Physiology and Anatomy

Peripartum cardiomyopathy is a rare disease accountable for giving a heart failure, which affects women in the last month of pregnancy or within the first 5 postpartum months. Early signs and symptoms of heart failure may not be seen, they are often considered as a normal part of pregnancy. When such symptoms and signs are not diagnosed or managed accurately, the consequences can be deleterious for the patient. We are going to briefly report a case of a 28-years-old woman, without any preexisting structural heart disease. The woman, after 3 months of vaginal delivery following normal pregnancy, was admitted for cardiogenic shock and distal lower Limb Necrosis secondary to peripartum cardiomyopathy. Such complications are uncommon, and the management was not easily accepted by the patient.

Cronkhite Canada Syndrome (CCS) is a rare, non-hereditary disease that combines chronic diarrhea, diffuse intestinal polyposis and onychodystrophy. We are reporting on the observation of the first case of Cronkhite Canada Syndrome in Morocco. The case has to do with a 33-year-old patient with chronic bloody diarrhea associated with alopecia and onychodystrophy within a context of general deterioration and significant weight loss. The biological assessments were characterized by the presence of microcytic anemia with hypo albuminemia, malabsorption syndrome and hydro electrolyte disorders. The colonoscopy had shown several hamartomatous polyps located at the recto sigmoid level. The histopathological examination showed hyperplastic inflammatory polyps with extensive propria oedematous lamina, and cystic glands. The diagnosis of CCS was made in the face of a host of clinical, biological, endoscopic and histological arguments. Our patient received oral corticosteroids as treatment, along with nutritional support and a treatment of electrolyte disorders. Cronkhite Canada syndrome is associated with high mortality and a risk of malignant transformation. Clinicians should considerand think about CCS for a patient with unexplained chronic diarrhea and dermatological manifestations (Alopecia, Onychodystrophy, Hyperpigmentation).

This study assessed the effect of lemongrass tea (LGT) on liver function indices in humans. One hundred and five participants ingested the LGT prepared from 2, 4, and 8g of LGL powder once daily for 30 days. Serum ALP level increased throughout the study period; although only the increase at day 30 reached statistical significance, while serum AST and ALT were not significantly different from baseline values. At days 10 and 30, serum total bilirubin significantly increased and decreased respectively. Ingestion of LGT may be associated with transient hyperbilirubinemia, and sustained elevation of ALP.

More than millions of people are living under the threat of influenza virus over the world countries including Nepal. The pathogenesis of this disease is not clearly understood and is probably attributed to genomic variations in viral strains as well as the host genetic makeup. The present study is to determine the role of polymorphism of TNF-alpha promoter regions at positions -238G/A, -308G/A, -857C/T and -863C/A in the severity of Influenza A Pdm/09 patients. Total of 500 patients including 300 Influenza A Pdm/09 (RT-PCR positive) and 200 apparently healthy individuals (Influenza A Pdm/09 Negative by RT-PCR) were included in the study. Polymerase chain reaction restriction fragment length polymorphism (PCR-RFLP) using site specific restriction enzymes were implemented for polymorphism study of TNF alpha promoter. Following the analysis of the digestion patterns of four polymorphic sites of the TNF- alpha promoter region, a significant association was observed between the allele -308A with the patients of Influenza A Pdm /09 patients. TNF- alpha 308 G/A has been shown to be associated with elevated TNF- alpha transcriptional activity. As per the literature search, this is the first study to identify the role of TNF- alpha promoter in Influenza A Pdm/09 infection. Our results show that subjects with - 308A more vulnerable to the severe form of Influenza A Pdm/09 infection

Breast is a host to many diseases which present as lumps in the breast. Fine Needle Aspiration Cytology’ (FNAC) and ‘Core Needle Biopsy’ (CNB) are commonly used to obtain pathologic diagnosis. Total 104 patients presenting with palpable breast lumps were subjected to FNAC then Core needle biopsy in a single sitting. Finally the results of FNAC and Core Needle biopsy were compared in the light of excision biopsy results. Sensitivities of FNAC and Core Needle biopsy were 83.33 % and 95.83 % and specificities were 96.55 % and 100 % respectively showing that Core Needle biopsy was more accurate than FNAC.

Crohn's disease is a chronic inflammatory disorder of the gastrointestinal tract. Perineal manifestations are a marker for disease severity. Anal strictures result from fibrotic scarring after several inflammatory attacks and are responsible for impaired quality of life. The aim of our work is to study the epidemiological profile and the management of these lesions. This is a descriptive retrospective study over a 17-year period from January 2002 to January 2019, concerning a monocentric cohort of 1053 cases of Crohn's disease. 22 patients had anal stricture, a prevalence rate of 2.08%. The main symptoms were painful passing of stools in all patients, emission of pus in 12 patients (54.5%) cases, imperiosity in 5 patients (22.7%), abdominal pain in 10 patients (45.4%) and an Obstructed defecation syndrome in 3 patients (13.6%). Penetrating phenotype B3 and the colonic localization L2 were the most frequent. Pelvic MRI confirmed anal stenosis in all patients, associated with complex fistulas, PARKS grade 4 in 18% (n = 4) cases. The treatment of the stenosis consisted of finger dilatation in 21 patients (90%), associated with dilation by Hegar dilatators in 63.6% (n = 14) cases and by balloons in 31.8% (n = 7) cases; the stenosis biopsy revealed squamous cell carcinoma in only one case, 4.5%. The medical treatment for CD was based on immunosuppressants in 72.7% (n = 16) cases, anti TNF in 18.18% (n = 4) cases, and Combination therapy in 9% (n = 2) cases. The prevalence of anal strictures in our study remains low compared to literature series; these are young women with LAP, a Penetrating phenotype and pancolitis.

Urachal cyst is one of a spectrum of urachal abnormalities most commonly found in children. But it is a rare pathologic disease entity in the adult, which may present only with abdominal pain. We describe a case of a 49 year old male who presented with abdominal pain, fever and dysuria. Diagnosis of an infected urachal cyst was confirmed on Computed tomography of the pelvis. He was treated initially with broad spectrum antibiotics in order to allow sepsis to resolve prior to surgical excision of the cyst and fibrous tract. Histology of the excised specimen showed chronic inflammation with no evidence of malignancy. Postoperative recovery was uneventful. Urachal abnormalities are rare in adults. Clinical presentation is non-specific and must be considered as a rare differential for abdominal pain, when diagnosed, surgical excision is advised because of the risk of malignant transformation.

Sarcomas of the prostate are rare and represent less than 0.1% of cancers of this gland, represented mainly by leiomyosarcomas. It is a rare type of tumor, with a 5-year survival rate of approximately 53%. occur mainly in children and young adults. These tumours show predilection for bones and soft tissues in the paraspinal region and lower extremities . Its therapeutic means represent a real problem for the urologist. We report the case of a young patient admitted for urine disorder, the MRI showed that the diagnois was prostatic PNET.

Childhood cancers have been on the rise globally. There is insufficient data on patterns of childhood cancers in Kenya. We aimed at profiling and identifying the stages of these malignancies during 2016 and 2017 at Kenyatta National Hospital in Kenya. The age most affected with cancer was 0-4years (46.9%) followed by 5-9 years (31.1%) and 10-15 years (22%). 29.8% of the cancers were diagnosed at In-situ stage. CNS tumors were the most common and the least was lymphomas. The frequency was found to be higher in boys than girls.

The incidence of stenosis of the subclavian artery represents 3 to 4% of the general population [1]; atherosclerosis is the most common cause. We conducted this study to review the stenocclusive pathology of the subclavian artery, and to expose our experience in surgical and endovascular management. It is a retrospective and analytical study conducted within the department of vascular surgery of Mohammed VI CHU. Surgical treatment consisted of subclavio-carotid transposition in 2 cases, carotid-bypass grafting in one case and angioplasty with stent placement in the latter case. It is important for the surgeon to have a thorough understanding of the anatomy and etiology of subclavian artery stenosis, while considering the surgical options. This case series presents some of the treatment options available to vascular surgeons for the management of symptomatic subclavian artery disease.