Advanced magnetic resonance imaging with histopathological correlation in papillary tumor of pineal region: report of a case and review of literature.

Papillary tumors of the pineal region are recently described as rare mass lesions with limited literature available on their natural history and imaging features. Magnetic resonance imaging (MRI) including perfusion, diffusion, and spectroscopic features were described in an 18-year-old girl with papillary tumor of pineal region. A well-defined, T1 hyperintense and contrast-enhancing mass lesion was noted in pineal region with few cystic spaces within. Solid portion of lesion showed minimal diffusion restriction with average apparent diffusion coefficient of 0.812 Χ 10 -3 mm 2 /s; on MR spectroscopy elevated myo-inositol peak with reduced N-acetylaspartate and elevated choline in the tumor. On perfusion study there was significantly high relative cerebral blood volume (rCBV) (6-9 times) and relative cerebral blood flow (rCBF). Our findings agree with previous descriptions of cystic areas with T1 hyperintense appearance of this tumor but very high level of tumor perfusion, diffusion restriction, and presence of myo-inositol peak are important imaging findings and may correlate with the recent reports of high tumor recurrence in these cases.

Correlation of CD4 counts and CD4/CD8 ratio with HIV-infection associated oral manifestations.

BACKGROUND: The relationship between oral lesions arising from HIV infection and CD4/CD8 cell ratios is of relevance in clinical assessment of immune suppression. OBJECTIVE: To correlate the prevalence of oral manifestations arising from HIV infection and the levels of CD4/CD8 cell ratios. DESIGN: A cross-sectional study. SETTING: Kenyatta National Hospital, Nairobi, Kenya. SUBJECTS: Two hundred and seven HIV-infected patients in medical wards were recruited in the study. RESULTS: Seventy eight (37.7%) were male and 129 (62.3%) female, with an age range of 18-73 years (mean=34.81 years). Oral manifestations encountered with highest prevalence in the oral cavity included: hyperplastic candidosis (labial mucosa) 15%, erythematous candidosis (gingival) 5%, angular cheilitis 32.4%, herpes simplex (corner of the mouth) 0.5%, persistent oral ulceration (labial mucosa) 0.5%, Parotid enlargement 2% and Kaposis sarcoma (hard/soft palate) 2.9%. CONCLUSION: The prevalence of oral manifestations was higher with low CD4 count <200 cell/mm3 and mean CD4/CD8<0.39(95%CI 0.32-0.48).

Patterns of homocysteine in Kenyans with type 2 diabetes without overt cardiovascular disease at Kenyatta National Hospital, Nairobi.

BACKGROUND: Increased total homocysteine (tHcy) is an independent risk factor for cardiovascular disease. The measurement of tHcy in blood is therefore of potential great importance especially in patients with type 2 diabetes. OBJECTIVE: To determine the total homocysteine levels in ambulatory patients with type 2 diabetes. DESIGN: Cross-sectional, prospective study. SETTING: Outpatient diabetic clinic of the Kenyatta National Hospital. SUBJECTS: Ambulatory patients with Type 2 diabetes without overt cardiovascular, renal, liver or other chronic disease. MAIN OUTCOME MEASURES: Serum levels of tHcy, HbA1c, lipids and socio-demographic characteristics. RESULTS: A total of 115 patients, 48% males, with type 2 diabetes were included in the study. The mean (sd) age of the males was 56.85 (8.96) years and of the females was 55.68 (8.93) years. The mean (sd) total serum homocysteine for males of 12.97 (6.06) micromol/l was significantly higher than that of the females of 10.64 (4.41) micromol/l. The cholesterol, glycated haemoglobin, the body mass index and blood pressure of the study subjects did not show any statistically significant influence on their homocysteine levels. However, increasing age and duration of diabetes showed a significant linear relationship with rising level of total serum homocysteine. Some study participants reported smoking habit but unreliably. CONCLUSION: There was a significant proportion of the study patients with high levels of serum homocysteine, although most of them were of low to intermediate risk category. It may be prudent to assay homocysteine levels in patients with type 2 diabetes who are either older or have had diabetes for long duration for potential intervention.

Lipid profile of ambulatory patients with type 2 diabetes mellitus at Kenyatta National Hospital, Nairobi.

BACKGROUND: Patients with type 2 diabetes are at high of cardiovascular events because they have abnormal lipid status compared to their non-diabetic counterparts. OBJECTIVE: To determine the quantitative lipid profile of ambulatory patients with type 2 diabetes mellitus. DESIGN: Prospective, cross-sectional descriptive study. SETTING: Out-patient diabetic clinic of the Kenyatta National Hospital. SUBJECTS: Ambulatory patients with type 2 diabetes but without obvious cardiovascular, renal or foot complications. RESULTS: A total of 213 patients with type 2 diabetes were studied, 56.8% were females. The age range of the study population was 34 to 86 years, mean(sd) age of females was 54.45 (9.4) years and that of males was 55.83 (9.3) years. The mean body mass index (BMI) of females was 27.85 (6.2) kg/m2 and 25.98 (5.8) kg/m2 for males. The female subjects were more obese than the males in this study. Over 70% of the study participants had total cholesterol > 4.2 mmol/l, 43.8% and 57.6% of the females and males respectively had LDL-C > 2.6 mmol/l , 25.6% of the females and 30% of the males had HDL-C < 1.00 mmol/l. Only a modest proportion of males (28.3%) and females (32.2%) had triglycerides > 1.7 mmol/l. The LDL-C showed a significant positive correlation with age, duration of diabetes, fasting blood glucose, and total cholesterol but no correlation with glycated haemoglobin, body mass index, gender and the mode of glucose-lowering treatment. CONCLUSION: There was significant proportion of quantitative dyslipidaemia in the study population especially with the Total--and LDL- cholesterols. Although treatment goals and lipid thresholds for cardiovascular risk in diabetes are not yet well-defined, even by the large randomized trials, high-risk patients with significant quantitative dyslipidaemia would require deliberate effort to correct the abnormal values to reduce the risk status. These high-risk patients without complications but already had significant dyslipidaemia, which enhances the risk of cardiovascular events, certainly required therapeutic intervention.

Cardiovascular risk factors in patients with type 2 diabetes mellitus in Kenya: levels of control attained at the Outpatient Diabetic Clinic of Kenyatta National Hospital, Nairobi.

OBJECTIVES: To determine the proportion of specific cardiovascular risk factors in ambulatory patients with type 2 diabetes and the levels of control achieved in them. DESIGN: Prospective, cross-sectional study over a six month period. SETTING: Out-patient diabetic clinic of the Kenyatta National Hospital. SUBJECTS: Two hundred and eleven patients with type 2 diabetes. MAIN OUTCOME MEASURES: Sociodemographic attributes, duration of diabetes, levels of glycaemia, body weight, blood pressure, fasting lipids and modes of treatment. RESULTS: A total of 211 patients were enrolled, 57.3% were females. The mean (SD) age for women was 54.45 (9.44) and that of men was 55.8 (9.02) years. About 77% of the study population were on oral glucose-lowering agents with or without insulin but less than 30% achieved HbA1c < 7%; 15% were active cigarette smokers; about 50% were hypertensive with female predominance but 65% of them did not achieve desired blood pressure level inspite of treatment. Just over 50% had raised LDL-cholesterol and over 75% had raised total cholesterol but only three men were on statins without achieving desired targets. Body mass index above 30 kg/m2 as a measure obesity was found in 32% of females and 16% males. Most of the study patients admitted use of Aspirin at certain times in the course of their diabetes. CONCLUSION: The study showed that specific cardiovascular risk factors of hyperglycaemia, dyslipidaemia, hypertension and obesity were prevalent although not adequately controlled to targets. Statin use was extremely low in people who already needed them. Regular Aspirin use was infrequent because many patients did not quite understand its role in their diabetes treatment. It is recommended that a more pro-active approach in multifactorial address of cardiovascular risk factors be used in high-risk patients with type 2 diabetes to forestall future cardiovascular events.

Oral manifestations of HIV/AIDS in a Kenyan provincial hospital.

BACKGROUND: In Kenya many patients exposed to the HIV infection present with orofacial lesions as the primary manifestations of the disease and only a few studies have been performed to document this observation. OBJECTIVE: To clinically evaluate and document the range and pattern of oral lesions in a group of hospitalised patients with HIV-infection. DESIGN: A prospective study. SETTING: Coast Province General Hospital in Mombasa, Kenya, which is the main referral institution serving a population of approximately two million people. METHODS: Examination of all the cases included in the study was performed according to the WHO criteria. Both male and female patients aged 16 years and above were selected. The criterion of recruitment was based on a suspicion of immunosuppression, the presence of oral manifestations and the willingness to participate in the study. Prior to the examination each patient had undergone counselling followed by two consecutive screening tests using the ELISA technique. Where indicated incisional biopsy was performed to confirm the clinical diagnosis of the relevant lesions. In collaboration with the medical team, treatment was administered as per the needs of the patient in terms of anti-fungals, antivirals or topical cortisteroids. RESULTS: Of the 61 cases, 25(41%) were males and 36(59%) females with an age range of 19 to 65 years (mean = 34.7 years). While all the cases had periodontal disease, over 80% had candidiasis of the hyperplastic, erythematous and pseudomembraneous types. Lymphadenopathy and angular cheilitis were each diagnosed in 27.9% of the cases; while oral Kaposi's sarcoma was seen in 13% of the patients. Other conditions seen included persistent oral ulceration (11.5%), oral hairy leukopLakia and herpes zoster each constituting 4.9%; herpes simplex, mucosal hyperpigmentation, parotomegaly and facial palsy each comprised six per cent and oral warts seen in one case. In accordance with the pattern and prevalence of oral manifestations in our study, the results were largely consistent with those documented elsewhere. CONCLUSION: For the alleviation of the morbidity arising from the commonly occurring lesions, early detection is mandatory. Furthermore, documentation of the varied regional patterns of occurrence of these lesions may aid in the rational application of the emerging treatments.

PGF2 alpha on drug-induced contractile responses of frog rectus abdominis muscle.

In the present study, augmentation of contractile responses to acetylcholine, potassium chloride and caffeine by prostaglandin F2 alpha on frog rectus abdominis muscle is documented. The PG-induced responses to ACh was restricted to brief exposure of the tissue to PG. Prolonged exposure resulted in disappearance of the enhancing effect and depression of ACh responses. The augmentation of ACh response was unaltered in presence of physostigmine and the pA2-value of d-tubocurarine was not changed by PGF2 alpha ruling out the involvement of a cholinergic mechanism. In potassium depolarized muscle, PGF2 alpha abolished the contractile response to caffeine, indicating an action at the trigger calcium site. PGF2 alpha also permitted reactivation contracture during repolarization.