Background
Whipple’s disease (WD) is a rare, chronic, infection caused by gram-positive filamentous aerobic actinobacterium Tropheryma whipplei occurs classically in the gastrointestinal tract and shows histopathologically foamy macrophages with typical numerous PAS-positive, non-acid fast particles. Ocular WD in the form of uveitis may occur in the absence of systemic disease but has not been reported to present with scleral manifestation. We describe for the first time to the best of our knowledge 2 cases of scleral nodules with typical histopathological morphology of WD and without systemic involvement.
Case presentation
The first was a 53-year old diabetic male farmer who presented with 2 nontender right eye scleral nodules for 3 months, had a negative systemic workup, and surgical excision showed Periodic acid Schiff (PAS)-positive eosinophilic structures inside macrophages. Grocott’s methenamine silver (GMS) stain and acid-fast bacilli (AFB) stain of the tissue itself were negative. The second case was a 60-year old male who presented with an asymptomatic superior scleral nodule for 4 months, which showed similar appearance and negative GMS and AFB stains.
Conclusion
WD should be included in the differential diagnosis of scleral nodules even in the absence of systemic symptoms. Surgical excision without systemic treatment resulted in successful outcome without recurrence.
Objectives:To determine the prevalence of irritable bowel syndrome (IBS) among school teachers in Qassim region, Kingdom of Saudi Arabia (KSA) and it’s impact on their performance -as teachers- and on life duties.Methods:A cross-sectional study was held in Qassim region, KSA between 2012 and 2013. The study was conducted among 300 school teachers selected by multistage stratified random sample method in 2013. The sample size was calculated according to the formula: n = (Z2 * (p) * (q))/c2. A confidential, anonymous, and a self-administered questionnaire was used to collect personal and sociodemographic data, teacher performance oriented questions were included. Rome III Criteria were used. Teachers with red flag symptoms were excluded.Results:The prevalence of IBS symptoms among teachers in Qassim region of KSA is 40.7% with no significant gender predilection. The IBS symptoms significantly affect the work performance of the teachers (61.6%) with high absenteeism rate (46.6%), especially among 51-60 years and 21-30 years, age groups (p<0.05 in chi-square test). Significant proportion (45.3%) of IBS criteria +ve teachers find IBS symptoms to be hindrance in their life duties.Conclusion:Prevalence of IBS in Qassim school teachers is becoming an important issue with 40.7% of teachers reporting symptoms suggestive of IBS in a random sample. Majority of teachers are having frequent performance problems - as teachers - and in usual life duties associated with their IBS Symptoms. Significantly, IBS criteria +ve teachers are more likely to have discipline problems compared with healthy teachers. We recommend a health care program to tackle the problem among the teachers, to improve their performance and reduce working hours loss. Also, follow up studies need to be conducted to assess the health care of IBS patients in local public health care centers.
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