Nasopharyngeal mucoepidermoid carcinoma: A case report and review of literature

Background

Salivary gland-type tumors originating in the nasopharynx are rare, and only a few articles about mucoepidermoid carcinomas (MEC) in this location have been reported. We describe one case of nasopharyngeal MEC and, based on a review of the literature, discuss different therapeutic approaches that can be taken regarding the result of histological findings, radiological tests and extent of disease.

Case presentation

A 47-year-old woman diagnosed with mucoepidermoid carcinoma of nasopharynx, T1 N3 M0 (stage IV-B) was treated in 2007 with a combination of radiotherapy and chemotherapy to a maximum dose of 70 Gy and concomitant Cisplatin during the radiation. One year later, with the head and neck disease under control, mediastinal nodes relapse appeared which were treated with exclusive radiotherapy to a maximum dose of 65 Gy. One year after the first relapse, a second relapse was detected in the right lung, next to the previously treated mediastinal regions, and the patient initiated a treatment with exclusive chemotherapy based on TPF scheme.

Conclusion

For limited or resectable MEC, combined surgery with radiotherapy, or radiochemotherapy, should be considered the main treatment policy. On the other hand, in poorly differentiated, unresectable tumors or nasopharyngeal MEC, radiochemotherapy could be currently the main treatment approach.     

Diagnosing tuberculosis in pregnancy: a case report

A case of miliary tuberculosis complicated by deciduitis and sub-chorionitis in a pregnant woman manifesting also influenza A/H1N1v infection and urinary tract infection is reported. Diagnosis of tuberculosis was obtained before delivery by examining amniotic fluid for Mycobacterium tuberculosis. Even though maternal symptoms did not suggest TB, diagnosis was early enough to start effective treatment in both the mother and the neonate and prevent in-hospital M.tuberculosis diffusion. A high index of suspicion by health professionals is required to detect and manage tuberculosis in pregnancy and newborns in both the developed and developing word.     

人体鼻咽部微生物群落多样性研究进展

定殖于鼻咽部的微生物与人体始终处于动态生态平衡,对于维持人体健康发挥着重要作用,也与多种上呼吸道疾病的发生发展有密切关系。鼻咽部微生物之间及其与宿主之间的相互作用是引发人体上呼吸道疾病的重要因素。微生物的培养方法与分子生物学技术的结合使人们越来越深入地了解人体鼻咽部微生物群落的组成和结构。定殖于人体鼻咽部的微生物以肺炎链球菌(Streptococcus pneumoniae)和流感嗜血杆菌(Haemophilus influenzae)等潜在致病菌为主。本文将分别从鼻咽部微生物与机体的平衡关系、鼻咽部微生物群落的研究方法以及鼻咽部微生物群落的组成及其相互关系三个方面,综述近年来鼻咽部微生物群落结构的相关研究进展,从而为指导实践提供可靠的理论依据。     

Analysis of a mathematical model for tuberculosis: What could be done to increase case detection

This paper presents qualitative and quantitative study of a TB mathematical model to test results from a survey carried out in Benin City, Nigeria. The purpose of the survey was to determine factors that could enhance the case detection rate of tuberculosis. Results from the survey identified four key factors that must be combined for an effective control of TB and increase the case detection rate: effective awareness programme, active cough identification, associated cost factor for treatment of identified cases and effective treatment. The overall effect of these factors on the basic reproduction number under treatment, R_T, of the TB model was considered. In all, a serious concentration on tuberculosis awareness programmes and active cough identification as a marker for someone having TB was shown to significantly reduce the value of the reproduction number, hereby reducing the severity of the disease in the presence of treatment.     

A case report of a 24-year-old male with a large hemorrhagic pericardiai effusion

Although bloody pericardial effusion often suggests neoplasia,such an event is not rare in tuberculosis (TB),especially in those countries with a high TB disease burden.Meanwhile,TB accounts for 50％ and greater than 90％ of large pericardial effusions in human immunodeficiency virus (HIV)-negative and HIV-positive patients,respectively.Here we report a case of a 24-year-old HIV-negative male who presented with fever and hemorrhagic pericardial effusion.The patient was given presumptive anti-TB treatment before diagnosis was established.Eventually the patient responded well to the anti-TB treatment at the last follow-up and the diagnosis was confirmed by aspirated pericardial fluid culture on LowensteinJensen (LJ) medium.     

Severe pulmonary tuberculosis complicating Ileocecal intussusception due to intestinal tuberculosis: a case report

Adult intussusception is a rare clinical entity that is most often caused by a tumor, such as a lipoma, adenoma, or malignant tumor. A case of adult intussusception due to intestinal tuberculosis of the ileocecal region is reported. There are few cases of intussusception due to intestinal tuberculosis.     

A case report of a 24-year-old male with a large hemorrhagic pericardial effusion

Although bloody pericardial effusion often suggests neoplasia, such an event is not rare in tuberculosis (TB), especially in those countries with a high TB disease burden. Meanwhile, TB accounts for 50% and greater than 90% of large pericardial effusions in human immunodeficiency virus (HIV)-negative and HIV-positive patients, respectively. Here we report a case of a 24-year-old HIV-negative male who presented with fever and hemorrhagic pericardial effusion. The patient was given presumptive anti-TB treatment before diagnosis was established. Eventually the patient responded well to the anti-TB treatment at the last follow-up and the diagnosis was confirmed by aspirated pericardial fluid culture on Lowenstein-Jensen (LJ) medium.     

Bacteriological conversion in twenty urinary tuberculosis patients treated with ofloxacin, rifampin and isoniazid: a 10-year follow-up study

Twenty patients with urinary tuberculosis were treated with ofloxacin (200 mg/day, 6 months), rifampin (600 mg/day, 3 months) and isoniazid (300 mg/day, 3 months) between 1989 and 1990. All patients were new cases, diagnosed by observation and/or isolation of Mycobacterium tuberculosis in one of the three morning urine samples. Bacteriological culture conversion (negativization) was assessed as a clinical guide of efficacy, comparing it, as the only parameter, against a control group (150 patients) with urinary tuberculosis who received conventional therapy. Bacteriological follow-up studies were performed in both groups monthly for 6 months, then again 6 months later and then every year for 10 years after completion of treatment. In the 20 patients, the initial culture was positive with over 100 colonies per culture (>50%); the smear was positive in 45% of the patients (most were 2+). All strains were susceptible to rifampin, isoniazid and ofloxacin. Two patients discontinued treatment. Beginning with the first month of treatment, the bacteriological conversion was 100%, 89.5% and 100% in the remaining controls. In the control group, which received conventional treatment, the conversion was: 90%, 87%, 93% and 100% in the remaining controls. Treatment with ofloxacin resulted in a bacteriological conversion similar to that following conventional treatment (p>0.05, Fisher's exact test). After 10 years of patient follow-up, we conclude that ofloxacin, in combination with rifampin and isoniazid (both for 3 months only is effective against M. tuberculosis, providing satisfactory bacteriological and clinical efficacy. Electronic Publication     

To treat or not to treat: the case of tuberculosis

. Incomplete treatment of patients with infectious tuberculosis (TB) may not only lead to relapse but also to the development of antibiotic resistant TB – one of the most serious health problems facing society today. In this article, we formulate one-strain and two-strain TB models to determine possible mechanisms that may allow for the survival and spread of naturally resistant strains of TB as well as antibiotic-generated resistant strains of TB. Analysis of our models shows that non-antibiotic co-existence is possible but rare for naturally resistant strains while co-existence is almost the rule for strains that result from the lack of compliance with antibiotic treatment by TB infected individuals. Received 22 May 1995; received in revised form 28 February 1996     

Tropical pulmonary eosinophilia misdiagnosed as miliary tuberculosis: a case report and literature review

Tropical pulmonary eosinophilia is prevalent in the tropical and subtropical regions of the world. It is an occult form of human filariasis and results from an exaggerated immune response to filarial parasites Wuchereria bancrofti and Brugia malayi. Tuberculosis is prevalent in our country and may mimic almost any pulmonary disease on chest skiagram. Here we describe a patient with acute chest symptoms and micro-nodular opacity over chest roentogenogram, diagnosed as miliary tuberculosis and treated accordingly. Actually he was suffering from tropical pulmonary eosinophilia and showed response to combined diethylcarbamazine and corticosteroid therapy. This case serves as a reminder that tropical pulmonary eosinophilia may be wrongly diagnosed as miliary tuberculosis if one rely solely on a chest X-ray with micronodular opacities. We also stress on early diagnosis and treatment of this condition to avoid unfavorable outcomes.     

A muscle controlled finite-element model of laryngeal abduction and adduction

A three-dimensional finite-element model was developed to simulate the complex movement of the laryngeal cartilages during vocal fold abduction and adduction. The model consists of cricoid and arytenoid cartilages, as well as the intralaryngeal muscles and vocal folds. The active and passive properties of the muscles were idealised by one-dimensional elements based on the Hill theory. Its controlling input value is a time dependent stimulation rate. Optimisation loops have been carried out for the arrangement of the individual stimulation rates. Since in vivo measurements are not feasible, the developed biomechanical model shall be used to analyse the force distribution within the laryngeal muscles during phonatory manoeuvres. Simulations of abduction and adduction in different pitches of voice lead to realistic tensions of the vocal folds. The model is a first step to analyse motional vocal fold diseases and to predict the consequences of phonosurgical interventions.     

Multi-institutional comparison of simulated treatment delivery errors in ssIMRT,manually planned VMAT and autoplan-VMAT plans for nasopharyngeal radiotherapy

PurposeTo quantify the impact of simulated errors for nasopharynx radiotherapy across multiple institutions and planning techniques (auto-plan generated Volumetric Modulated Arc Therapy (ap-VMAT), manually planned VMAT (mp-VMAT) and manually planned step and shoot Intensity Modulated Radiation Therapy (mp-ssIMRT)).MethodsTen patients were retrospectively planned with VMAT according to three institution’s protocols. Within one institution two further treatment plans were generated using differing treatment planning techniques. This resulted in mp-ssIMRT, mp-VMAT, and ap-VMAT plans. Introduced treatment errors included Multi Leaf Collimator (MLC) shifts, MLC field size (MLCfs), gantry and collimator errors. A change of more than 5% in most selected dose metrics was considered to have potential clinical impact. The original patient plan total Monitor Units (MUs) were correlated to the total number of dose metrics exceeded.ResultsThe impact of different errors was consistent, with ap-VMAT plans (two institutions) showing larger dose deviations than mp-VMAT created plans (one institution). Across all institutions’ VMAT plans the significant errors included; ±5° for the collimator angle, ±5 mm for the MLC shift and +1, ±2 and ±5 mm for the MLC field size. The total number of dose metrics exceeding tolerance was positively correlated to the VMAT total plan MUs (r = 0.51, p < 0.001), across all institutions and techniques.ConclusionsDifferences in VMAT robustness to simulated errors across institutions occurred due to planning method differences. Whilst ap-VMAT was most sensitive to MLC errors, it also produced the best quality treatment plans. Mp-ssIMRT was most robust to errors. Higher VMAT treatment plan complexity led to less robust plans.     

Isolated skeletal muscle metastasis following successful treatment of laryngeal cancer: case report

Skeletal muscle metastases from tumors are a rare occurrence and can present difficult management decisions. We report here on a patient that had been previously treated for squamous cell laryngeal cancer with surgical resection and adjuvant systemic chemotherapy that presented with a metastasis to the rectus abdominis muscle without evidence of recurrent disease at the primary site. After a metastatic workup with PET/CT scan suggested this to be an isolated lesion, surgical excision with negative margins was performed based upon limited treatment options secondary to the location of the tumor and his favorable prognosis suggested by his pathological staging at the time of the initial resection. Here we discuss the incidence of distant metastases from laryngeal cancer and appropriate screening methods. Additionally, skeletal muscle metastases and treatment considerations are discussed.     

呼吸道合胞病毒下呼吸道感染与患儿鼻咽部定植菌群的关系

研究鼻咽部定植菌群与呼吸道合胞病毒（RSV）下呼吸道感染患儿病情特点的关系,从微生态角度寻找预防或治疗RSV下呼吸道感染的理论依据。

回顾性分析我院2020年8月1日到2021年10月31日收治的RSV下呼吸道感染患儿,根据鼻咽部分泌物培养结果分为阴性组、阳性组,对比两组患儿临床特点及潮气肺功能检测结果。

1 090例RSV下呼吸道感染患儿中培养阳性者290例（26.58%）,中位数年龄为8个月（3.24个月,14个月）。各年龄层患儿鼻咽部菌群定植率及定植菌群差异有统计学意义（均P＞0.05）。各年龄层患儿鼻咽部定植菌均以肺炎链球菌为主。金黄色葡萄球菌、大肠埃希菌及卡他莫拉菌定植的患儿发热率较低。与喘息相关定植菌为肺炎链球菌、流感嗜血杆菌及金黄色葡萄球菌。与重症相关的定植菌为肺炎链球菌、流感嗜血杆菌、金黄色葡萄球菌、大肠埃希菌。与大叶性肺炎发生相关的只有肺炎链球菌。肺炎链球菌及流感嗜血杆菌定植的达峰容积比（Z = −4.12,P＜0.001;Z = −1.99,P = 0.046）与达峰时间比（Z = −4.24,P＜0.001;Z = −1.98,P = 0.047）均低于阴性组。

特定鼻咽部定植菌的存在会影响RSV下呼吸道感染患儿的临床表现,同时降低婴幼儿潮气肺功能检测结果。

     

PhyTB: Phylogenetic tree visualisation and sample positioning for M. tuberculosis

Background

Phylogenetic-based classification of M. tuberculosis and other bacterial genomes is a core analysis for studying evolutionary hypotheses, disease outbreaks and transmission events. Whole genome sequencing is providing new insights into the genomic variation underlying intra- and inter-strain diversity, thereby assisting with the classification and molecular barcoding of the bacteria. One roadblock to strain investigation is the lack of user-interactive solutions to interrogate and visualise variation within a phylogenetic tree setting.

Results

We have developed a web-based tool called PhyTB (http://pathogenseq.lshtm.ac.uk/phytblive/index.php) to assist phylogenetic tree visualisation and identification of M. tuberculosis clade-informative polymorphism. Variant Call Format files can be uploaded to determine a sample position within the tree. A map view summarises the geographical distribution of alleles and strain-types. The utility of the PhyTB is demonstrated on sequence data from 1,601 M. tuberculosis isolates.

Conclusion

PhyTB contextualises M. tuberculosis genomic variation within epidemiological, geographical and phylogenic settings. Further tool utility is possible by incorporating large variants and phenotypic data (e.g. drug-resistance profiles), and an assessment of genotype-phenotype associations. Source code is available to develop similar websites for other organisms (http://sourceforge.net/projects/phylotrack).     

Diagnosis of clinically unsuspected extrapulmonary tuberculosis by fine needle aspiration: a case report.

BACKGROUND: Mycobacterium tuberculosis (MTb) infection remains the cause of higher morbidity and mortality than any other infectious disease in the world. Intact cellular immunity is necessary to resist the disease, and therefore the AIDS epidemic has greatly contributed to the resurgence of MTb. Depending on the degree of immunosuppression, the presentation of MTb in patients with AIDS can be atypical and difficult to diagnose as compared to the classical presentation of MTb in the nonimmunocompromised population. CASE: A patient who was not known to be HIV positive had a clinical picture of extensive abdominal and pelvic lymphadenopathy without chest radiographic abnormalities. The diagnosis of MTb was made by fine needle aspiration (FNA) of a pelvic lymph node. CONCLUSION: Miliary tuberculosis associated with AIDS may have an unusual clinical presentation and unusual cytologic features on ENA.     

Successful use of an inhalational phytochemical to treat pulmonary tuberculosis: a case report.

Multi-drug resistant strains of tuberculosis pose a serious threat in many third- and first-world countries. The aim of this case report is to describe a potential new method for treating those with primary pulmonary tuberculosis using phytochemicals via inhalation. We report the first case of using inhaled phytochemicals in treating primary pulmonary tuberculosis. A 28-year-old female presented with symptoms suggestive of primary pulmonary tuberculosis, and she was found to be positive via chest X-ray and sputum culture. She subsequently underwent treatment with conventional DOTS treatment. Ten days post-inhalation of the phytochemical, the patient is tuberculosis negative (via sputum culture), with no clinical symptoms. This may be a potential new method and type of treatment for pulmonary tuberculosis.