predator at the snail habitat can reduce schistosomiasis prevalence. We suggest using snail predators which can hunt and kill snails effectively as a biological control agent.

Hopf bifurcation and stability analysis of the Rosenzweig-MacArthur predator-prey model with stage-structure in prey.

We consider a stage-structure Rosenzweig-MacArthur model describing the predator-prey interaction. Here, the prey population is divided into two sub-populations namely immature prey and mature prey. We assume that predator only consumes immature prey, where the predation follows the Holling type II functional response. We perform dynamical analysis including existence and uniqueness, the positivity and the boundedness of the solutions of the proposed model, as well as the existence and the local stability of equilibrium points. It is shown that the model has three equilibrium points. Our analysis shows that the predator extinction equilibrium exists if the intrinsic growth rate of immature prey is greater than the death rate of mature prey. Furthermore, if the predation rate is larger than the death rate of predator, then the coexistence equilibrium exists. It means that the predation process on the prey determines the growing effects of the predator population. Furthermore, we also show the existence of forward and Hopf bifurcations. The dynamics of our system are confirmed by our numerical simulations.

Are Pathogenic Leptospira Species Agents of Community-Acquired Pneumonia? Case Reports of Leptospirosis Presenting as Pneumonia.

We report four Indonesian cases meeting the clinical and radiological criteria for community-acquired pneumonia and other findings suggestive of leptospirosis. Quantitative PCR (qPCR) analyses of serum and urine samples and serology confirmed the diagnosis of leptospirosis in each. Results of qPCR analysis of throat swabs were concordant with those obtained with acute-phase serum samples, which suggests its potential for use as a noninvasive diagnostic tool for leptospirosis.

Viruses and Gram-negative bacilli dominate the etiology of community-acquired pneumonia in Indonesia, a cohort study.

OBJECTIVE: Knowledge about the etiology of community-acquired pneumonia (CAP) is essential for adequate management. Presently, few studies about CAP are available from Southeast Asia. This study aimed to investigate the etiology, severity, and outcome of CAP in the most populous Southeast Asia country, Indonesia. METHODS: From October 2007 to April 2009, adult patients admitted with CAP to two hospitals in Semarang, Indonesia, were included to detect the etiology of CAP using a full range of diagnostic methods. The severity of disease was classified according to the Pneumonia Severity Index (PSI). The outcome was assessed as 30-day mortality. RESULTS: In total, 148 consecutive patients with CAP were included. Influenza virus (18%), Klebsiella pneumoniae (14%), and Streptococcus pneumoniae (13%) were the most common agents identified. Other Gram-negative bacilli, Mycobacterium tuberculosis, Chlamydia pneumoniae each accounted for 5%. The bacteria presented wild type antibiotic susceptibility profiles. Forty-four percent of subjects were high-risk patients (PSI class IV-V). The mortality rate (30%) was significantly associated with disease severity score (P<0.001), and with failure to establish an etiological diagnosis (P=0.027). No associations were found between etiology and underlying diseases, PSI class, nor mortality. CONCLUSIONS: Viruses and Gram-negative bacilli are dominant causes of CAP in this region, more so than S. pneumoniae. Most of the bacteria have wild type susceptibility to antimicrobial agents. Patients with severe disease and those with unknown etiology have a higher mortality risk.

Comparison of tumor density by CT scan based on histologic type in lung cancer patients.

AIM: To investigate the differences of tumor density of lung cancer by CT scan based on histopathologic type of cancer cell. METHODS: Subjects were lung cancer patients at Dr. Kariadi hospital Semarang between January 2002 and December 2003. Diagnosis was made based on clinical symptoms, histologic examination and lateral chest radiograph, and thorax CT scan. Density of tumor was measured within area which had most enhancements before and after contrast administration. Then, it was followed by transthoraxic fine needle aspiration (TNFNAB) and histopathologic examination. Study design was a cross sectional study. Inclusion criteria were primary lung cancer and exclusion criteria were non lung cancer, metastatic cancer, histopathologic non interpreted. Estimated number of samples was 41 patients. Density value before and after contrast were analyzed using Wilcoxon signed rank test. Difference of tumor density for each type of cancer cell was analyzed using chi-square test with significant level at p < 0.05 and confidence interval of 95%. RESULTS: Forty-one patients with lung cancer were enrolled in this study. There were 30 males (73.2%) and 11 females (26.8%). Histopathologic types of cell cancer were epidermoid in 17 patients (14.5%), adenocarcinoma 8 patients (19.5%), large cell 7 patients ( 17.1%), small cell 7 patients ( 17.1%) and undifferentiated cell 2 patients ( 4.5%). Mean of increasing HU before and after contrast in epidermoid carcinoma was 26.8 (10.4) HU, adenocarcinoma 17.2 (7.1) HU, large cell 8.7 (4.5) HU, small cell 9.9(4.1) HU and undifferentiated cell 23.5 (1.5) HU with overall increase of all cancer cell types was 17.3(9.2) HU, p < 0.001. Histopathologic type of non small cell lung carcinoma (NSCLC) with density < 60 HU was found in 30 patients (73.2%) and small cell lung carcinoma with density > 60 HU was found in 5 patient (12.2%), p=0.01. CONCLUSION: There was evident increase of density in all histopathologic type of cell cancer, p < 0.0001, with mean of density after contrast administration was 17.2 (7.1). There was significant difference between NSCLC and SCLC group and tumor density > 60 HU and < 60 HU, p=0.01.