Head and Neck Mycetoma: The Mycetoma Research Centre Experience

Mycetoma is a unique neglected tropical disease which is endemic in what is known as the “mycetoma belt”. The disease has many devastating impacts on patients and communities in endemic area and is characterised by massive deformity, destruction and disability. Mycetoma is commonly seen in the foot and hand and less frequent in other parts of the body. Mycetoma of the head and neck is a rarity and is associated with high morbidity and even mortality if not treated early. In this communication we report on 49 patients with head and neck mycetoma followed up at the Mycetoma Research Centre in Khartoum. Most of the reported patients had actinomycetoma and the majority were young adult males from mycetoma endemic areas in the Sudan. Most of them were students, farmers and workers. Prior to presentation the majority had long disease duration and the cause was multifactorial. Advanced disease with massive lesion, deformity and disability was the common presentation. There was no obvious history of local trauma, familial tendency or other predisposing factor identified in this group of patients. MRI and CT scan were the most accurate diagnostic tools to determine the disease extent. The treatment outcome was rather poor and characterised by low cure rate, poor outcome and high follows-up dropout. Such a gloomy outcome calls for structured and objective health education programs.     

Mycetoma in China: A Case Report and Review of the Literature

Mycopathologia - Mycetoma is a chronic granulomatous infectious disease that can affect the skin, subcutaneous tissue, fascia and bone. It can be caused by filamentous bacteria or fungi and usually...     

山楂童锤角叶蜂的生物学及防治

山楂童锤角叶峰是近年来在安徽大别山区发现的一种新害虫。该虫严重为害山植和梨树、1年发生1代,以预蛹在茧内越夏越冬。幼虫食叶为害,每年5月上中旬为猖极为害期。此虫发生与海拔高度及温湿度关系密切。     

Mycetoma: Experience of 482 Cases in a Single Center in Mexico

Mycetoma is a chronic granulomatous disease. It is classified into eumycetoma caused by fungi and actinomycetoma due to filamentous actinomycetes. Mycetoma can be found in geographic areas in close proximity to the Tropic of Cancer. Mexico is one of the countries in which this disease is highly endemic. In this retrospective study we report epidemiologic, clinical and microbiologic data of mycetoma observed in the General Hospital of Mexico in a 33 year-period (1980 to 2013). A total of 482 cases were included which were clinical and microbiology confirmed. Four hundred and forty four cases (92.11%) were actinomycetomas and 38 cases (7.88%) were eumycetomas. Most patients were agricultural workers; there was a male predominance with a sex ratio of 3∶1. The mean age was 34.5 years old (most ranged from 21 to 40 years). The main affected localization was lower and upper limbs (70.74% and 14.52% respectively). Most of the patients came from humid tropical areas (Morelos, Guerrero and Hidalgo were the regions commonly reported). The main clinical presentation was as tumor-like soft tissue swelling with draining sinuses (97.1%). Grains were observed in all the cases. The principal causative agents for actinomycetoma were: Nocardia brasiliensis (78.21%) and Actinomadura madurae (8.7%); meanwhile, for eumycetomas: Madurella mycetomatis and Scedosporium boydii (synonym: Pseudallescheria boydii) were identified. This is a single-center, with long-follow up, cross-sectional study that allows determining the prevalence and characteristics of mycetoma in different regions of Mexico.     

落叶松树种的体细胞胚胎发生与规模化技术体系

植物体细胞胚胎发生技术是植物体细胞在人为可控条件下通过与合子胚胎发生类似的途径 ,发育出新个体的再生技术 ,自问世以来 ,已被广泛用于生命科学领域。对落叶松及其杂种胚性细胞系的大规模增殖培养、原胚发育状态、体细胞胚成苗和专用生物反应器技术体系的建立以及其应用、展望等方面进行了探讨 ,表明落叶松体细胞胚胎发生过程中专用生物反应器技术体系的完善与建立迫在眉睫 ,并将为现代林木育种与繁殖工程及生命科学相关学科的发展带来重要影响 。     

Actinomycotic mycetoma. Report of a case with diagnosis by fine needle aspiration

Mycetoma (madura foot, maduromycosis) is present worldwide but more so in the tropics. We report a case of actinomycetoma diagnosed by fine needle aspiration using cell smears. The authors believe it to be the first case so diagnosed. Definitive diagnosis of the etiologic agent is made by culture, leading to a delay in institution of treatment. The authors advocate the use of fine needle aspiration for rapid diagnosis, thus instigating further workup and treatment.     

Hand Mycetoma: The Mycetoma Research Centre Experience and Literature Review

Mycetoma is a devastating, neglected tropical disease characterised by extensive tissue involvement resulting in destruction, deformities and disabilities in the affected patients. The hand is commonly affected by mycetoma thus compromises its functionality and hinder the patient’s daily activities of living. In this communication, we report on 533 patients with hand mycetoma managed over a period of 24 years at the Mycetoma Research Centre, University of Khartoum, Khartoum, Sudan. Eumycetoma was the commonest type of mycetoma (83.3%) encountered. Males were predominately affected (69.2%) with a sex ratio of 2.2:1. The majority of the patients (84%) were young adult below the age of 40 years old at presentation. The generality of patients (86.4%) were from the Sudan mycetoma belt. Children and adolescents (28.1%), farmers (18.2%) and workers (17.4%) were more frequently affected. The majority of patients (67.4%) had disease duration of less than 5 years at presentation. The study, did not document significant history of local trauma, familial tendency, concomitant medical diseases or other predisposing cause for mycetoma in this population. Pain (23.1%) was not a disease feature in this series and 52% of patients had past surgery for mycetoma and recurrence. The right hand was affected most (60.4%), and 64% of them had small lesion at presentation. Conventional x-ray was only helpful in patients with advanced disease and the MRI accurately determined the disease extension. Cytological smears, surgical biopsies histopathological examination and grains culture were the principal diagnostic tools for causative organisms’ identification. In the present series it was difficult to determine the treatment outcome due to high patients follow up dropout.     

Systematic whole-genome sequencing reveals an unexpected diversity among actinomycetoma pathogens and provides insights into their antibacterial susceptibilities

Mycetoma is a neglected tropical chronic granulomatous inflammatory disease of the skin and subcutaneous tissues. More than 70 species with a broad taxonomic diversity have been implicated as agents of mycetoma. Understanding the full range of causative organisms and their antibiotic sensitivity profiles are essential for the appropriate treatment of infections. The present study focuses on the analysis of full genome sequences and antibiotic inhibitory concentration profiles of actinomycetoma strains from patients seen at the Mycetoma Research Centre in Sudan with a view to developing rapid diagnostic tests. Seventeen pathogenic isolates obtained by surgical biopsies were sequenced using MinION and Illumina methods, and their antibiotic inhibitory concentration profiles determined. The results highlight an unexpected diversity of actinomycetoma causing pathogens, including three Streptomyces isolates assigned to species not previously associated with human actinomycetoma and one new Streptomyces species. Thus, current approaches for clinical and histopathological classification of mycetoma may need to be updated. The standard treatment for actinomycetoma is a combination of sulfamethoxazole/trimethoprim and amoxicillin/clavulanic acid. Most tested isolates had a high IC (inhibitory concentration) to sulfamethoxazole/trimethoprim or to amoxicillin alone. However, the addition of the β-lactamase inhibitor clavulanic acid to amoxicillin increased susceptibility, particularly for Streptomyces somaliensis and Streptomyces sudanensis. Actinomadura madurae isolates appear to have a particularly high IC under laboratory conditions, suggesting that alternative agents, such as amikacin, could be considered for more effective treatment. The results obtained will inform future diagnostic methods for the identification of actinomycetoma and treatment.     

Cytodiagnosis of eumycotic mycetoma: a case report

BACKGROUND: Mycetoma is a late-stage clinical manifestation of a subcutaneous infection produced by bacteria (actinomycetoma) or fungi (eumycetoma). Only a few articles have described the morphologic appearance of this uncommon pathology on cytology. The distinction between eumycetoma and actinomycetoma in fine needle aspiration cytology (FNAC) is as accurate as in histopathology, as demonstrated in the present case. CASE: A 30-year-old man presented with a large swelling on his left foot with a discharging sinus. FNAC of the swelling yielded pus-like material. Initial Papanicolaou and Giemsa stains showed the presence of septate, branching fungal hyphae and black granules against the inflammatory background. The presence of fungus was confirmed by PAS stain. The species was identified as Exophiala jeanselmei on fungal culture. CONCLUSION: Mycotic mycetoma can be accurately diagnosed by FNAC, which is a simple, inexpensive and rapid technique when there is a high index of suspicion. Special stains and culture studies are helpful in confirmation of diagnosis and species identification.     

Complete Genome Sequence Analysis of Nocardia brasiliensis HUJEG-1 Reveals a Saprobic Lifestyle and the Genes Needed for Human Pathogenesis

Nocardia brasiliensis is an important etiologic agent of mycetoma. These bacteria live as a saprobe in soil or organic material and enter the tissue via minor trauma. Mycetoma is characterized by tumefaction and the production of fistula and abscesses, with no spontaneous cure. By using mass sequencing, we determined the complete genomic nucleotide sequence of the bacteria. According to our data, the genome is a circular chromosome 9,436,348-bp long with 68% G+C content that encodes 8,414 proteins. We observed orthologs for virulence factors, a higher number of genes involved in lipid biosynthesis and catabolism, and gene clusters for the synthesis of bioactive compounds, such as antibiotics, terpenes, and polyketides. An in silico analysis of the sequence supports the conclusion that the bacteria acquired diverse genes by horizontal transfer from other soil bacteria, even from eukaryotic organisms. The genome composition reflects the evolution of bacteria via the acquisition of a large amount of DNA, which allows it to survive in new ecological niches, including humans.     

Cervical cytology EQA – the Northern experience

The experience of the Northern region using the 1995 draft National Gynaecological Cervical Cytology External Quality Assurance (EQA) Scheme is given. Over three rounds, 390 staff reporting Cervical Cytology took part, and using a cumulative non-numeric marking scheme, five participants were deemed "unacceptable" at the end of three rounds. A total of 3450 responses were given to the 40 test slides used, with an overall false-positive rate of 5.9% and a false-negative rate of 1.4%. Grading was assessed for pathologists, and many appeared to perform badly by accumulating discrepancies for non-clinically-significant grading differences. The problems of slide selection/staining and grading consistency/accuracy are highlighted. This EQA scheme serves its dual function of education and identifying poor performance. It must be seen as a viable EQA scheme, although other options must be considered, given advances in technology.     

Breast cancer: dietary and environmental oestrogens

Breast cancer is among the most common of the cancers that occur in women living in western societies. It is a much-feared disease and the risks are confusing and often badly reported. Oestrogen levels are a known risk factor. But is it possible to lower the risk? And where are all the oestrogens coming from?     

用于胃癌检测的漫反射光谱

胃癌正严重地威胁人类的健康,为了开发一种可以诊断早期胃癌的新型光学检测技术,建立了一套简便的组织体漫反射光谱检测装置.首先,根据组织体的光学特性,介绍光谱检测方法的基本原理.然后,利用组织癌变导致的组织体光学特性变化,建立漫反射光谱检测的实验装置.最后,利用该实验装置分别获取正常胃组织和胃癌组织的漫反射光谱.实验结果表明:癌变和正常胃组织的漫反射光谱在可见光区域有明显差别,特别是在波长为500 nm和630 nm处,但是漫反射光谱检测无法分辨来自组织不同层的光谱信息.这些结果说明漫反射光谱检测装置可用于胃癌的辅助检测.     

Possibility of using hematopoietic stem cells in relation to their generation age

A hypothesis of the use of hemopoietic stem cells with a view of satisfying the demand for mature cells depending on their generation age predicts that CFUs that survived after repeated treatment with hydroxyurea should have a greater capacity for self-renewal. It has been demonstrated that after repeated administrations of hydroxyurea according to the scheme devised by the authors of the hypothesis (3-4 times) and as a result of a more prolonged treatment (6 times, every other 12 or 15 h), the capacity of the survived hemopoietic stem cells for self maintenance was not only lower than normal but commonly significantly decreased. The generation-age hypothesis of the use of hemopoietic stem cells thus remains badly needing experimental support.     

Subjects and Objects: Metaphysics, Biology, Consciousness, and Cognition

Over the past half-century, the Freeman laboratory has accumulated a large volume of data and a correspondingly extensive interpretive framework centered around an alternative perspective on brain function, that of dynamical systems. The purpose of this paper is first briefly to summarise this work, and bring it into dialogue with other perspectives. The contents of consciousness are seen as an inevitably sparse sample of events in the perception–action cycle. The paper proceeds to an attempt to elucidate the contents of this sparse sample. A critical concept is that of selfhood, and how it presents itself phenomenologically. It is argued that our experience of selfhood is an artifact of the necessity of preservation of subject/object relations. As this part of metaphysics has been badly misunderstood, we scrutinise it at some length in quantum mechanics, biology, and cognition. It is argued that Pattee's approach, while valuable, tends to premature closure on these issues. The paper then proceeds to outline a view on how selfhood is best considered wrt the immune response. This is interrelated with phenomenology, and some data are adduced to support this central hypothesis. Finally, consequences for the social sciences in general are hinted at.     

Global Burden of Human Mycetoma: A Systematic Review and Meta-analysis

Mycetoma is a chronic infectious disease of the subcutaneous tissue with a high morbidity. This disease has been reported from countries between 30°N and 15°S since 1840 but the exact burden of disease is not known. It is currently unknown what the incidence, prevalence and the number of reported cases per year per country is. In order to estimate what the global burden of mycetoma is, a meta-analysis was performed. In total 50 studies were included, which resulted in a total of 8763 mycetoma cases. Most cases were found in men between 11 and 40 years of age. The foot was most commonly affected. Most cases were reported from Mexico, Sudan and India. Madurella mycetomatis was the most prevalent causative agent world-wide, followed by Actinomadura madurae, Streptomyces somaliensis, Actinomadura pelletieri, Nocardia brasiliensis and Nocardia asteroides. Although this study represents a first indication of the global burden on mycetoma, the actual burden is probably much higher. In this study only cases reported to literature could be used and most of these cases were found by searching archives from a single hospital in a single city of that country. By erecting (inter)national surveillance programs a more accurate estimation of the global burden on mycetoma can be obtained.     

Mycetoma Herbal Treatment: The Mycetoma Research Centre,Sudan Experience

It is still challenging and difficult to treat patients with eumycetoma; the current treatment has many side effects and has proven to be expensive and characterized by high recurrence rate, hence the poor patients'' treatment compliance. Most of the patients are of low socio-economic status, have many financial constraints and hence, many of them rely on alternative and herbal medicine for the treatment of their disease. With this background, the current study was conducted to determine the prevalence of herbal medicine usage among patients with eumycetoma. This cross-sectional, observational, questionnaire-based study was conducted at the Mycetoma Research Center, University of Khartoum, Khartoum, Sudan. A convenience cohort of 311 patients with confirmed eumycetoma was invited to participate in the study after informed consent. The study showed that 42.4% of the study population used herbal medicine for the treatment of eumycetoma at some stage of their illness. The commonly used herbs were Moringa oleifera, Acacia nilotica, Citrullus colocynthis and Cuminum cyminum. Most of the patients claimed no benefits from the herbal treatment. Ninety one patients (29.3%) had encountered complications with herbal treatment. The high prevalence of herbal treatment encountered in the study can be explained by the patients'' dissatisfaction with the current medical therapeutic modalities. To reduce the high prevalence of herbal medicine usage, governmental control and health policies are mandatory; likewise, native healers need to be educated in that. Moringa oleifera was the commonly used herb in this study and many reports claimed medicinal properties of this tree; hence, further in-depth studies to determine the active ingredients in the different parts of the tree and its effect are required.     

植酸酶的多样性及其分类

植酸酶是一类催化植酸水解逐步释放磷酸基团形成低级肌醇磷酸衍生物的正磷酸单酯磷酸水解酶。植酸酶在动物营养、资源环境保护和人类健康等领域有巨大的应用潜力。目前,人们对植酸酶的多样性及其分类的认识比较模糊甚至错误,严重影响了植酸酶的研究进程和水平。首先简要概述了基于最适pH和立体专一性的植酸酶分类,然后着重论述了基于结构和催化机理的植酸酶分类及其代表酶特征的最新研究进展,最后探讨了根据不同分类标准特别是基于结构和催化机理准确理解和全面表征各种植酸酶的重要性,以期为植酸酶的研究和应用提供参考。