Tarik El Scheich’s research while affiliated with Heinrich Heine University Düsseldorf and other places

Since the publication of the protocol elaborated by International experts convened by the WHO in Cairo 1993, practical experience has been gained by groups working on Asian schistosomiasis. Based on the analysis of their work and our own experience, we propose some modifications to improve the protocol. For the standard investigations we propose: 1. to omit all measurements from standard investigations except for the portal stem. 2. ultrasound pictures should be compared to standard image patterns (IP) covering both, interseptal fibrosis (“network patterns”) and portal fibrosis. 3. combined network- and portal fibrosis patterns are proposed. 4. network patterns should be sub-devided into two classes with predominant mesh size <2.5 and >2,5 cm. 5. to obtain a more finegrained grading in “inbetween”- findings and to reduce intra- and inter-observer variance we porpose that the ultrasonographist should have a second image pattern (IP) choice. 6., risk scoring for gastrointestinal bleeding should be simplified by a score built by the IP-score and the portal vein (PV) quotient (PVQ= PV/height. 7., all reports on hepatic abnormalities due to schistosomiasis must state how many patients have been screened for hepatic co-infections such as liver flukes, HBV, HCV, HDV. Additional investigations should include: 1., height-adjusted spleen length and depth to allow the evaluation of the relation to portal hypertension and hypersplenism in non-malaria endemic areas. 2., gallbladder changes including sludge, calculi as well as the response to the ultrasonographic Murphy manoevre. With the advent of more sophisticated portable ultrasound machines including Doppler facilities as well as in hospital settings of emerging or industrialized countries comparison of ultrasound findings with other techniques including elastography of liver and spleen, contrast ultrasonography, CT and MRI the knowledge will increase with respect to the nature and dynamics of intestinal, hepatic, portal circulatory and splenic abnormalities encountered in hepatosplenic schistosomiasis.

Since the publication of the protocol elaborated by International experts convened by the WHO in 2000, practical experience has been gained by research groups working on schistosomiasis. Based on a systematic analysis of their work and our own experience, we propose some modifications for improving the protocol. For the standard investigations we propose: 1., to provide height adjusted minimal urinary bladder fillings allowing a proper examination, in order to rule out erroneously assumed pathology. 2., to state whether or not the bladder contains blood clots, sediment, sludge or calculi. 3., to simplify and improve the urinary bladder findings scoring as follows: grade 0: no abnormality of the urinary bladderwall which is less then to 5 mm thick; grade 1: any area of bladder wall with minor thickening of the bladder wall 5-7mm; grade 2: maximum bladder-wall thickening of 8–9 mm; grade 3: maximum bladder-wall thickening of 10 mm or more, thus including any polyp, mass or tumor 4., to provide a more finegrained urinary tract obstruction (UTO) scoring including the information if there a fissure of the renal pelvis between 2 and 5 mm, 6 and 10 mm, or 11 mm and more is present Optional investigations: “fibrosis of the renal pelvis” should be omitted since this has never been observed. Presence of ureteric lesions, of calcifications, of prostatic echogenic lesions, of hydrocele or any other possible sign of genital involvement should be added. In pregnant women fetal growth parameters should be specificly compared with gestation time and placenta should be scanned for any lesion.

Since the publication in 2000 of the protocol elaborated by International experts convened by the WHO, practical experience has been gained by groups working on schistosomiasis. Based on a systematic analysis of their work and our own experience, we propose some improvements of the protocol. For the standard investigations we propose: 1. to omit all measurements from standard investigations except for the portal stem. 2. to obtain a more finegrained grading also covering “in-between”-findings and to reduce intra- and interobserver variance we the ultrasonographist should have a second image pattern (IP) choice. 3. risk scoring for gastrointestinal bleeding should be simplified by a score built by the IPscore for portal fibrosis and the portal vein quotient (PVQ=PV diameter/height). 4., gallbladder changes including external echogenic wall protuberances, sludge, calculi as well as the result of a ultrasonographic Murphy manoevre should be part of the standard protocol. 5. all reports and publications on hepatic abnormalities due to schistosomiasis must state how many patients have been screened for co-infections due to HBV, HCV, or HDV. Additional investigations should include: 1., assessment of height-adjusted spleen length and depth for evaluating its relation to portal hypertension and hypersplenism in non-malaria endemic areas as well for regression of morbidity after therapy. 2., with the advent of more sophisticated portable ultrasound machines including Doppler facilities portal flow and portosystemic collaterals may be assessed more accurately. 3., intestinal lesions might be assessed more accurately with high frequency transducers, hydrosonography. 4., gallbladder contractility after a fatty meal may be assessed. In hospital settings of emerging or industrialized countries comparison of ultrasound findings with other techniques including elastography of liver and spleen, contrast ultrasonography, CT and MRI increase the knowledge on the nature and dynamics of liver, portal circulation and spleen abnormalities encountered in hepatosplenic schistosomiasis.

In 2000, the World Health Organization (WHO) issued an ultrasound field protocol for assessing the morbidity due to Schistosoma (S.) haematobium and S. mansoni. The experience with this classification has recently been reviewed systematically. The WHO protocol was well accepted worldwide. Here we review the use of ultrasound to assess the morbidity due to schistosomiasis with emphasis on easy, quick, and reproducible ways that can be used in the field. Findings obtained with high-end ultrasound scanners in the hospital setting that might eventually have applications in the field are also described. © Georg Thieme Verlag KG Stuttgart · New York.

The aim of this study is to review the worldwide acceptance of the World Health Organization (WHO) ultrasound protocol for assessing hepatosplenic morbidity due to Schistosoma mansoni since its publication in 2000. A PubMed literature research using the keywords "schistosomiasis and ultrasound," "schistosomiasis and ultrasonography," and "S. mansoni and ultrasound" from 2001 to 2012 was performed. Case reports, reviews, reports on abnormalities due to parasites other than S. mansoni, organ involvement other than the human liver, and reports where ultrasound method was not described were excluded. Six studies were retrieved from other Brazilian sources. Sixty studies on 37,424 patients from 15 countries were analyzed. The WHO protocol was applied with increasing frequency from 43.75 % in the years 2001 to 2004 to 84.61 % in 2009 to 2012. Results obtained using the pictorial image pattern approach of the protocol are reported in 38/41 studies, whereas measurements of portal branch walls were applied in 19/41 and results reported in 2/41 studies only. The practical usefulness of the pictorial approach of the WHO protocol is confirmed by its wide acceptance. This approach alone proved satisfactory in terms of reproducibility, assessment of evolution of pathology, and comparability between different settings. The measurements of portal branches, also part of the protocol, may be omitted without losing relevant information since results obtained by these measurements are nonspecific. This would save resources by reducing the time required for each examination. It is also more feasible for examiners who are not specialized in medical imaging. As with all protocols, incipient liver fibrosis is difficult to distinguish from normal ultrasound findings of the liver. The ability of this protocol to predict complications in severe cases should be further evaluated in a higher number of patients.

Abstract We report on a 16-year-old body builder who suffered from an acute ischemic stroke. In the urine, cannabis metabolites as well as metabolites of the oral androgenic-anabolic steroid methandrostenolone were detected, both known to be associated with stroke events. This report highlights the role of cannabis and steroid abuse that induce strokes in the absence of arteriopathy, cardioembolism or thrombophilia. Owing to new upcoming socio-behavioral aspects of late childhood and early adolescent life, this formally rare abuse of cannabis and/or anabolic steroids as well as their associations with strokes becomes more current than ever.

Worldwide, only nine cases of revealing slipped capital femoral epiphysis (SCFE) associated with primary hyperparathyroidism (PHP) have been reported. This study included adolescent subjects with the described association, the clinical course, and exhibiting the leading pathogeneses. Here, we reviewed all known cases and developed an effective approach to the management of SCFE and PHP. In cases of emergency, SCFE fixation is primarily done regardless of any preexistent hypercalcemia due to PHP and followed by parathyroidectomy as soon as possible. In cases of mild and moderate hypercalcemia, whether SCFE fixation is followed by parathyroidectomy and vice versa or resolved during a single operating session depends on manifest side effects due to hyercalcemia. Patients with severe hypercalcema should undergo urgent parathyroidectomy, followed by immediate orthopedic surgery, even as a simultaneous procedure. This is to avoid onset of hypercalcemic side effects or worsening of preexisting side manifestations resulting from hypercalcemia. Our report demonstrates that SCFE presenting with hypercalcemia, with signs of low bone density, or in atypical age deserves further workup for secondary causes. In addition, the newly developed systematic approach toward achieving an effective, efficient management should help to improve the patients' long-term outcome.

The study was conducted to assess infection intensity and morbidity due to Schistosoma mansoni in schoolchildren on Ukerewe Island in Lake Victoria, Tanzania, East Africa. Three hundred and sixty pupils who have never been treated previously were enrolled (180 males/180 females, age 6-17 years [median 10 years]) in three different schools of the island. Double stool samples were collected from each pupil and egg excretion was classified according to WHO recommendations. Ultrasound investigations were performed in accordance with the WHO Niamey-Belo-Horizonte protocol. Male (112/180, 62.2%) and female (104/180; 57.7%) pupils were infected (difference, not significant [n.s.]). In the positive 216 cases, egg excretion varied from 1 to 2,440 eggs per gramme stool (epg) [median 165 epg]. There were 69/216 (31.9%) who had a low grade, 105/216 (53.2%) had a moderate and 42/216 (14.8%) had a heavy infection. There was no significant difference between male and female sex nor with regard to age groups. There were 354/360 children who underwent sonography: 321 (90.7%) had splenomegaly, 316 (89.3%) showed a left lobe and 109 (30.9%) had a right lobe hepatomegaly. Overt signs of portal fibrosis (PF) were present in 19 children (5.4%) out of whom 11 presented with echogenic thickening of peripheral portal and 8 with thickening of central portal branches. Non-specific portal wall changes were seen in 6 children (1.7%). Association of PF to quantitative egg excretion was not seen (median in PF, 172 epg vs. median in non PF, 168 epg; difference, n.s.). Portal vein dilatation was seen in 101/354 (28.5%) cases. In Ukerewe, the prevalence of S. mansoni infection and infection intensity in children is high, yet overt hepatic morbidity is low as compared to other endemic foci. Non-specific ultrasonographic abnormalities including hepatosplenomegaly and portal vein dilatation were seen frequently but the fraction attributable to schistosomiasis is difficult to assess.

Immigrants to Germany and their children are at particular risk for tuberculosis (TB). - 35 Patients (10 male / 25 female aged 2 - 59 years (median 33 years) originating mostly from high incidence countries in Asia (19 (54.3%)) in Africa (14 (40.0%) and East Europe (2 (5.7%)), attended at the Tropical Medicine Unit were analysed. - Primary clinical presentation was most frequently lymphadenitis (13 (37.1%)). Other organs involved included bones (7 (20.0%)), central nervous system (5 (14.3%)), urogenital organs (3 (8.6%)), lung (3 (8.6%)), mediastinum, (2 (5.7%)) and abdomen (2 (5.7%)). ESR was abnormal in 21/28 (75.0%), CRP in 20/35 (57.1%), and protein electrophoresis in 22/26 (84.6%) cases. The tuberculin skin test was strongly positive in all 15 cases where the test had been performed. Tuberculosis interferon gamma release assay (TB-IGRA) was positive in all 35 cases (100%). PCR for nucleic acids of Mycobacterium (M.) tuberculosis complex was positive in only 7/20 (35.0%) cases. M. tuberculosis was identified in 32/35 (91.4%), M. bovis in 2 (5.7%) cases. 1 case was diagnosed clinically. All patients were negative for HIV. Typical histopathology was seen in the 29 cases, where biopsies had been taken. Chest-X-ray did not reveal specific pulmonary lesions in the majority of cases (22/35 (62.9%)). Diagnosis of TB was mostly delayed (4 to 299 weeks, (median 8)). The most frequent primary suspicion was a malignancy (17/35 (48.6%)) while TB was initially suspected in 5 cases only. Diagnosis of TB is impeded by its multifaceted presentation especially in immigrants.

A severe rare complication in patients with branched-chain organic acidurias (BCOA) is pancreatitis with a limited number of patients published so far. Here, we report on a patient with methylmalonic aciduria (MMA) who developed chronic pancreatitis after several episodes of acute pancreatitis. In addition, an overview is given about some previous published cases with BCOA who developed pancreatitis in the course of the disease. In half of the published MMA patients with pancreatitis, an acute pancreatitis was reported while the rest suffered from a chronic form of this disease. Acute pancreatitis in BCOA patients can clinically present in the context of recurrent vomiting and an impaired general physical condition even without typical signs of pancreatitis. Any form of pancreatitis should be ruled out in the assessment of acutely ill patients with BCOA.