OPPORTUNISTIC DIGESTIVE PARASITOSIS IN PATIENTS INFECTED WITH HUMAN IMMUNODEFICIENCY VIRUS IN MOROCCO

Introduction: Opportunistic intestinal parasites (OIP) are a major cause of diarrhea in patients with HIV infection. We carried out this study to assess the prevalence and characteristics of OIP in Marrakech. Method: A retrospective cross-sectional study in a hospital environment was carried out in the infectious diseases department of Mohammed VI University Hospital, from January 2007 to October 2019. The diagnosis of OIP was made by parasitological examination of the stool, gastro panel intestinal FilmArray® multiplex PCR and / or histology. Result: Forty-eight patients with IOP were included. The prevalence of IOP was 5.17%, 40 patients had cryptosporidiosis, 6 patients had microsporidiosis and 2 patients had isosporosis. Thirty patients had co-infection with other opportunistic infections. Thirty-five patients were on ARVs. Eleven patients (22.9%) died during the study and 77.1% did well. Conclusion: The results of our study should prompt physicians treating HIV-infected patients in Morocco to request a stool exam and specific tests for Cryptosporidium, microsporidia and Isospora, especially in patients with low CD4 count.

PATH-47. THE 2016 WHO CLASSIFICATION AND IT'S CLINICAL IMPACT: THE LEEDS TEACHING HOSPITALS NHS TRUST EXPERIENCE

INTRODUCTION In 2016 the WHO Classification of Tumours of the Central Nervous System was updated to include molecular testing, in addition to the previous standard histological methods; producing a final integrated diagnosis. Although molecular information can guide treatment and aid in prognostication, it adds a significant workload to pathology and genetic testing services. Delayed diagnosis can also add anxiety to patients, at an already traumatic time. AIMS: To determine if final integrated diagnoses, for patients undergoing neurosurgery for CNS tumours, is being provided in an appropriate time frame, and whether it changes clinical management. METHODS All patients >16 years at the time of surgery with a histopathologically-confirmed CNS tumour were identified from 2016-2020. A retrospective analysis of the time taken to produce an integrated histological diagnosis took place, using the date of surgery and date of verified final integrated report being the first and last data points respectively. Data were collected by accessing electronic and paper health records, and local databases. Changes in clinical management between the initial histology result and the final integrated diagnosis were classified as no change or a major change. RESULTS 1390 surgical procedures for CNS pathology were identified between 2016-2020, producing 361 final integrated diagnosis reports. 64 (18%) of these reports resulted in a major change in clinical management when compared to the initial histology report. The turn-around time for initial histology from date of surgery was a mean of 9 days and a mean of 34 days for the final integrated diagnosis. CONCLUSIONS The integrated diagnosis is essential for providing the gold standard of treatment for patients, although for the majority of patients it does not change their clinical management. Further study and discussion is required about the role of the final integrated diagnosis in the management of patients with CNS tumours.

Liquid-Based Screening Tests Results: HPV, Liquid-Based Cytology, and P16/Ki67 Dual-Staining in Private-Based Opportunistic Cervical Cancer Screening

The baseline data from the private-based opportunistic cervical cancer screening with HRHPV14, liquid-based cytology (LBC) and p16/Ki67 testing, and its quality assessment/quality control (QA/QC) tools are lacking. The age-stratified analysis of 30,066 screening tests results in a Polish population, including the investigation of HRHPV14 status, LBC, and p16/Ki67 dual-staining reporting rates, along with immediate histopathologic correlations, was conducted. For cytopathologic QA/QC, the College of American Pathologists (CAP) benchmarks and enhanced safety protocol were used. The NILM/ASC-US/LSIL/ASC-H/HSIL/AGC reporting rates were 93.9/3.4/2.0/0.22/0.24/0.11, respectively, with correlating HRHPV14-positive rates of 8.4/48.9/77.2/84.6/90.7/26.7. The reporting rates for HSIL (CIN2+) in HRHPV-positive women with NILM/ASC-US/LSIL/ASC-H/HSIL/AGC referred for a colposcopy with biopsy were 19.1/25.8/22.5/12.4/19.1/1.1% of the total HSIL (CIN2+). In total, of the 1130 p16/Ki67 tests, 30% were positive. In NILM HRHPV14-positive women with available histology result, HSIL(CIN2+) was detected in 28.3% of cases. In the first such large-scale Polish study presenting HRHPV14, informed LBC and HSIL (CIN2+) results, the reporting rates were highly consistent with data from American and other CAP-certified laboratories, confirming the possibility of using the 2019 ASCCP risk-based guidelines as one of the screening strategies outside of the US, in conditions of proper QA/QC. The private-based screening model can be effective in cervical cancer prevention, particularly in countries with low population coverage of public funds-based systems.

Mesenterialis actinomycosis

Összefoglaló. Egy 46 éves nőbeteg esetét ismertetjük, akinél láz és görcsös hasi fájdalom miatt kezdődött kivizsgálás. A hasi ultrahangvizsgálat során a colon transversum területén megvastagodott falú konglomerátum volt látható. A kolonoszkópia során organikus eltérés nem igazolódott. A hasi komputertomográfiás vizsgálat retroperitonealis térfoglalást írt le, ezért onkológiai bizottság javaslata alapján műtét mellett döntöttünk. Egy hónappal a panaszok jelentkezése után megtörtént a műtét, melynek során úgy tűnt, hogy egy megközelítőleg 5 × 8 centiméteres, a vékonybélből kiinduló, a colon ascendenst és a sigmabelet is érintő, daganatnak imponáló terimét találtunk. Jobb oldali hemicolectomiát végeztünk, és reszekáltuk a sigmabélfal részletét. A szövettani vizsgálat malignitást nem igazolt, hanem a bélfallal összefüggést nem mutató, mesenterialis actinomycosist írt le. A hasi, mesenterialis actinomycosis ritka kórkép, mégis fontos, hogy gondoljunk rá mint differenciáldiagnosztikai lehetőségre, így a beteg a lehető leghamarabb megkaphatja a megfelelő kezelést. Esettanulmányunk bemutatásával a kórkép ismeretének fontosságára szeretnénk felhívni a figyelmet. Orv Hetil. 2021; 162(3): 116–119. Summary. We present the case of a 46-year-old female, who presented with fever and abdominal pain. Abdominal ultrasound revealed a thickened-walled conglomerate near the transvers colon. Colonoscopy did not show any organic abnormality. Abdominal computed tomography described a retroperitoneal mass, so we decided on surgery based on the multidisciplinary team decision. One month after the onset of symptoms, laparotomy was performed, and it seemed that we found an approximately 5 × 8 centimetre tumour attached to the small intestine involving the ascending and sigmoid colon. We performed right hemicolectomy and sigmoid colon wall resection. Histology result showed mesenteric actinomycosis with no connection to the intestinal wall, no malignancy was revealed. Although the abdominal, mesenteric actinomycosis is a rare disease, it is important to think of it as a differential diagnostic option, so the patient can get proper treatment and cured sooner. Our aim with presenting this case report is to highlight the significance of this disease. Orv Hetil. 2021; 162(3): 116–119.

Accuracy of Fine Needle Aspiration Cytology in Solitary or Dominant Nodular Goitre: A Single Centre Study

Background: Thyroid swelling or goitre is a common condition, either asymptomatic or symptomatic. The diagnosis is usually established by ultrasound or fine needle aspiration cytology (FNAC) as a gold standard. The sensitivity of the test is inversely related to increasing size of the nodule. The objective of this study is to evaluate the accuracy of FNAC especially in cases of large goitre. Material and methods: This is a retrospective study on patients who underwent thyroidectomy between January 2000 to December 2007 for solitary or dominant nodular goitre. The analysis was made only on those patients with complete data on FNAC and histology. Result: There were 235 patients, but only 161 patients were analysed after excluding the suspicious and inadequate sample. The patients’ mean age was 42.1 year old (21 to 60). The size of the thyroid nodule ranged from 2.1 to 5.0 cm (mean = 3.9 cm). The overall sensitivity was 67.4% and the overall accuracy was 86.3%. The accuracy of FNAC according to the sizes above and below the value were as follows; 2 cm (72.2% vs. 88.1%); 3 cm (88.0% vs. 87.4%) ; 4 cm (86.6% vs. 84.4%) ; 5 cm (87.3% vs. 78.8%). This was most obvious in the sensitivity of the FNA which also showed reducing trend as the nodules increased in size. Conclusion: FNAC is an essential diagnostic tool in the management of nodular goitre. Our study showed that the accuracy of FNAC decreased as the size of the nodule getting bigger. Cautious approach should be taken in the management of large goitre and decision should not be based only on the result of FNAC.

Histopathological profile of cervical biopsy specimens at Paropakar Maternity and Women’s Hospital

Aims: The lesions at uterine cervix cannot be always established only with cytology. Thus, it is very important that cytological abnormality be subsequently correlated with biopsy for confirmation of cervical lesion. Thus it is to see histopathological findings of different types of cervical pathology in cervical biopsies.Methods: This is retrospective analysis of histology result of 1184 cervical biopsy specimens from 2011 to 2016.Results: Out of 1108 histologically adequate cervical specimens, benign cervical lesion formed the major part (44.76%)followed by cervical inflammatory lesion (27.43 %). Malignant and borderline cervical lesion constituted 14.35% and 13.44% respectively; 6.4% biopsy samples were inadequate to report.CIN I was common among borderline lesions followed by CIN III. The most common cervical malignancy was squamous cell type and mostly moderately differentiated.Conclusions:Benign cervical lesions were the most common cervical lesions followed by inflammatory conditions. Among borderline cervical lesions CIN I was commonly found followed by CIN III.

Extract of Nanas Bongsai (Ananas comosus var. microstachys) on The Histology of The Limph and Uterus of White Rat (Rattus norvegicus)

Nanas Bongsai (Ananas comosus var. microstachys L.) is an amazing herb which is used in traditional medicine by local people of Muara Lembu district as a potion to reduce pain while menstruation period for a women. The present work was designed to investigate its probable side effects on the histopathologic changes in limph and uterus tissues after treated with A. comosus var. microstachys L extract in female white rats. This is an experimental research consisted of five treatments and three repetitions. Treatment composed of two controls (P0 and P+) and given Nanas Bongsai extract with three different dosages. Histology result of lymph show that all treatments given with Nanas Bongsai with three different dosages have different diameter average of white pulp and there is no significant changes with normal control. While observation towards histology structure of endometrium thickness with dosage P1, dosage P2, dosage P3 is 206.333±33.486; 215.667±33.486; 197.667±60.871 respectively. The most thin endometrium layer found in treatment with dosage P3 compared to control P0. From this study showed that there is no toxic effect on uterus and lymph function of of Nanas Bonsai (A. comosus var. microstachys L.) at different doses, so the plant is secure for consumption by the community.

Metastasis of a Dorsal Melanoma to a Pituitary Adenoma Mimicking Pituitary Apoplexy

Metastases to pituitary adenomas are very rare. From the 20 cases found in the literature, none originated from a cutaneous melanoma. We present the case of a 67-year-old man with a history of transcranial approach to treat a pituitary macroadenoma followed by adjuvant radiotherapy. Fifteen years later, he presented a dorsal nodular melanoma, and three years after that, he developed symptoms of pituitary apoplexy. He was submitted to transsphenoidal surgery, and the histology result revealed metastasis of the melanoma into a pituitary adenoma.The similarity in the clinical presentation of the two entities—pituitary apoplexy and metastasis of the melanoma into a pituitary adenoma—and the rarity of this type of metastization alert to challenges in the differential diagnosis that may confound the neurosurgeon's decision.

Pulmonary Gangrene - Severe And Rare Complication Of Pneumonia

SummaryPneumonia is an inflammatory lung disorder characterized by consolidation due to presence of exudates in the alveolar spaces. Most pneumonias can be effectively treated with appropriate oral antibiotics, with intravenous antibiotics being reserved for those with severe infections. We present two cases of girls admitted in our clinic with pneumonia where our conventional therapy was not sufficient. Case 1: A 15-year-old girl with cystic fibrosis, with left lobular pneumonia, for which an aggressive conservative treatment was initiated. After significant improvement, sudden detorioration and pneumothorax of the left lung occurred. She was transferred to the surgical department for intervention. Due to failure to respond to initial drainage she underwent thoracotomy and resection of the left lower lobe of the lung. The histology result confirmed gangrene. Case 2: A four-year old girl was treated for pneumonia in the right lung with aggressive intravenous antibiotic. After temporary improvement sudden deterioration was observed. The patient was transferred to the surgery department, where pulmonary gangrene was confirmed. After the lower lobe of the right lung was resected, she was discharged in good health. The careful follow up, accurate diagnosis and correct medication choice are crucial for reducing the complications of “common” pneumonia.