This study describes an informatics effort to track subjects through a National Pharmaceutical Stockpile (NPS) distribution drill. The drill took place in Seattle on 1/24/2002. Washington and the State Department of Health are among the first in the nation to stage a NPS drill testing the distribution of medications to mock patients, thereby testing the treatment capacity of the plan given a post-anthrax exposure scenario. The goal of the Public Health Informatics Group at the University of Washington (www.phig.washington.edu) was to use informatics approaches to monitor subject numbers and elapsed time. This study compares accuracy of time measurements using a mobile phone Java application to traditional paper recording in a live drill of the NPS. Pearson correlation = 1.0 in 2 of 3 stations. Differences in last station measurements can be explained by delay in recording of the exit time. We discuss development of the application itself and lessons learned. (MeSH Bioterrorism, Informatics, Public Health)
Attachment of Vibrio cholerae to the mucosal surface of the intestine is considered to be an important virulence characteristic. Vibrio cholerae, an autochthonous member of brackish water and estuarine bacterial communities, also attaches to crustacea, a significant factor in multiplication and survival of V. cholerae in nature. The ability of V. cholerae to attach to the gut wall of the blue crab (Callinectes sapidus) was examined, and attachment was observed only in the hindgut and not the midgut of crabs, confirming a requirement for chitin in the attachment of V. cholerae to invertebrate and zooplankton surfaces. The new finding of attachment of V. cholerae to the hindgut of crabs may be correlated with the epidemiology and transmission of cholera in the aquatic environment. The crab model may also prove useful in elucidating the mechanism(s) of ion transport in crustacea.
The influence of water temperature, salinity, and pH on the multiplication of toxigenic Vibrio cholerae serovar O1 cells and their attachment to live planktonic crustaceans, i.e., copepods, was investigated by using laboratory microcosms. By increasing water temperatures up to 30 degrees C, a pronounced effect on the multiplication of V. cholerae was demonstrated, as was attachment of the cells to live copepods. These were measured by culturable counts on agar plates and direct observation by scanning electron microscopy, respectively. Of the three salinities examined (5, 10, and 15%), maximum growth of V. cholerae and attachment to copepods occurred at 15%. An alkaline pH (8.5) was optimal both for attachment and multiplication of V. cholerae, as compared with pH 6.5 and 7.5. It is concluded that conditions affecting attachment of V. cholerae serovar O1 to live copepods observed under laboratory conditions may also occur in the natural estuarine environment and, thereby, are significant in the epidemiology of cholera.
Strains of Vibrio cholerae, both O1 and non-O1 serovars, were found to attach to the surfaces of live copepods maintained in natural water samples collected from the Chesapeake Bay and Bangladesh environs. The specificity of attachment of V. cholerae to live copepods was confirmed by scanning electron microscopy, which revealed that the oral region and egg sac were the most heavily colonized areas of the copepods. In addition, survival of V. cholerae in water was extended in the presence of live copepods. Attachment of viable V. cholerae cells to copepods killed by exposure to -60 degrees C was not observed. Furthermore, survival of V. cholerae was not as long in the presence of dead copepods as in the live copepod system. A strain of Vibrio parahaemolyticus was also seen to attach to copepod surfaces without effect on survival of the organism in water. The attachment of vibrios to copepods was concluded to be significant since strains of other bacteria, including Pseudomonas sp. and Escherichia coli, did not adhere to live or dead copepods. Attachment of V. cholerae to live copepods is suggested to be an important factor of the ecology of this species in the aquatic environment, as well as in the epidemiology of cholera, for which V. cholerae serovar O1 is the causative agent.
Vibrio cholerae serotype O1 has been isolated from Chesapeake Bay in Maryland and estuaries and sewers in Louisiana. The occurrence of V. cholerae O1 in the aquatic environment in the absence of human disease suggests that this organism survives and multiples in the natural environment.
An occurrence of Vibrio cholerae non-O1/O139 gastroenteritis in the U.S. Gulf Coast is reported here. Genomic analysis revealed that the isolate lacked known virulence factors associated with the clinical outcome of a V. cholerae infection but did contain putative genomic islands and other accessory virulence factors. Many of these factors are widespread among environmental strains of V. cholerae, suggesting that there might be additional virulence factors in non-O1/O139 V. cholerae yet to be determined. Phylogenetic analysis revealed that the isolate belonged to a phyletic lineage of environmental V. cholerae isolates associated with sporadic cases of gastroenteritis in the Western Hemisphere, suggesting a need to monitor non-O1/O139 V. cholerae in the interest of public health.
Hypernatremia (serum sodium ≥150mmol/L) is one of the most life-threatening complications of childhood diarrhea, and its management remains challenging, even in a highly advanced critical care setting. This case report describes the acute clinical course and 3-month neurological follow-up after discharge of an infant with extreme hypernatremia in an intensive care unit in Dhaka, Bangladesh.
A 6-month-old Asian Bangladeshi girl of middle-class socioeconomic status was admitted to the intensive care unit of our institution in 2012 with acute watery diarrhea, lethargy and hypernatremia (208mmol/L serum sodium). She had a history of taking excess oral rehydration salt: five packets each, inappropriately prepared, rice-based, properly diluted, glucose-based oral rehydration salt. Her hypernatremia was treated exclusively with oral rehydration salt solution. She experienced seizures on the third day of her hospitalization and was treated with anticonvulsant drugs. Later in the course of her hospitalization, Enterobacter spp bacteremia was detected and successfully treated with ciprofloxacin. Although magnetic resonance imaging of her brain at discharge showed cerebral edema, brain magnetic resonance imaging appeared normal at a follow-up examination 3 months after discharge. Electroencephalograms taken at discharge and at her 3-month follow-up examination also appeared normal.
Successful management of extreme hypernatremia with only oral rehydration salt did not result in observable neurological consequences, which emphasizes the importance of the use of oral rehydration salt for the clinical management of childhood hypernatremia.
Bangladesh; Diarrhea; Hypernatremia; Infant; Oral rehydration salt
Neck of femur (NOF) fractures are the most common injury among elderly patients and a significant burden on our healthcare system.
This study aimed toevaluate if an Australian rural hospital serviced by general surgeons can meet the established standards of care for the management of NOF fractures by undertaking surgery within 48 hours.
An audit of patients presenting to an Australian rural hospital with NOF fractures over a seven-year period. Patients were excluded if they were transferred or suffered peri-prosthetic or multi-trauma-related fractures. Outcomes included time to surgery, length of stay, and in-hospital mortality, and were compared to three similar Australian studies from hospitals with specialist orthopedic units. Descriptive statistics and meta-analysis were performed.
Overall, 182 patients presented with NOF fractures and 114 met our inclusion criteria. Only 12 per cent of patients were transferred. Patients were mostly female (74 per cent) and elderly (mean age 84.0 years). A total of 79 per cent of patients were operated on within48 hours; other studies reported 67–86 per cent. Mean length of stay was 11.9 days (versus 7.7–13.7), and in-hospital mortality was 4 per cent (versus 2–7 per cent).
This audit suggests that an Australian rural hospital serviced by general surgeons can meet the established standards of care for management of most NOF fractures. Some post-surgery outcomes are similar to those reported by larger centers with specialized orthopedics units.
Neck of femur; hip fractures; hip surgery; rural health; aged care; health outcome
Helicobacter pylori is recognized as the most common pathogen to cause gastritis, peptic and duodenal ulcers, and gastric cancer. The organisms are found in two forms: (1) spiral-shaped bacillus and (2) coccoid. H. pylori coccoid form, generally found in the environment, is the transformed form of the normal spiral-shaped bacillus after exposed to water or adverse environmental conditions such as exposure to sub-inhibitory concentrations of antimicrobial agents. The putative infectious capability and the viability of H. pylori under environmental conditions are controversial. This disagreement is partially due to the fact of lack in detecting the coccoid form of H. pylori in the environment. Accurate and effective detection methods of H. pylori will lead to rapid treatment and disinfection, and less human health damages and reduction in health care costs. In this review, we provide a brief introduction to H. pylori environmental coccoid forms, their transmission, and detection methods. We further discuss the use of these detection methods including their accuracy and efficiency.
Helicobacter pylori; environmental coccoid form; detection methods; LAMP; PCR
Presentation of research at annual national orthopaedic conferences not only serves as a forum for the dissemination of knowledge but is also often a requirement of orthopaedic training programmes. The expected outcome is publication in a peer-reviewed journal. However, publication rates vary for a variety of reasons. The objective of this study was to determine publication rates of presentations from our local Singapore Orthopaedic Association (SOA) annual scientific meeting (ASM) and some of the potential associated factors. We also compared our findings to equivalent meetings worldwide to assess value of scientific content of various orthopaedic conferences.
All presentations of six SOA ASMs were entered into a database. Using presentation titles, author names and keywords in PubMed and Google Scholar, we determined how many presentations progressed to publication in a peer-reviewed journal. Various comparisons were made to determine factors that could influence publication rates. A comparison with national orthopaedic meetings of America, United Kingdom, Ireland, Australia, Germany, Turkey and Brazil was also conducted.
Excluding the ASMs with less than 4 years of follow-up, the publication rate was 35.8%. Both podium and international presenters were found to have significantly higher publication rates than poster and local presenters, respectively, while basic science and clinical research were found to have equivalent rates. Publication rates from other countries’ national conferences ranged between 26.6% and 58.1%.
We suggest that the quality of a presentation is related to its subsequent publication in a peer-reviewed journal. Our findings support the general consensus that the annual meeting of the American Academy of Orthopaedic Surgeons (AAOS) is the gold standard for the dissemination of orthopaedic knowledge updates and advancements in our specialty. Each national orthopaedic association could determine the ratio of “presentations at ASM” to “publication within five years of presentation” and use this as a measure of their annual conference’s impact on the addition and advancement to the orthopaedic literature. This tool may in turn assist clinicians in determining which meetings to attend.
The objective of this study was to assess the level of agreement between stroke subtype classifications made using the Trial of Org 10172 Acute Stroke Treatment (TOAST) and Causative Classification of Stroke (CCS) systems.
Study subjects included 13,596 adult men and women accrued from 20 US and European genetic research centers participating in the National Institute of Neurological Disorders and Stroke (NINDS) Stroke Genetics Network (SiGN). All cases had independently classified TOAST and CCS stroke subtypes. Kappa statistics were calculated for the 5 major ischemic stroke subtypes common to both systems.
The overall agreement between TOAST and CCS was moderate (agreement rate, 70%; κ = 0.59, 95% confidence interval [CI] 0.58–0.60). Agreement varied widely across study sites, ranging from 28% to 90%. Agreement on specific subtypes was highest for large-artery atherosclerosis (κ = 0.71, 95% CI 0.69–0.73) and lowest for small-artery occlusion (κ = 0.56, 95% CI 0.54–0.58).
Agreement between TOAST and CCS diagnoses was moderate. Caution is warranted when comparing or combining results based on the 2 systems. Replication of study results, for example, genome-wide association studies, should utilize phenotypes determined by the same classification system, ideally applied in the same manner.
An integrated maternal health intervention in a rural sub district of Bangladesh focused on the training and deployment of a required number of Community Based Skilled Birth Attendants (CSBAs). The aim of the study was to assess the effect of the intervention on use of skilled provider care during pregnancy, delivery and after delivery.
The effect compared the skilled providers care in low performing areas with high and medium performing areas through pre–and post–intervention surveys. The post-intervention survey was conducted two years after the completion of the intervention. Village clusters, with populations of approximately 3000, were randomly assigned to the surveys. Mothers who had delivered within the 6 months prior to the surveys, were recruited for the structured interviews. Logistic regression was conducted to compare the effect.
Majority of mothers in the low performing areas belonged to a poor economic quintile. The level of skilled attendance for 4+ Antenatal Care (ANC) and delivery increased sharply from baseline to endline survey in low performing areas (ANC: 1.6% to 15.3%, p < 0.0001; skilled birth attendant at delivery: 12.6% to 38.3%, p < 0.0001). Less than 1% of the women received Post Natal Care (PNC) from a skilled provider prior to the intervention, and this proportion increased to 20% at the end of the intervention. Adjusted odds showed that the intervention had an effect on the individual performing area on use of skilled provider care during ANC, delivery and PNC. The increase of 4+ ANC from skilled providers and skilled birth attendants during delivery in the low performing areas due to the integrated maternal health intervention was significant relative to the increase in the high performing areas [4+ ANC from skilled providers – OR: 3.8 (1.9–7.6); skilled birth attendants – OR: 2.8 (2.1–3.8)].
An integrated maternal health care intervention focused on deployment of a required number of CSBAs increased the opportunity for underprivileged women to benefit from skilled providers care during their pregnancy. This integrated intervention might improve the maternal health in developing countries where home delivery with unskilled attendants is common.
Bangladesh; Maternal health; Remote rural area; Skilled provider care
We had previously shown that arcuate fasciculus is poorly developed in patients with Intellectual and Developmental Disabilities (IDD) using diffusion tensor imaging (DTI). In the present study, we used exome sequencing to identify the candidate variants in IDD patients with and without DTI abnormalities.
Eighteen children with IDD (age: 67±36 months, 9 females) were included in the present study. The DTI was used to determine the integrity of arcuate fasciculus. The next generation sequencing was performed on the Solid 4 platform. A novel, analytical strategy was developed to identify a set of candidate genes of interest. Novel, nonsynonymous variants in the patients were then looked for within this subset of genes and in known IDD genes.
Seven novel, nonsynonymous (all of them were heterozygous, missense) variants belonged to ultra-conserved genes that are known to cause abnormal brain morphology in mutant mice. Similarly, 3 novel, nonsynonymous (all of them were heterozygous, missense) variants belonged to known IDD genes. Two patients with underdeveloped arcuate fasciculus contained novel, nonsynonymous variants in genes (MID1 and EN2) regulating axon guidance pathway.
Exome sequencing identified several new the genetic causes of IDD.
Background and Purpose
Improving actionable stroke knowledge of a witness or bystander, which in some cases are children, may improve response to an acute stroke event.
We used a quasi-experimental pretest (PT) post-test design to evaluate actionable stroke knowledge of 210 children aged 9–10 years in response to a single 15-minute exposure to a stroke education video game conducted in the school computer lab. Following immediate post-testing (IP) we provided remote password-protected online video game access, and encouraged children play at their leisure from home. An unannounced delayed post-test (DP) occurred seven weeks later.
Two hundred ten children completed PT, 205 completed IP, while 198 completed DP. 156 (74%) children had home Internet access, and 41 (26%), mostly girls, played the video game remotely. There was significant improvement of stroke symptom composite scores, calling 911 and all individual stroke knowledge items, including a distractor across the testing sequence (p<0.05). Children who played the video game remotely demonstrated significant improvement in knowledge of one symptom (sudden imbalance) compared to children who did not (p<0.05), although overall composite scores showed no difference.
Stroke education video games may represent novel means for improving and sustaining actionable stroke knowledge of children.
health education; health disparities; stroke; stroke prevention
West Nile virus (WNV), mosquito-borne and water-based disease, is increasingly a global threat to public health. Since its appearance in the northeastern United States in 1999, WNV has since been reported in several states in the continental United States. The objective of this study is to highlight role of hydroclimatic processes estimated through satellite sensors in capturing conditions for emergence of the vectors in historically disease free regions. We tested the hypothesis that an increase in surface temperature, in combination with intensification of vegetation, and enhanced precipitation, lead to conditions favorable for vector (mosquito) growth. Analysis of land surface temperature (LST) pattern shows that temperature values >16°C, with heavy precipitation, may lead to abundance of the mosquito population. This hypothesis was tested in West Virginia where a sudden epidemic of WNV infection was reported in 2012. Our results emphasize the value of hydroclimatic processes estimated by satellite remote sensing, as well as continued environmental surveillance of mosquitoes, because when a vector-borne infection like WNV is discovered in contiguous regions, the risk of spread of WNV mosquitoes increase at points where appropriate hydroclimatic processes intersect with the vector niche.
vector-borne disease; precipitation; land surface temperature; MODIS; infectious diseases; prediction models
ShK, from the sea anemone Stichodactyla helianthus, is a 35-residue disulfide-rich peptide that blocks the voltage-gated potassium channel Kv1.3 at ca. 10 pM and the related channel Kv1.1 at ca. 16 pM. We developed an analog of this peptide, ShK-186, which is currently in Phase 1b-2a clinical trials for the treatment of autoimmune diseases such as multiple sclerosis and rheumatoid arthritis. While ShK-186 displays a >100-fold improvement in selectivity for Kv1.3 over Kv1.1 compared with ShK, there is considerable interest in developing peptides with an even greater selectivity ratio. In this report, we describe several variants of ShK that incorporate p-phophono-phenylalanine at the N-terminus coupled with internal substitutions at Gln16 and Met21. In addition, we also explored the combinatorial effects of these internal substitutions with an alanine extension at the C-terminus. Their selectivity was determined by patch-clamp electrophysiology on Kv1.3 and Kv1.1 channels stably expressed in mouse fibroblasts. The peptides with an alanine extension blocked Kv1.3 at low pM concentrations and exhibited up to 2250-fold selectivity for Kv1.3 over Kv1.1. Analogs that incorporates p-phosphono-phenylalanine at the N-terminus blocked Kv1.3 with IC50s in the low pM range and did not affect Kv1.1 at concentrations up to 100 nM, displaying a selectivity enhancement of >10,000-fold for Kv1.3 over Kv1.1. Other potentially important Kv channels such as Kv1.4 and Kv1.6 were only partially blocked at 100 nM concentrations of each of the ShK analogs.
immunomodulator; T lymphocyte; potassium channel; disulfide-rich peptide; sea anemone toxin; K+ channel blocker
Tobacco smoking rates are increasing in developing countries and so are tobacco-related chronic diseases. Reported figures from the WHO show rates of smoking in Egypt as high as 20% but limited information is available about smoking specifically among physicians and medical students.
Materials and methods
Final-year medical students of Cairo University were surveyed regarding their tobacco behavior and attitudes using a modified Global Health Professions Student Survey. We approached 220 students by randomly selecting clinical units into which they were assigned and requested completion of the survey.
Ever users of some form of tobacco comprised 46.7% of students sampled, current users of cigarettes comprised 17.4%, and current users of water pipe ‘sheesha’ comprised 17.6%. The vast majority (87.7%) of students believed that smoking is a public health problem in Cairo and supported restriction of tobacco. Yet, only 58.5% stated that they were taught it is important for physicians to provide tobacco education materials to patients. Among ever users of cigarettes, 54.4% believed health professionals do not serve as health role models for patients, and only a small percentage of all students (34.2%) stated that they had received some form of training on smoking cessation in their medical curriculum to be able to instruct patients.
Conclusion and recommendations
A high rate of smoking was revealed among medical students in Cairo. Overall, approximately 23.4% of students were currently smoking cigarettes and/or sheesha, and 46.7% were ever users of some form of tobacco. A formal antitobacco program for medical students should be incorporated into their medical curriculum to change the attitudes of medical students and overcome the anticipated increase in chronic diseases in Egypt.
curriculum; Egypt; medical students; tobacco
Therapeutic food interventions have reduced mortality in children with severe acute malnutrition (SAM) but incomplete restoration of healthy growth remains a major problem1,2. The relationships between the type of nutritional intervention, the gut microbiota, and therapeutic responses are unclear. In the current study, bacterial species whose proportional representation define a healthy gut microbiota as it assembles during the first two postnatal years were identified by applying a machine-learning-based approach to 16S rRNA datasets generated from monthly fecal samples obtained from a birth-cohort of children, living in an urban slum of Dhaka, Bangladesh, who exhibited consistently healthy growth. These age-discriminatory bacterial species were incorporated into a model that computes a ‘relative microbiota maturity index’ and ‘microbiota-for-age Z-score’ that compare development (defined here as maturation) of a child’s fecal microbiota relative to healthy children of similar chronologic age. The model was applied to twins and triplets (to test for associations of these indices with genetic and environmental factors including diarrhea), children with SAM enrolled in a randomized trial of two food interventions, and children with moderate acute malnutrition. Our results indicate that SAM is associated with significant relative microbiota immaturity that is only partially ameliorated following two widely used nutritional interventions. Immaturity is also evident in less severe forms of malnutrition and correlates with anthropometric measurements. Microbiota maturity indices provide a microbial measure of human postnatal development, a way of classifying malnourished states, and a parameter for judging therapeutic efficacy. More prolonged interventions with existing or new therapeutic foods and/or addition of gut microbes may be needed to achieve enduring repair of gut microbiota immaturity in childhood malnutrition and improve clinical outcomes.
The highly populated floodplains of the Bengal Delta have a long history of endemic and epidemic cholera outbreaks, both coastal and inland. Previous studies have not addressed the spatio-temporal dynamics of population vulnerability related to the influence of underlying large-scale processes. We analyzed spatial and temporal variability of cholera incidence across six surveillance sites in the Bengal Delta and their association with regional hydroclimatic and environmental drivers. More specifically, we use salinity and flood inundation modeling across the vulnerable districts of Bangladesh to test earlier proposed hypotheses on the role of these environmental variables. Our results show strong influence of seasonal and interannual variability in estuarine salinity on spring outbreaks and inland flooding on fall outbreaks. A large segment of the population in the Bengal Delta floodplains remain vulnerable to these biannual cholera transmission mechanisms that provide ecologic and environmental conditions for outbreaks over large geographic regions.
University of Pittsburgh Medical Center (UPMC) installed an Emergency Department Notification System (EDNS) in one of its hospitals. The system, manufactured by Thermo Fisher Scientific (Thermo Fisher Scientific, Inc., 81 Wyman Street, Waltham, MA 02454), consists of four NaI(Tl) scintillation detectors, a 2.5 L PVT gamma counter, a 512 channels multi-channel analyzer, a system controller, and a database-monitoring server. We evaluated a portable Interceptor™ hand-held detector as part of the system for potential ambulance-based early detection and warning unit. We present the minimum detectable activity, distance, and isotope identification success rates along with the change in detector response to various radioisotope sources placed in a Rando® humanoid phantom. The present paper reports these results.
The presence of SXT/R391-related integrating conjugative elements (ICEs) in V. cholerae O1 and non-O1/non-O139 isolated from clinical and environmental samples in Haiti in 2010 was studied. The main finding of this work was the identification of the novel ICEVchHai2 among closely related V. cholerae non-O1/non-O139 clinical strains. The mosaic structure of this element confirms the role of ICEs as efficient recombination systems whereby new genetic material can be acquired and exchanged, according V. cholerae strains new accessory functions.
Vibrio cholera; Non-O1/non-O139; Haiti; Integrative conjugative elements
Adipocytes, which are the main cellular component of adipose tissue, are the building blocks of obesity. The nuclear hormone receptor PPARγ is a major regulator of adipocyte differentiation and development. Obesity, which is one of the most dangerous yet silent diseases of all time, is fast becoming a critical area of research focus.
In this study, we initially aimed to investigate whether the ginsenoside Rf, a compound that is only present in Panax ginseng Meyer, interacts with PPARγ by molecular docking simulations. After we performed the docking simulation the result has been analyzed with several different software programs, including Discovery Studio, Pymol, Chimera, Ligplus, and Pose View. All of the programs identified the same mechanism of interaction between PPARγ and Rf, at the same active site. To determine the drug-like and biological activities of Rf, we calculate its absorption, distribution, metabolism, excretion, and toxic (ADMET) and prediction of activity spectra for substances (PASS) properties. Considering the results obtained from the computational investigations, the focus was on the in vitro experiments.
Because the docking simulations predicted the formation of structural bonds between Rf and PPARγ, we also investigated whether any evidence for these bonds could be observed at the cellular level. These experiments revealed that Rf treatment of 3T3-L1 adipocytes downregulated the expression levels of PPARγ and perilipin, and also decreased the amount of lipid accumulated at different doses.
The ginsenoside Rf appears to be promising compound that could prove useful in antiobesity treatments.
adipocyte; ginsenoside Rf; molecular docking; Panax ginseng; PPARγ
Primary tumors of the paratesticular region are rare, with paratesticular sarcomas constituting a major proportion of these tumors, particularly in the elderly. The paratesticular region consists of mesothelial, various epithelial and mesenchymal cells and may therefore give rise to a number of tumors with various behaviors. Defining the association between the paratesticular mass and the testicle, and differentiation between benign and malignant masses using radiology is challenging, therefore the mass is usually considered to be malignant and radical orchiectomy with high ligation is performed. The present study reports the cases of seven patients with tumors of the paratesticular region and presents the clinical and significant histological features of the tumors. In total, two patients suffered from dedifferentiated liposarcoma (DDLS), two exhibited leiomyosarcoma, two exhibited low-grade fibromyxoid sarcoma and one case of undifferentiated pleomorphic sarcoma was identified. Radical orchiectomy with high ligation was performed in five cases; simple orchiectomy was performed in one case and excisional biopsy was performed in the remaining case. A leiomyosarcomatous and epithelial membrane antigen (EMA) positive whorl pattern was observed during microscopy in the two DDLS cases. Additionally, one of the low-grade fibromyxoid sarcoma patients exhibited pleomorphism and mitosis in focal areas. To the best of our knowledge, the present study is the second time low-grade fibromyxoid sarcoma cases with paratesticular localization have been reported in the literature. Of the seven cases, four patients succumbed to the disease, one patient is living with the disorder and the two cases of DDLS are living without the disease. Paratesticular sarcomas are often aggressive and a multidisciplinary approach is required for the diagnosis and treatment of these tumors.
paratestis; sarcomas; dedifferentiated liposarcoma; fibromyxois sarcoma; leiomyosarcoma; spindle cell liposarcoma; pleomorphic sarcoma; whorl pattern