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  • Clinical and Histopathological Evaluation of Prurigo Nodularis

    Background: Prurigo nodularis (PN) is a well-defined chronic recognized entity as a cause of severe chronic itching. However, this medical problem is not well studied and evaluated previously in Iraqi population. Objective: To do full clinical and histopatholgical evaluation of patient with PN. Patients and methods: This study is an observational cross sectional that was conducted at the Center of Dermatology, Medical City Teaching Hospital. All cases with classical PN and localized variant where collected. Full clinical evaluation was carried out. Biopsies were taken from 10 patients out of 50 with prurigo nodularis processed and stained with Hematoxylin and Eosin. Results: Fifty patients were included, there were 22 (44%) males and 28 (56%) females ,their ages ranged from less than 20-60 years with mean ± SD of age (40 ± 16) years .The common associated disease was atopic dermatitis in 36 (72%) patients, while family history of disease was seen in 24 (48%) patients, psychological factor was seen in 30 (60%) patients . The clinical picture was excoriated nodular lesions commonly on limbs with symmetrical fashion in 40 (80%) of cases while localized pattern was detected in 10 (20%) of patients. Histopatholgical evaluation in ten patients had shown hyperkeratosis (100%), acanthosis (60%), and pseudoepithelamatous hyperplasia (40%). Eosinophils were seen in one patient. Conclusion: This study showed classical prurigo nodularis in 80% of cases while localized in 20% of the patients. It is a disease of middle age patients, more in females than males. Family and personal history of atopic dermatitis was a high finding the histopathology is typical of prurigo nodularis with sparse eosinophils.

  • Gastric Outlet Obstruction: Transform in Etiogenesis

    Objective: To determine the frequency of various etiologies of Gastric Outlet Obstruction in Northern part of Rajasthan, India. Design & Duration: Prospective study carried out from March 2018 to March 2019. Methodology: The data of all the patients who presented with the features of Gastric Outlet Obstruction during the above mentioned period was collected. This data was analyzed with specific reference to recent trends in its etiology. This change in trend was compared with other local and international studies. Results: Fifty patients were included in the study. All patients underwent upper GI endoscopy and biopsy; 40 cases were diagnosed by this method and the remaining by CT scan. Gastric carcinoma was the most common cause of Gastric Outlet Obstruction seen in 36% of the cases. The next common etiology was peptic ulcer disease which was responsible for 32% of the patients. Conclusion: The ratio between benign and malignant etiologies of Gastric Outlet Obstruction is showing a gradual change in favour of malignant lesions. This change is similar to the trends reported in the western literature.

  • Analysis of Cases of Tuberculosis Related to Diabetes Patients and the Concurrent Use of Licit and Ilicit Drugs in the State of Pernambuco

    INTRODUCTION: Tuberculosis is an infectious disease caused by the bacterium Mycobacterium tuberculosis. In Brazil, TB is considered a public health problem due to the high rate of cases, ranking 20th in the notified cases ranking. The transmission of the disease is related to some lifestyles, since there is a higher incidence in patients with diabetes Who use illicit and licit drugs such as tobacco and alcohol. Factors such as diabetes, alcoholism, smoking and illicit drugs favor the spread of the disease and may shift from latent to active tuberculosis. OBJECTIVE: Given the above, the objective of this study was to verify the cases of tuberculosis related to patients with diabetes and the use of licit and illicit drugs in the state of Pernambuco from 2015 to 2018. METHODS: This is a descriptive study with approach. To verify the incidence of tuberculosis in a given group. For this data were obtained from the SINAM / DATASUS database. The variables used were: diabetes, alcoholism, smoking and illicit drugs. RESULTS: From 2015 to 2018, 19,733 cases of tuberculosis patients were reported. Of these 1,890 (10%) were affected by diabetes, and in 2017 the most affected with (26.5%). Greater susceptibility to develop tuberculosis due to hyperglycemia, leading to insulin dependence which generates indirect cellular effects. It was observed that of the notified by tuberculosis about 4,584 (23%) stated to use alcohol. Alcohol is also considered a risk factor as it alters the immune response due to liver damage, thus leading to an increase to develop TB with an increase of (26.6%) in 2017. TB involvement in patients who have tobacco use was 4,258 (22.1%) with an increase of (31.5%) in 2018, the tobacco is a risk factor because it has reduced immune response due to ciliary dysfunction, developed by cigarette smoke . Given the…

  • Vitiligo Treated by Soaking in an Earth Pond Containing KELEA Activated Water

    Vitiligo completely regressed in two patients who spent several hours for each of three consecutive days in a pond that contains water with a heightened quantity of a non-thermal activity attributed to a natural force called KELEA (Kinetic Energy Limiting Electrostatic Attraction). KELEA is further defined as the source of cellular energy, which comprises the alternative cellular energy (ACE) pathway. The ACE pathway differs from the cellular energy obtained from food metabolism. It is expressed as an added dynamic (kinetic) quality of the body’s fluids. The body utilizes the ACE pathway in both chemical and electrical cellular reactions, including the recovery and regenerative processes following cellular damage. The ACE pathway supports the higher levels of brain functioning including the likelihood of improving upon the presumed KELEA receiving capacity of the brain. The ACE pathway can also limit the triggering and maintenance of the inflammatory response. Each of these activities is presumably involved in the clinical regression of the vitiligo in the two patients. Enhancing the ACE pathway may provide an effective therapeutic approach for many patients with vitiligo.

  • Clinical Picture of Celiac disease: Experience from a health care provider in Arabia

    Background: Most studies describing clinical features and associations of celiac disease come from the studies conducted in the western world. Our aim was to determine the clinical features and associations of Celiac disease from our centre serving a Middle East population in Saudi Arabia. Methods: This retrospective study was conducted in a health care provider serving the Eastern Province of Saudi Arabia. All patients with biopsy-confirmed celiac disease receiving health care at our centre between April 2002 and December 2018 were identified. Individual case records were reviewed. In addition, the Slicer Dicer function was also used from the Electronic medical health record [EPIC] for analysing the clinical features and associations. Results: We analyzed the clinical features of 149 patients with Celiac disease. 66% of these were females. There was progressively increased yield of confirmed Celiac disease over the study period. This was paralleled by an increase in TTG antibody tests performed year by year. 77 (51.6%) patients had gastrointestinal symptoms. 26% of patients had iron deficiency anemia. 24 patients (16%) had diabetes, of which 46% were type 2. 18 (12%) patients had osteoporosis or osteopenia, and 28 (19%) had various skin diseases. Conclusion: In Saudi Arabia, celiac disease is being increasingly recognized, largely because of increased awareness and increasing TTG antibody testing. Many patients present with non-gastrointestinal symptoms. Knowledge about the varied clinical features and the targeted use of celiac serology should lead to even earlier recognition of the disease.

  • Single Oral Dose of Ivermectin as a New Therapeutic Trial for Contacts of Patients with Scabies

    Background: Scabies is one of the common epidemic and endemic diseases worldwide. Many topical therapeutic modalities for scabies are available. Topical ivermectin has been used effectively in treatment of scabies but there is no oral effective therapy that prevents contacts to get scabies. Objective: To evaluate the effectiveness of oral ivermectin in prevention of scabies contacts to get scabies. Patients and Methods: The study is a single-blinded therapeutic study that was conducted in the Center of Dermatology, Baghdad Teaching Hospital, Baghdad, Iraq during the period from April 2018 through October 2019.Two hundred sixty healthy scabies contacts were included in this study, their ages ranged from 5-60 years with a mean ± SD of 19.3± 1.9 years. All these contacts were screened for active scabies and they were all free. The contacts of scabies were treated by ivermectin tablet 200 microgram per kg as a single dose after 2 hours from dinner. They were seen regularly after 4 weeks to be re-examined and to record any scabies and drug side effects. Results: The response after four weeks of single dose therapy of healthy contacts showed that 245 (94%) from 260 were free of scabies and only 15(6%) contacts showed infection with scabies and this was statistically significant Chi-square (c2= 148, P-value less than 0.00000001. No any side effects were noticed in any treated contacts. Conclusion: Oral single ivermectin dose is an effective therapy to prevent scabies contacts to get infection. It an easy method of prevention which is very useful in condition of scabies outbreaks and epidemics to stop the rapid spread of the disease.

  • Keratosis Pilaris Rubra Totalis: Clinical and Histopathological Study with New insights

    Background: Keratosis pilaris rubra (KPR) is a common but unrecognized follicular keratinizatioin. It is a common skin problem among Iraqi population and most cases were misdiagnosed as dermatitis as there are few reports in medical literature. Objective: To do full clinical and histopathological evaluation of KPR in Iraqi population. Patients and Methods: This is case descriptive, clinico-histopathological outpatient based study. It was done in the Center of Dermatology and Venereology, Baghdad Teaching Hospital, Medical City, Iraq during the period from March 2016 to October 2017. Sixty patients were enrolled in this study. History and dermatological examination were carried out for all patients. Skin biopsy was done for 10 patients for histopathological study using Hematoxylin and Eosin stain. Results: A total of the 60 patients were diagnosed as KPR during the study period. Thirty nine (65%) males and 21 (35%) females. The age at onset of disease ranged from since birth to 8 (2.9± 2.17) years . Facial involvement included the cheeks in 60 (100%) patients. Other sites of involvement included the arms where the lateral aspects involved in 60 (100%) patients and the medial aspect 11 (18.3%), thighs including the buttocks in 51 (85%), trunk 25 (41.6%), legs 22 (36.6%) and the neck 15 (25%).The rash was erythematous all over but most obvious on the sides of face presenting as red, rough face. Histopathological evaluation showed follicular plugging in (100%) with dilatation of both superficial and deep vascular plexus in (75%) of cases. Limitation: The main limitation of this study was the lack of follow up data related to the subject of the study. Conclusion: KPR is a common condition among Iraqi population and this study is the largest study carried out all over the world. As most areas of body are involved, the name keratosis pilaris rubra totalis is…

  • Polypoid Collagenous Colitis: A Microscopic Colitis with a Macroscopic Appearance

    Collagenous colitis is a type of microscopic colitis which was originally named based on specific histologic features and the lack of macroscopic abnormalities in the colon. However, there are reports in the literature that describe various macroscopic findings on colonoscopy in patients with histologically confirmed microscopic colitis. We report a case of collagenous colitis that was characterized by a diffusely polypoid colonic mucosa on gross examination of a right hemicolectomy specimen that was performed for a benign neoplasm in a 72 year old man. It is important for endoscopists to be aware of the various macroscopic abnormalities that may be present in this “microscopic” disease.

  • 2019 Coronavirus Disease (COVID-19) Outbreak: A Review Article

    In December 2019, an outbreak of severe acute respiratory syndrome coronavirus 2 infections occurred in Wuhan, Hubei Province, China and spread across China and beyond. On February 12, 2020, WHO officially named the disease caused by the novel coronavirus as Coronavirus Disease 2019(COVID-19). The COVID-19 is a respiratory illness caused by a coronavirus and pandemic is now a major global health threat. Coronaviruses (CoV) belong to the genus Coronavirus with its high mutation rate in the Corona viridae. This review focuses to have a preliminary opinion about the disease, the ways of treatment, and prevention in this early stage of COVID-19 outbreak.


    Background: Upper gastrointestinal complaints are common, and the underlying diseases varies widely. Upper gastrointestinal endoscopy is the gold standard investigation for upper gastrointestinal symptoms. It helps in the proper diagnosis and the appropriate management of the underlying lesions. Aim: To determine the characteristics of the patients undergoing upper gastrointestinal endoscopy in a rural community in south-western Nigeria. Methods: This was a retrospective cohort study of all patients who had upper gastrointestinal endoscopy between February 2016 and February 2020 (a period of 4 years). The Age, Gender, Indication and the Endoscopy findings were obtained from the Endoscopy Register. A total of 181 upper gastrointestinal endoscopies had been performed over the period. The data obtained was analyzed using the Statistical Package for the Social Sciences (SPSS) version 21.0. Descriptive statistics used included frequency tables, means and standard deviations. Results: A total number of 181 Oesophagogastroduodenoscopies (OGDs) were performed during the period under review, out of which 95 (52.5%) were males and 86 (47.5%) were females with a male to female ratio of 1.1 to 1. The age range of the patients was 9 to 89 years with a mean(±SD) of 52.4(±1.69) and median of 52.0 years. The highest number of OGDs were performed on individuals within the age bracket of 50-59 years whom were mostly females. Dyspepsia constituted the commonest indication for OGD (51.9%) followed by symptoms of upper gastrointestinal bleeding (haematemesis/melaena) 16.0%, unexplained persistent vomiting 6.6% and clinical suspicion of a gastric tumour 5.5%. The commonest endoscopic abnormality detected from this study was Gastritis 28.2% followed by Gastric erosions 12.2%, Duodenal ulcers 8.8%, Gastric tumours 8.3% and Oesophagitis 7.2%. Normal endoscopy findings were found in 24.9% of the patients. Gastritis was also the commonest endoscopic finding (constituting 40.4%) in patients who had OGD done on account of dyspepsia followed by Duodenal…