Saint Francis University

About: Saint Francis University is a education organization based out in Loretto, Pennsylvania, United States. It is known for research contribution in the topics: Population & Osteoblast. The organization has 1694 authors who have published 2038 publications receiving 87149 citations.

HIV-associated psoriasis.

Abstract: A 43-year-old man with an established diagnosis of advanced HIV infection presented with severe psoriasis aff ecting the entire body (fi gure, A). He had not taken antiretroviral treatment for several months and had failed to keep several scheduled appointments. The discomfort of his skin ailment resulted in his return to the hospital. Laboratory examination revealed a CD4+ lymphocyte cell count of 4 cells per μL, CD8+ lymphocyte cell count of 564 cells per μL, CD4+/CD8+ ratio of 0·02, and viral load of 8000 copies per μL. While in the hospital the patient was treated with steroids and highly active antiretroviral therapy (HAART) with efavirenz and lamivudine-zidovudine. The patient’s psoriasis improved markedly over the course of the next 5 days (fi gure, B). During the next year the patient had two admissions to the hospital with similar symptoms and was given the same treatment with excellent results. The prevalence of psoriasis in patients with HIV is approximately 5–6% and is no higher than in the general population. However, patients with HIV infection often present with more severe clinical manifestations of psoriasis than the non-HIV population and treatment is usually diffi cult. Some patients with HIV-associated psoriasis have pre-existing psoriasis, whereas others develop it with the progression to AIDS. Pre-existing psoriasis can undergo severe exacerbation in HIV infection, and psoriasis reportedly becomes more severe with progression of immunodefi ciency. Because the psoriasis is mediated by activated T cells, the association of HIV infection and psoriasis appears paradoxical. It has been postulated that immunodysregulation resulting from HIV infection could trigger psoriasis. Treatment of HIV infection with HAART partly corrects the immune defect caused by chronic HIV infection. This case emphasises the importance of strict adherence to HAART in patients with coexisting HIV infection and psoriasis. It is paradoxical that, although drugs that target T lymphocytes are eff ective in psoriasis, the condition is exacerbated by HIV infection.

Clinical and Endoscopic Features of Angiosarcoma of the Colon: Two Case Reports and a Review of the Literature

Abstract: Background Angiosarcoma of the gastrointestinal tract is an extremely rare tumor. We present two cases of angiosarcoma of the colon. One patient developed syncope and anemia and the other had rectal bleeding.

Safety in infants of SPf66, a synthetic malaria vaccine, delivered alongside the EPI

Abstract: The malaria parasite Plasmodium falciparum causes more morbidity and mortality than any other parasitic disease of man. However malaria control efforts have been frustrated by delays in the development of an effective vaccine. So far only SPf66 a multistage synthetic peptide has shown any evidence of protection in phase III vaccine field trials. Research has shown that SPf66 has an estimated combined efficacy of 23% in reducing the incidence of first attacks of clinical malaria and that further evaluation is warranted. Since most malaria disease and death is concentrated among very young children in sub-Saharan Africa the only realistic way to deliver a vaccine to that age group is through the Expanded Program of Immunization (EPI) which begins its schedule at birth. This paper reports the safety and reactogenicity of SPf66 when delivered alongside the EPI program to infants aged 1 2 and 7 months in southern Tanzania. The study was of randomized double-blind placebo-controlled design. The monitoring of safety and reactogenicity during the trial included detailed clinical and laboratory assessments on 98 infants and the assessment of adverse effects within 1 hour of vaccination for all 1207 children vaccinated. Surveillance systems monitored attendances as outpatients admissions to hospital and fatal events in the community. No serious adverse effects were detected more frequently among SPf66 recipients than among placebo recipients suggesting that this vaccine can be safely administered to very young infants.

Full clinical recovery after topical acyclovir treatment of Epstein-Barr virus associated cutaneous B-cell lymphoma in patient with mycosis fungoides.

Abstract: Primary cutaneous T- and B-cell lymphomas are a heterogeneous group of diseases with varied clinical presentations and prognosis. The use of new molecular, histological, and clinical criteria has improved their recognition. Cutaneous B-cell and T-cell lymphomas are seldom found together in the same patient. Here we report a rare case of mycosis fungoides variant of a cutaneous T-cell lymphoma (CTCL) which later developed Epstein-Barr virus (EBV) associated cutaneous B-cell lymphoproliferative disorder. The patient initially presented with generalized erythroderma, extensive plaques, and axillary lymphadenopathy. Histopathology and immunophenotyping of her tumor from the right breast nodule revealed a T-cell lymphoma consistent with mycosis fungoides. She was initially treated with pentostatin, followed by topical mechlorethamine and topical steroids. After progression of her mycosis fungoides with worsening diffuse skin lesions on this regimen, her treatments were changed to oral bexarotene with an initial partial response followed by stable disease. Three years from her initial presentation, she developed ulcerated cauliflower-like nodules on her forehead. Biopsy of these lesions revealed EBV-positive large- and medium-sized pleomorphic B-cells consistent with EBV-driven B-cell lymphoproliferative disorder. She was treated with topical acyclovir cream on the involved skin areas while continuing with oral bexarotene for mycosis fungoides. Skin lesions gradually diminished and totally disappeared after four weeks of topical acyclovir treatment. Bexarotene treatment was continued for another year until the mycosis fungoides progressed and became wide spread causing her death four and a half years after the initial diagnosis. The coexistence of two cutaneous non-Hodgkin lymphomas of different lineage in the same patient and the complete clinical response of EBV-related B-cell cutaneous component to topical acyclovir makes this rare case particularly interesting.

Caesarean section audit to improve quality of care in a rural referral hospital in Tanzania

Abstract: Caesarean section (CS) is often a life-saving procedure, but can also lead to serious complications, even more so in low-resource settings. Therefore unnecessary CS should be avoided and optimal circumstances for vaginal delivery should be created. In this study, we aim to audit indications for Caesarean sections and improve decision-making and obstetric management. Audit of all cases of CS performed from January to August 2013 was performed in a rural referral hospital in Tanzania. The study period was divided in three audit blocks; retrospective (before auditing), prospective 1 and prospective 2. A local audit panel (LP) and an external auditor (EA) judged if obstetric management was adequate and indications were appropriate or if CS could have been prevented and yet retain good pregnancy outcome. Furthermore, changes in modes of deliveries, overall pregnancy outcome and decision-to-delivery interval were monitored. During the study period there were 1868 deliveries. Of these, 403 (21.6%) were Caesarean sections. The proportions of unjustified CS prior to introduction of audit were as high as 34 and 75%, according to the respective judgments of LP and EA. Following introduction of audit, the proportions of unjustified CS decreased to 23% (p = 0.29) and 52% (p = 0.01) according to LP and EA respectively. However, CS rate did not change (20.2 to 21.7%), assisted vacuum delivery rate did not increase (3.9 to 1.8%) and median decision-to-delivery interval was 83 min (range 10 - 390 min). Although this is a single center study, these findings suggest that unnecessary Caesarean sections exist at an alarming rate even in referral hospitals and suggest that a vast number can be averted by introducing a focused CS audit system. Our findings indicate that CS audit is a useful tool and, if well implemented, can enhance rational use of resources, improve decision-making and harmonise practice among care providers.