Idiopathic and Autoimmune Diseases

                                        http://austinpublishinggroup.com/immune-research/

In our homeopathic practice we regularly come across a patients having some idiopathic or autoimmune diseases as these diseases has no treatment in allopathy.

In such a patients before starting to a treatment we take their complete history, family history, previous diseases and treatments taken. from this history we used to regularly observe that these patients are having some disease which is also running through their families and these are get suppressed by some anti inflammatory drugs, steroids, or for skin disease by strong external application ointments initially. for example some patients come to us with some chronic diseases either some idiopathic or autoimmune disease is having history of eczema which is also running through his family got suppressed by antihistamine, steroid ointments. Then these patient after some days present with severe life threatening diseases of vital organ in body to these they usually named as idiopathic or autoimmune diseases. these are Rheumatoid arthritis, idiopathic thrombocytopenic purpura, insulin resistance diabetes etc.

In these patients we prescribe a drug which is very similar to the behavioral, genetic, constitutional make up of patient. This leads to the reappearance of old ailments of previous diseases like itching, burning, eruptions on skin and as these eruptions flares up on the skin patients suffering get more and better. Similar to the suppression skin diseases allergies there is increased use of hormones in treatment of some specific diseases or even excessive and unnecessary use of drugs like HCG in natural phenomenon like pregnancy will definitely going to affect hormone mediated immunity too.

Malakoplakia of the Vulva Following Lung Transplantation

                                           http://austinpublishinggroup.com/invitro-fertilization/

A67-year-old woman with a past medical history of interstitial lung disease, status post bilateral lung transplant, presented with persistent painful bilateral labial lesions, which first appeared three months post-transplant. The lesions were biopsied and initially diagnosed as an abscess. Additional lesions developed and cultures grew Escherichia coli; however, despite treatment with multiple antibiotics and tapering of immunosuppressive agents, the lesions never resolved. A subsequent pelvic exam revealed three to five erythematous papules on bilateral labia measuring up to 4 mm in greatest dimension without spontaneous drainage. The patient underwent complete excision of all vulvar lesions and the specimens were received in surgical pathology.

Microscopicexamination revealed a nodular proliferation of sheets of histiocytes occupying the dermis with admixed lymphocytes and neutrophils, underlying an unremarkable epidermis. Numerous targetoid, basophilic Michaelis-Gutmann bodies were conspicuously seen within the proliferation, highlighted by von Kossa and periodic-acid Schiff stains. Special stains for infectious organisms were negative. A diagnosis of malakoplakia of the vulva was made.

Ethmoid-Nasal Phosphaturic Mesenchymal Tumour

                                         http://austinpublishinggroup.com/infectious-diseases/

Male patient, 53 years old, had been showing nasal obstruction for six months, otitis treated with inhaled antibiotics and crenotherapy with no results. He also reported paresthesia on left hard palate. He underwent rhinoscopy with optical fibres showing evidence of a neoformation of the right nasal concha, basis right of the nasal cavity with subtotal occlusion of the right posterior nasal aperture which impeded to see the Eustachian tube orifice. A CT with contrast medium confirmed the presence of a neoformation with partial involvement of the right pterygopalatine fossa, delimited by a confining bone. As the neoformation was located, the patient underwent an endoscopic transnasal surgical removal of the neoformation. Thehistological result initially showed the neoformation as a pleomorphic adenoma of the right nasal cavity. After a revision of the slides in another centre a phosphaturic mesenchymal tumour was diagnosed, due to the histological polymorphism characterized by hyalinization with microcystic spaces and a prevalence of chondroid and myxochondroid pattern. Later, the patient underwent a revision of the surgery with enlargement of the surgical margins and with a completely negative histological result for the disease. Moreover the concentration of calcium, phosphatemia and phosphaturia excluded Tumour-Induced Osteomalacia (TIO). Today, after 8 months since the second surgery, the patient appears to be free from the disease.

ETM PMTs are extremely rare. The diagnose is usually late due to the presence of osteomalacia or to symptoms linked to a local invasion. Patients affected by paraneoplastic syndrome can show nonspecific bone pain, muscular weakness and pathological fractures. PMT doesn’t show to have any link with sex and emerges to affect a very ample range of patients, from the age of 3 to 73. 95% of PMTs were observed in bones and only 5% in craniofacial districts. Among these about 50% of tumours were found in the sinonasal tract. In our revision it was observed that 20 cases of PMT reported in literature involve the sinonasal tract, while the rest of them involve other ETM tracts, as mandible, mouth, pharynx, larynx, thyroid and temporal bone. From a histological point of view PMT is characterized by spindle-shaped or stellar cells in a myxochondroid or myxoid matrix with calcification. Osteocytes in PMT are responsible for osteomalacia through the production of Fibroblast Grow Factor 23 (FGF23), which inhibits the transport of the sodium phosphate renal tubules leading to a phosphaturia and a consequent bone demineralization. PMT is mostly suspected when a not familial hypophosphatemia is present. Diagnostic workup must take into consideration the patient’s history, an objective systemic exam and a search for localizations in arms and legs and ETM. An otorhinolaryngologist who finds himself in front of a histological PMT must investigate a possible osteomalacia, as most cases see the presence of a paraneoplastic syndrome, and exclude the involvement of the bones. In the series displayed in chart 1 it is possible to observe that only 6 patients didn’t present TIO. In an extensive revision carried out by Folpe et al. on 109 mesenchymal tumours on the extremities, only 3 cases didn’t present TIO. The first line treatment is surgical resection with ample margins, which leads to a normalization of phosphatemia and phosphaturia with an improvement of the mineralization of bones. The persistence of metabolic alterations after surgical resection is predictive of an incomplete surgical resection or a relapse. Surgery appears to be the best choice also for the rare malignant manifestations of PMT, while adjuvant chemotherapeutic treatments haven’t been established, yet, due to the small amount of cases.

The Risk Criteries of Central Nervous System Involvement and the Management of its Treatment in Patients with Langerhans Cell Histiocytosis

                                       http://austinpublishinggroup.com/austin-hematology/

Langerhans Cell Histiocytosis (LCH) is a rare disease of monocytic-macrophage system and it is characterized by reactive clonal proliferation and accumulation of pathologic dendritic cells. Therefore, LCH was suggested recently to be a neoplastic disease and BRAF-V600E mutation is seen 60% of patients with LCH. LCH affects various organs such as bone, lungs, skin, liver, spleen, lymph nodes and Central Nervous System (CNS). LCH CNS disease can be divided into two groups. One is focal mass lesions; other is lesions associated with progressive neurodegeneration. Focal, space-occupying mass lesions are localised in meninges, choroid plexus and brain parenchyma which may contain CD1a+ LCH cells, lymphocytes and macrophages with histology similar to extra cranial lesions. The most common involvement sites are the hypothalamic pituitary region which is leading to anterior and posterior pituitary involvement that results DI, growth hormone deficiency and thyroid function abnormalities. 

The other neurological findings of LCH are progressive neurodegeneration (ND-LCH) which is characterized by progressive radio logical and clinical abnormalities. The ND-CNS-LCH occurs mostly in children, but rarely in adult LCH patients. There are two stages in ND-CNS-LCH: an early neurologically symptom-free stage characterized by MRI abnormalities alone and a second stage that includes prominent neurological symptoms Typical T2-weighted MRI findings are the increased symmetrical MRI signal in the dentate nucleus of the cerebellum, basal ganglia, plexus choroideus and pons. LCH – associated abnormal clinical findings such as ataxia, tremor, abnormal cerebellar tests are characterized by absence of CD1a+ histiocytes, an inflammatory collection of CD8+ lymphocytes with neuronal and axonal degeneration and extensive demyelination, Purkinje cell loss, gliosis that is explained as ‘paraneo plastic phenomena’.

LCH patients known to have an increased risk for CNS complications have craniofacial involvement at the time of diagnosis (single skull lesions of the orbit, temporal, mastoid, sphenoid and ethmoid bones), Multi System (MS) involvements such as bone marrow, lung, liver and bone marrow involvements, children below the age of 2, carrying BRAF-V600E mutation in CD207+ cells, treatment-resistant cases to prednisolone plus in blastin therapy for 6 months and those patients with multisystem disease (with or without detectable BRAF-V600E mutation). LCH spread to CNS would be hematogeneous or lymphatic routes. Sometimes, CNS manifestations occur even in the absence of detectable disease elsewhere in the body. 

Magnitude of Hepatitis B Virus among Barbers in Addis Ababa, Ethiopia

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Viralhepatitis is a major health problem worldwide. Hepatitis B virus (HBV) is of the greatest concern due to its burden of illness and death. WHO and the U.S Centers for Disease Control (CDC) estimate that over 500 million people are currently living with chronic viral hepatitis and globally around 2 billion people have been infected with hepatitis B virus with around 1 million people die every year due to complications of hepatitis B, including cirrhosis and liver cancer. HBV can cause both acute and chronic diseases. Hepatitis B virus is 50-100 times more infectious than human immunodeficiency virus (HIV) and 10 times more infectious than hepatitis C virus (HCV) and an infectious dose is so low that a contaminated razor or blade can easily transmit the infection.

Thehepatitis B virus can survive in the environment for at least 7 days. During this time, the virus can still cause infection if it enters the body of a person who is not protected by the vaccine. It can also spread by percutaneous or mucosal exposure to infected blood and various body fluids, as well as through saliva, menstrual, vaginal, and seminal fluids. Infection in adulthood leads to chronic hepatitis in less than 5% of cases. In addition, infection can occur during medical, surgical and dental procedures, through tattooing, or through the use of razors and similar objects that are contaminated with infected blood or during barbershop shaving.

Razorsharing and shaves from the barbers have been identified as an important risk factors for blood-borne viruses spread as several investigations carried out all over the world demonstrate this facts. In many parts of Africa and Asia, the widespread cultural practice of shaving at a shop or roadside barber is an underestimated route of blood-borne viral disease transmission. For barbers, the use of blades and razors is part of their occupation, which can expose them to blood of customers while shaving and hair cutting. This exposure can put them at risk of many blood-borne diseases including viral hepatitis.

Surgery Following Failure of Repeated Chemotherapy for Squamous Cell Carcinoma of the Tongue can be Fatal and Futile

                                    http://austinpublishinggroup.com/head-neck-oncology/

SquamousCell Carcinoma of the Oral Cavity (OSCC) has a strong presence in this part of the world – with the 2012 GLOBOCAN estimates reporting the highest age-standardized rate, with respect to the world population, in the World Health Organization (WHO) South-East Asia region (6.0 per 100,000). OSCC is known to carry high mortality and morbidity, with various cohorts having described five-year Overall Survival (OS) between 36.1% to 62.5%, and complications rates ranging from 47% to 62%. The tongue is the most common subsite in OSCC.

Surgery has been established as the treatment of choice in OSCC, with chemotherapy and radiotherapy largely being used in the adjuvant setting for patients with specific risk features, and in the palliative setting for patients with recurrent or unresectable disease. Multidisciplinary care is imperative for ensuring favorable outcomes. Nevertheless, some patients seek alternative non-surgical treatment in the primary setting due to concerns of surgical morbidity and its impact on essential functions of eating, drinking, chewing, swallowing, and speaking.

While it is understandable that concerns arising from potential surgical morbidity may deter patients from accepting treatment upfront, non-surgical treatment in the primary setting for resectable OSCC has been associated with poorer outcomes. There is little published data on the outcomes of patients who avoid surgery and instead undergo multiple cycles of non-surgical treatment for OSCC.

The Most Common Cause of Sudden Cardiac Death in Athletes: Hypertrophic Cardiomyopathy-Associated Genes and Mutations

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SuddenCardiac Death (SCD) is natural and unexpected death from cardiac causes, heralded by abrupt loss of consciousness within 1hour of the onset of an acute change in cardiovascular status. It is difficult to estimate the incidence of SCD but cardiovascular diseases are responsible for approximately 17 million deaths every year in the world, approximately 25% of which are SCD. Several factors like age, race, gender and heredity influence the incidence of SCD. The risk of SCD is higher in men than in women and it increases with age due to the higher prevalence of Coronary Artery Disease (CAD) in older age. Cardiac diseases associated with SCD differ in young vs. older individuals. In the young, there is a predominance of channelopathies and cardiomyopathies, myocarditis and substance abuse, while in older populations, chronic degenerative diseases predominate.

Causes of SCD are numerous: atherosclerotic coronary artery disease, nonatherosclerotic coronary abnormalities, ventricular hypertrophy of myocardium including hypertrophic cardiomyopathy, myocardial diseases and heart failure, congenital heart diseases and diseases of cardiac valves, electrophysiological abnormalities of cardiac conduction system (eg: Wolff Parkinson White Syndrome, Brugada Syndrome, long QT interval syndromes) and miscellaneous causes including extreme physical activity, blunt chest trauma(commotio cordis) and aortic dissection.