Basal cell carcinoma (BCC) is one of the most common malignant tumors worldwide, involving the skin. It is also part of keratinocyte carcinomas, alongside its squamous counterpart. It has low mortality and extremely low metastatic rates (although when present, it indicates a poor patient prognosis); it also has a high morbidity rate through local destruction and recurrence, particularly when perineural invasion is observed, clinically or histopathologically. BCC development is the result of environmental and patient factors, with genetics and ultraviolet radiation playing major roles. The clinical and histopathological aspects vary according to tumor subtype, being classified as high-risk tumors (nodular, superficial, pigmented and infundibulocystic BCC with adnexal differentiation) and fibroepithelial subtypes, or as high-risk tumors (micronodular, infiltrating, sclerosing/morphoeic and basosquamous subtype or the type with sarcomatoid differentiation). Dermoscopy is now complimented by novel in vivo diagnostic tools (optical coherence tomography, reflectance confocal microscopy, high-resolution ultrasonography, Raman spectroscopy or terahertz pulse imaging), improving the diagnostic accuracy and providing tumor depth and lateral margins without the use of invasive techniques. Novel treatment approaches for the treatment of BCC have recently been investigated with the use of hedgehog pathway inhibitors, such as Vismodegib. These approaches aim for complete resolution, minimal side-effects, high patient satisfaction with the optimal cosmetic results, particularly in key areas, such as the face. The present review article summarizes and discusses the comprehensive clinical and histopathological aspects of BCC, and presents novel imaging tools and therapeutic approaches that have been identified.

Many children in sub-Saharan Africa die from AIDS, not having accessed HIV testing and care. Children of adult antiretroviral therapy (ART) patients are a target group for HIV testing in order to increase access to care, but the HIV test coverage of this group in Malawi is unknown. In a cross-sectional survey of 832 patients at a large urban ART clinic in Blantyre, we found that 81.2% of 1223 children and 37.7% of 488 spouses of adult ART patients were reportedly not HIV tested. Wives of male patients were significantly less frequently HIV tested than husbands of female patients (53.0% vs. 72.4%, p<0.0001). Children under the age of 8 years (adjusted odds ratios [aOR] 2.76), children of female patients (aOR 2.53) and of patients whose partner had been HIV tested (aOR 2.87) were significantly more likely to have been tested for HIV. More attention needs to be given to provider initiated testing of children and spouses of ART patients.

The MoH requires that ART sites that have adopted the EMR system also continue to run paper-based systems to serve as backup in the eventuality of EMR system failures. EMR data are fi rst backed up on the server at the health facility where the system is running and at an off-site central server on a daily basis. Case registration and information on ART outcomes generated through printouts of master card data in the form of adhesive labels from the EMR are manually transcribed by clinic staff into the paper-based register. The ART supervision team observed that there were differences in the data that were transferred and reported using the paper-based system as compared to the EMR. As national reporting and drug forecasting depends on the EMR, inaccuracies in the paper-based system in case of EMR failure could have important programmatic implications, such as incorrect drug forecasting.Our objective was to assess the extent of inaccuracies in the transcription of case registration and recorded deaths between the EMR and the paper-based data system. METHODS Design, study setting and populationWe conducted a retrospective audit of routine programme data at fi ve ART sites in the central and southern regions of Malawi. These ART sites included three district hospitals (Dedza, Ntcheu and Salima), one mission hospital (St Gabriel's Mission Hospital) and one central hospital (Queen Elizabeth Central Hospital [QECH]). The district hospitals each have two nurses, a clinician and two clerks. They typically attend to more than 200 patients on a clinic day, and their ART registers currently have more than 3000 patients each. QECH has four nurses, three clinical offi cers and two clerks, who attend to more than 400 patients per day; their ART register has more than 10 000 patients. St Gabriel's Mission Hospital has three nurses, two clinicians and one clerk, who see more than 100 patients a day; their ART register includes more than 200 patients. These sites were chosen as they were among the fi rst sites to start ART in Malawi, had high case loads and were among the fi rst to implement the EMR. All these fi ve sites also run paper-based register systems.All patients enrolled in the ART programme up to 31 December 2010 at these fi ve ART sites were included in the study. A review of the paper registers was conducted at all fi ve health facilities between January and February 2011. Interna onal Union Against Tuberculosis and Lung DiseaseHealth solu ons for the poor Setting: Antiretroviral treatment (ART) clinics at one central hospital, three district hospitals and one mission hospital in the central and southern regions of Malawi. Objective: To measure the extent of inaccuracies in the transcription of case registration and recorded deaths between electronic medical data (EMR) and paper registers. This was done to inform the Ministry of Health on the reliability of the paper-based system as backup in case of EMR failure. Design: Retrospective analysis of routine programme data.Results: A total of 31 763 registrations and 2...

Nasopharyngeal carcinoma (NPC) is an epithelial tumor, which develops most frequently from the lateral pharyngeal recess and holds some complex epidemiological characteristics. Its unusual race and geographic distribution suggests that not only the environmental factors are a contributing factor to the development of this rare cancer type, but also the genetic traits play an important role, along with nitrosamine-containing food consumption and Epstein-Barr virus infection. The signs and symptoms which a patient can present and suffer from are various and include nasal, otic, neurological as well as general ones; the way this tumor manifests being dependent on the stage of the tumor. The therapeutic management applicable in NPC needs to be established according to the case of the patient and include radiotherapy, chemotherapy, surgery, immune therapy, targeted therapy or combined treatment. The main objective of the treatment is local and regional tumor control; relapse is an important factor for future development of distant metastases. New therapeutic concepts are always sought of, current research focusing on precision medicine, meaning systemic treatment with a personalized radiotherapy approach according to the characteristics of the tumor.

Natural killer (NK)/T-cell lymphomas represent a rare type of lymphoid malignancy with mostly extranodal involvement, having NK cell or (rare) T cell lineage, classified by the World Health Organization into several subtypes which can involve the head and neck region, with the most frequent one being the nasal type. This article presents the case of a 31-year-old patient who presented at the Emergency Unit of Saint Andrew Emergency Clinical Hospital of Galati suffering from mycosis fungoides-like cutaneous lesions, associated with partial left eyelid ptosis of unknown etiology, as well as a poor health status with fever and respiratory failure. The final diagnosis was NK/T-cell non-Hodgkin lymphoma, possibly nasal type with medium sized T cells. The complexity of the rare diagnosis, associated with the unusual rapid patient evolution towards exitus 3 months after diagnosis, the intra-orbital metastatic involvement and the absence of a standardized treatment are case peculiarities, some of which are consistent with current literature data.

Cerebrospinal fluid ascites following ventriculo- peritoneal shunting for hydrocephalus is a very rare complication. We present the first case at our hospital. A 3year old female with communicating hydrocephalus presented with massive ascites. It recurred with 2-3weeks of ascitic tap to dryness. Other possible causes of ascites were excluded by normal renal and liver function tests and clinically normal cardiac function. Tests done on the ascitic fluid showed that it was consistent with cerebrospinal fluid with no signs of infection. CT abdomen excluded abdominal masses and CSF pseudo-cyst. A ventriculo-Atrial shunt was done and the ascites slowly regressed over the next 2-3 weeks with no recurrence. The reason why the peritoneum failed to absorb the CSF was not established.

Endometrial stromal sarcoma (ESS) is a rare tumor, predominantly occurring as a primary tumor of the uterus. Rare cases of primary extrauterine ESS (EESS) have been reported. Low-grade ESS (LG-ESS) is more common than high-grade ESS (HG-ESS). We present five cases of ESS and one case of EESS. All cases received external radiotherapy (EBRT) at the Radiotherapy Department of the Emergency Clinical Hospital 'Sfantul Apostol Andrei' Galati, during 2004-2020. Five cases underwent EBRT in two-dimensional (2D) technique and only one patient received EBRT with three-dimensinal conformational radiotherapy (3DCRT) technique with a linear accelerator, Elekta Synergy. Five patients were referred to postoperative radiotherapy after hysterectomy. The median age of the patients was 57.4 years. One patient was referred to radiotherapy with palliative intent. EESS localized in the retroperitoneum, in the para-aortic region, was identified in one 64-year-old patient with a personal history of hysterectomy and bilateral salpingo-oophorectomy in 1997; EESS was complicated with vertebral extension at the L1-L2 level and spinal cord compression syndrome. ESS represents a rare diagnosis and a high-or low-grade tumor profile is distinguished by immunohistochemistry (IHC) tests. Up to 30% of patients have EESS at presentation. The treatment of ESS is multimodal, its management requiring a multidisciplinary team, and it is different according to the primary tumor location and tumor staging. The role of adjuvant radiotherapy remains controversial in high-grade EESS and due to the rarity of these cases there are limited data concerning the efficacy of adjuvant EBRT available from prospective randomized control clinical trials.

The aim of this study was to assess the delays that can potentially occur in the emergency transfer of patients with ST-elevation myocardial infarction (STEMI) to percutaneous coronary intervention (PCI) centers. We conducted a retrospective study using the medical reports pertaining to 97 patients who presented to the Emergency Department of the Emergency County Hospital of Galati during the year of 2018 with the diagnosis of STEMI and meeting eligibility criteria for PCI, thus warranting transfer to a hospital with PCI facilities. The pick-up time of patients diagnosed with acute myocardial infarction from the emergency department by the transfer crew is significantly shorter (p < 0.05) than those transferred by air, regardless of the PCI center to which the transfer was performed, Iasi or Bucharest, when compared to the time required to process the patients transferred by land to the same PCI centers. The results of the study shows that the helicopter use for transferring acute myocardial infarction patients to a PCI center must be considered, given the distance between non-PCI and PCI centers is over 200 km.