3,4-Dimethoxybenzohydrazide derivatives (1-25) have been synthesized and evaluated for their urease inhibitory potential. Among the series, compounds 2, 3, 4 and 5 with IC50 values 12.61 ± 0.07, 18.24 ± 0.14, 19.22 ± 0.21, and 8.40 ± 0.05 µM, respectively, showed excellent urease inhibitory potentials when compared with standard thiourea (IC50 value 21.40 ± 0.21 µM). Compounds 1, 6, 8, 18, 19 and 20 also showed good to moderate inhibition, while the remaining compounds were found to be completely inactive. The structures of compounds 6 and 25 were confirmed through X-ray crystallography while the structures of remaining compounds were confirmed through ESI-MS and 1H NMR. Molecular docking studies were performed understand the binding interactions with enzyme active site. The synthesized compounds were evaluated for cytotoxicity and found to be nontoxic.
We report a unique case of differentiated thyroid carcinoma (DTC) with squamous metaplasia complicated with chronic discharging ulcer. A 76-year-old gentleman was referred to us after defaulted treatment 1 year post-total thyroidectomy. He presented to us with long-standing chronic, non-healing, ulcerative and discharging wound at the anterior neck at previous total thyroidectomy scar. The primary tumour was histologically diagnosed as papillary malignant cells with extensive squamous metaplasia. Squamous metaplasia is a rare finding in thyroid carcinoma that carried a poorer prognostic factor.
Fixed cutaneous sporotrichosis is a differential diagnosis that can be considered in diabetic patients who present with a poorly healing ulcer. Although its prevalence is low, it can occur in patients with immunocompromised status. Here we report a case of a 70-year-old man with diabetes mellitus who presented with a 1-month history of an unhealed ulcer over the tip of his left middle finger. He experienced a cat bite over his left middle finger 1 month prior to the appearance of the lesion. A skin biopsy revealed the presence of Sporothrix schenckii. Oral itraconazole 200 mg twice daily was started empirically and the patient showed marked improvement in the skin lesion after 2 months of therapy.
Zinc is a naturally occurring element with roles in wound healing and rescuing tissue integrity, particularly in the gastrointestinal system, where it can be detected in the mucosal and submucosal layers. Zinc chelates are known to have beneficial effects on the gastrointestinal mucosa and in cases of gastric ulcer. We synthesized complexes of zinc featuring a heterocyclic amine binding amino acids then investigated their ability to enhance the gastric self-repair. Zinc-morpholine complex, Zn(L)SCN, namely showed strong free-radical scavenging, promotion of the DNA and RNA polymerases reconstruction and suppression of cell damage. The complex's mode of action is proposed to involve hydrogen bond formation via its bis(thiocyanato-k)zinc moiety. Zn(L)SCN complex had potent effects on gastric enzymatic activity both in vitro and in vivo. The complex disrupted the ulcerative process as demonstrated by changes in the intermediate metabolites of the oxidative pathway - specifically, reduction in the MDA levels and elevation of reduced glutathione together with an attenuation of oxidative DNA damage. Additionally, Zn(L)SCN restored the gastric mucosa, inhibited the production of pro-inflammatory cytokines (IL-6, TNF and the caspases), and preserved the gastric mucous balance. Zn(L)SCN thus exhibited anti-oxidative, anti-inflammatory and anti-apoptotic activities, all of which have cytoprotective effects on the gastric lining.
COVID-19 rarely causes lower gastrointestinal bleeding even though its RNA has been detected in patient's stool. Urgent colonoscopy in a COVID-19 patient with massive bloody stool requires various procedural and equipment considerations. Here, we present a case of colonoscopic hemostasis of a cecal hemorrhagic ulceration in a patient on heparin for COVID-19 coagulopathy. We also share various management methods for the prevention of COVID-19 contamination. A 71-year-old man was diagnosed with COVID-19 pneumonia and subsequently underwent hemodiafiltration. Heparin was initiated for COVID-19 coagulopathy. At day 42, the patient experienced 2000 mL of bloody stool. An operator performed urgent colonoscopy with three assistants in a negative-pressure room with full personal protective equipment. A hemorrhagic ulceration was detected at the cecum, and endoscopic hemostasis was performed. Immunohistochemistry was positive for cytomegalovirus. Postprocedure, the endoscopic systems were thoroughly cleaned, and specific measures for endoscope reprocessing and disinfection were performed to prevent contamination with COVID-19.
Leishmaniasis is a widely spread zoonotic disease caused by the bite of infected sandflies, particularly in developing countries. Cutaneous leishmaniasis can have a diverse range of presentations, ranging from minor skin nodules to significant mucosal damage. However, nose involvement is infrequent. Our report highlights a 15-year-old female patient with a persistent skin lesion on her nose for three months, which is a rare manifestation of cutaneous leishmaniasis. The lesion started as a raised spot with a brownish-red color and a crust but eventually developed into an ulcer that spread over the entire lobe of the nose and even moved toward the eye. Microscopic examination revealed the presence of Leishmania amastigotes, and a biopsy confirmed a diagnosis of cutaneous leishmaniasis. The patient received daily intravenous sodium stibogluconate doses of 9 mg/kg for 20 days, and three weeks later, there was a significant clinical improvement, with the ulcer beginning to heal and no more amastigotes visible on microscopic examination. It is crucial to keep cutaneous leishmaniasis in mind as a possible diagnosis for patients with skin lesions, even in regions where the condition is not prevalent.
Gastric volvulus is an uncommon disorder with an unknown incidence, unless it stays in the back of the diagnostician's mind, diagnosis of gastric volvulus, which can have significant morbidity and mortality associated with it, can be easily missed and can present either in the acute or chronic setting with variable symptoms. When it occurs in the acute scenario, patients present with severe epigastric pain and retching without vomiting. Together with inability to pass nasogastric tube, they constitute Borchardt's triad. The presence of a hiatal hernia with persistent vomiting despite initial antiemetic treatment should trigger one to think of gastric volvulus, despite the patient appearing very stable. We report a case which presented in our hospital with abdominal pain and vomiting. As Oesophagogastroduodenoscopy shows hiatal hernia and peptic ulcer. Primary gastric volvulus occurs in the absence of any defect in the diaphragm or adjacent organ pathology and may be caused by weakening of gastric supports. As conclusion; Gastric volvulus is a surgical case, requiring early diagnosis and aggressive management, as a delay results into complications like gangrene and perforation which substantially increase the morbidity and mortality in these patients, and contrast enhanced computed tomography (CECT) is the best modality for diagnosis of gastric volvulus.
Introduction: Ascariasis is a parasitic infection, which commonly affects immunocompromised patients. Most pa-tients remained asymptomatic during the early larval migration stage and respond well with conventional anti-hel-minthic drugs. Previous literature had reported symptomatic Ascaris infection mimicking bacterial pneumonia and the typical eosinophilia found in Loeffler syndrome was absent in patients on corticosteroids. Thus, a high index of suspicion for ascariasis is needed for immunosuppressed patients presented with infection. We present here a case of severe ascariasis infection in a systemic lupus erythematosus patient. Case description: A 16-year-old boy presented with fever, generalized maculopapular rash associated with neutropenia and thrombocytopenia. He was treated initially as Dengue Fever initially. However his symptoms did not resolve at even day 14 of admission. On further assessment, we were convinced he has SLE based upon presence of malar rash, oral ulcers, urinary protein-uria, persistent leucopenia, thrombocytopenia with low complements and ANA positive. He was promptly started on IV hydrocortisone. He showed a good progress in the first few days. On day 5 of admission, he coughed out a round worm which later identified as Ascarisis lumbricoides. He was started on Albendazole. Unfortunately he developed hemoptysis and respiratory compromisation where he required intubation. Post intubation he went into cardiac arrest, which required CPR. Following that event, his condition further deteriorated with multi organ failure. He succumbed to his illness three days later. Conclusion: Immunocompromised patients are prone to opportunistic infections including parasitic infections. we present here a case of ascariasis in an SLE patient who unfortunately succumbed to the illness. Due to the variable clinical symptoms that mimic other infections, screening for parasitic infections needs to be considered especially if the patients do not respond to antibiotics and routine treatments.
A 103 year old patient was admitted with pain in the right iliac fossa. There was no response to conservative treatment. Subsequent laparatomy showed the presence of a perforated ulcer in the pyloric region. The condition improved gradually after the surgical management.
Introduction: Tropical phagedenic ulcer is a skin disease caused by a cocktail of bacteria. This painful ulcer forms over the lower limbs. It is also associated with necrotic slough and foul-smelling discharge that eventually lead to amputation and permanent disabilities. Tropical phagedenic ulcer in Malaysia has not been given much attention. In light of this situation, this research was conducted to assess the knowledge, attitude and practice regarding tropical phagedenic ulcer among the public in Shah Alam, Selangor. Methods: The total respondents were 384, consisting of 164 males and 220 females who were randomly selected. Data were obtained qualitatively through structured questionnaires and analysed using the chi-square test to study the association between the dependent variables and demographic factors. Results: The collected data showed that the respondents (67.2%) had poor knowledge of trop- ical phagedenic ulcer; merely 65.4% considered it to be a health problem, whereas 29.7% believed it is contagious. Also, the data revealed an association between age (χ2=13.587, p =0.004), marital status (χ2=15.435, p=0.001), time spent in community (χ2=6.438, p=0.04) and knowledge of the local name of tropical phagedenic ulcer. About 74.7% of the respondents did not know the cause of tropical phagedenic ulcer. Only 22.1% of the respondents had encoun- tered tropical phagedenic ulcer patients and an association was found between the variable with gender (χ2=4.672, p =0.031), age (χ2=24.134, p =0.000) and marital status (χ2=17.143, p =0.001). Conclusion: This study reveals mis- conceptions about the aetiology and transmission of tropical phagedenic ulcer which greatly influence the attitude of community members towards tropical phagedenic ulcer patients.
Introduction:A unilateral enlarged tonsil always is a suspicion of carcinoma. Especially if it is with fungating ulcer-ative surface. Neoplasms in unilaterally enlarged tonsil include squamous cell carcinomas and lymphomas. Lym-phomas in oropharynx are not common specially with fungating surface. Usually lymphomas in these areas are Non-Hodgkin’s type. Case description: A 62-year-old woman was admitted in the tertiary level hospital of Kota Kinabalu, Sabah, with the complaint of sore throat, odynophagia and right neck swelling. She was treated as a case of acute tonsillitis by general practitioner without any noticeable improvement. Oral cavity examination revealed a hugely enlarged right tonsil with fungating ulcerative surface and almost obstructing the oropharynx. Trismus was seen which make the examination difficult. A non-tender right upper neck swelling was palpable. All baseline lab-oratory investigations were normal. A contrast-enhanced computed tomography (CECT) showed a heterogeneously enhancing mass at oropharynx compromising the airway, right supraclavicular lymphadenopathy. Histology of biop-sy from right tonsillar mass showed High grade B-cell lymphoma. Chemotherapy was planned. First cycle of chemo-therapy was administered, Patient was discharged home with the complete plan of chemotherapy. Conclusion: This patient was clinically suspicious of carcinoma of palatine tonsil. But later proven as high grade B-cell lymphoma. All unilateral enlarged tonsils are not always carcinoma.
The microbial aetiology of genital ulcers was studied in 249 patients (241 men and 8 women) attending a Sexually Transmitted Disease Clinic in Kuala Lumpur, Malaysia. Herpes simplex virus type 2 was isolated in 48 (19.2%) patients, Haemophilus ducreyi from 22 (8.8%), Neisseria gonorrhoeae from seven (2.8%) and Chlamydia trachomatis from four (1.6%). Syphilis was diagnosed in 18 (7.2%) patients on the basis of dark field microscopy. Two (0.8%) patients were found to have both chancroid and syphilis and one (0.5%) had both gonorrhoea and syphilis. No organism was isolated in the remaining 151 (61.5%) patients. Overall, the accuracy of clinical diagnosis was 58% for single infection, 67% for herpes, 63% for syphilis, 47% for chancroid and 0% for lymphogranuloma venereum. Therefore, our study confirms the need for laboratory tests to diagnose accurately the aetiology of genital ulcer disease.