Immunoglobulin G4-related disease (IgG4-RD) is an increasingly recognized immune-mediated condition comprised of a collection of disorders that share specific pathological, serological, and clinical features. IgG4-RD is a fibroinflammatory condition with a tendency to form tumors with inflammatory infiltrate with IgG4 rich plasma cells and elevation of serum IgG4, which may affect virtually every organ and tissue. IgG4-related ophthalmic disease may present as dacryoadenitis, myositis, or involvement of other orbital tissue. Hypophysitis or pachymeningitis may manifest as cranial neuropathies. The diagnosis of IgG4-RD is based on a typical clinical scenario, supportive laboratory test, expected radiological characteristics, and distinct histopathological and immunohistochemical features. Corticosteroids and immunosuppressives form the mainline treatment.

Objectives: Sodium-glucose cotransporter 2 inhibitors (SGLT2-I) are a new class of antidiabetic drugs that might increase the risk of dehydration and hypoglycemia, particularly during the month of Ramadan in which Muslims abstain from eating and drinking for 14–16 hours daily. We aimed to provide real-life evidence about the safety of SGLT2-I during Ramadan. Methods: All patients over the age of 18 years on SGLT2-I before Ramadan 2016 who would be fasting during Ramadan were included. Demographic data, detailed medical history including comorbidities and medication profile, and laboratory results were collected before and after Ramadan. We also conducted a phone interview to evaluate the frequency and severity of hypoglycemia and dehydration. Results: Of the total of 417 patients, 113 (27.0%) experienced hypoglycemic events, and 93 of these (82.3%) checked their blood glucose using a glucometer. Confirmed hypoglycemia (< 70 mg/dL) was observed in 78 (83.8%). The hypoglycemic events were significantly more frequent in the SGLT2-I plus insulin-treated group than in those treated with SGLT2-I plus oral hypoglycemic agents group (p < 0.001). Confirmed hypoglycemic events were more frequent in those using SGLT2-I plus intensive insulin compared to those using SGLT2-I plus basal insulin
(p = 0.020). Symptoms of dehydration were seen in 9.3% (n = 39) of the total population. We observed statistically significant reductions in glycated hemoglobin and weight by the end of Ramadan (p < 0.001). There were no significant changes in lipid profile and creatinine levels by the end of the study. Conclusions: The use of insulin in combination with SGLT2-I increases the risk of hypoglycemia during Ramadan. Hypoglycemic events were mild and did not require hospital admission. However, careful monitoring during prolonged fasting is warranted. No significant harmful effects on renal function result from treatment with SGLT2-I during Ramadan.

Objectives: Nanoparticles induce oxidative stress in cells and damage them through the cell membrane and DNA damage, eventually resulting in cell death. This study aimed to evaluate the effect of titanium dioxide (TiO2) nanoparticles on apoptosis induction and invasion of gastric cancer cell line, MKN-45. Methods: We used the MTT assay to assess proliferation of MKN-45 gastric cancer cells after exposure to different forms of TiO2 nanoparticles including amorph, brookite, anatase, and rutile coated with polyethylene glycol (PEG) and bovine serum albumin (BSA). Ethidium bromide and acridine orange staining were used to visualize cancer cell apoptosis, and the wound healing assay technique (migration test) was used to assay cancer cell invasion. Results: Viability and proliferation of cancer cells in the presence of various forms of TiO2 nanoparticles were reduced (p ≤ 0.050). This reduction in cell proliferation and viability was directly related to concentration and duration of exposure to nanoparticles. Induction of cell death was seen in all groups (p ≤ 0.050). Increased cell invasion was seen in PEG-amorph TiO2 group compared to the control group. Cell invasion was decreased only in the brookite BSA group (p ≤ 0.050). Conclusions: Various forms of TiO2 nanoparticles reduced cell proliferation and induced apoptosis in cancer cells. Some forms of TiO2 nanoparticles such as brookite BSA also inhibited cell invasion. PEG-amorph TiO2 nanoparticles increased cell invasion. These differences seem to be due to the effects of different configurations of TiO2 nanoparticles. TiO2 may provide a new strategy for cancer treatment and more studies are needed.

Objectives: Interleukin-18 (IL-18) is a proinflammatory and proatherogenic cytokine, and its genetic variations may contribute to the development of coronary artery disease (CAD). We sought to investigate the role of -137G/C polymorphism and gene expression levels of IL-18 in patients with CAD.  Methods: The study population included 100 patients with angiographically proven CAD and 100 matched controls. Total RNA and DNA were extracted from leukocytes using appropriate kits. The genotype of -137G/C polymorphism and gene expression level of IL-18 was determined using allele-specific polymerase chain reaction (PCR) and real-time (RT)-PCR assay, respectively.  Results: The genotypic and allelic distribution of IL-18 -137G/C polymorphism was not significantly different between the two groups (p > 0.050). Moreover, the -137G/C polymorphism did not increase the risk of CAD in dominant and recessive genetic models (p > 0.050). However, subgroup analysis of CAD patients revealed that the IL-18 -137G/C polymorphism was significantly associated with increased risk of CAD in hypertensive patients (odds ratio (OR) = 7.51; 95% confidence interval (CI): 1.24–25.17; p = 0.019) and smokers (OR = 4.90; 95% CI: 1.21–19.70; p = 0.031) but not in the diabetic subpopulation (p = 0.261). The genotype distribution of IL-18 -137G/C genetic polymorphism was significantly different among patients with one, two, and three stenotic vessels (p < 0.050). The gene expression level of IL-18 was significantly higher in the CAD group than the control group (p < 0.001). Moreover, the carriers of CC genotype had significantly lower gene expression levels of IL-18 than carriers of GG genotype (p < 0.050). Conclusions: The -137G/C polymorphism of IL-18 may be associated with the CAD risk in hypertensive and smoker subgroup of CAD patients. The -137G/C polymorphism seems to play an important role in determining the severity of CAD. Increased IL-18 gene expression level is a significant risk factor for the development of CAD. The CC genotype of -137G/C polymorphism is associated with lower IL-18 gene expression levels.

Objectives: To compare the grade of hydronephrosis between the antenatal and first postnatal ultrasound (US) and their clinical outcomes. Methods: This retrospective study included all cases of isolated hydronephrosis detected by antenatal US from August 2005 to February 2011. Hydronephrosis was classified based on the standard criteria into mild, moderate, or severe. Cases associated with other major congenital anomalies were excluded. All patients were followed-up postnatally and outcomes available were analyzed at one year of age. Results: A total of 105 cases were included out of which 83 (79.0%) were males and 22 (20.9%) were females with a median gestational age of 38 weeks. First postnatal US of 105 cases showed that 20 (19.0%) were free of hydronephrosis, 39 (37.1%) had mild, 29 (27.6%) moderate, and 17 (16.1%) had severe hydronephrosis. Half (50.4%) of hydronephrosis cases improved in their clinical presentation while 13.3% showed deterioration and 36.3% remained the same. Almost half of all cases (52 cases) were diagnosed by US at the end of first year without any effect on renal function. Conclusions: Antenatal and postnatal US are sensitive tools for detecting hydronephrosis as well as for postnatal counseling. Fetal anatomy US is usually done at 18 weeks gestation and if this reveals any evidence of hydronephrosis, the patient is followed according to the severity. Postnatal US is not done routinely for cases where hydronephrosis resolves completely during pregnancy. Although newborns with antenatal hydronephrosis due to secondary causes are at greater risk for renal impairment, surgical intervention reserves renal function.

Objectives: We sought to evaluate the relationship between the prevalence of antibiotics resistance and virulence factors genes in methicillin-resistant Staphylococcal aureus (MRSA) and methicillin-sensitive S. aureus (MSSA) strains from clinical samples taken in west Iran. Methods: We performed a cross-sectional study using 100 MRSA and 100 MSSA samples isolated from clinical specimens. We used biochemical methods to identify the isolates, which were confirmed by the polymerase chain reaction (PCR) assay. Antibiotic susceptibility testing was performed using disk diffusion. PCR detected the presence of virulence factors, including enterotoxin genes, toxic shock syndrome toxin-1 (TSST-1), and exfoliative toxin. Results: The majority of MRSA isolates exhibited a high level of resistance to common antibiotics and susceptible to vancomycin, while most MSSA isolates were also resistant to erythromycin and ciprofloxacin. The prevalence of Staphylococcal enterotoxins (SEs) were reported 147 (73.5%). Among 100 MRSA samples, 92 (92.0%) harbored SAg genes. The most frequent toxin gene was sea (45.0%) followed by sec (39.0%). Among 100 MSSA isolates, 89 (89.0%) harbored SAg genes and the most prevalent genes were sea (42.0%), sek (38.0%), sec (35.0%,), and TSST-1 (10.0%). The prevalence of TSST-1 and exfoliative toxin genes in MRSA samples were 12 (12.0%). The association of SAg genes with MRSA and MSSA isolates showed a high prevalence of enterotoxin seq, seg, and sei in MRSA than MSSA with a statistically significant difference (p < 0.050). Conclusions: The prevalence of MRSA and the association of pathogenic agents with antibiotics resistance genes can lead to the emergence of strains with higher pathogenicity and less susceptibility.

Objectives: Due to increasing cardiac disease and its mortality rate, the frequency of cardiac imaging has grown and, as a result, interventional cardiologists potentially receive high radiation doses in cardiac examinations. This study aimed to assess the knowledge, attitude, and practice (KAP) level of radiation protection (RP) among interventional radiology staff in Iranian health care centers across the country. Methods: We used a validated questionnaire survey consisting of 30 multiple-choice questions to perform a cross-sectional study. Participants were healthcare personnel working professionally with radiation at different levels (i.e., secretary, radiology technologists, nurse, and physician). The questionnaire was divided into three sections to assess KAP regarding RP. Results: Significant differences exist in RP KAP mean scores based on educational age (p < 0.050). There was no significant difference in RP KAP mean scores when looking at sex, practice age, and hospital type (p > 0.050). We found a significant difference between RP KAP mean scores and different regions (p < 0.050). Conclusions: Educational and practice age, sex, type of hospital, and geographical region affect he KAP of interventional radiology staff regarding RP. Since many of the subjective radiation harms for both medical team and patients, this can be easily controlled and prevented; a checkup for personnel of interventional radiology departments, considering samples from different parts of the country with different levels of education, continuous training, and practical courses may help map the status of KAP. The results of this study may also help authorized health physics officers design strategic plans to enhance the quality of such services in radiation departments.

Objectives: We sought to determine the prevalence of traditional and complementary medicine (TCM) use for knee osteoarthritis and its associated factors among patients attending a referral hospital in an eastern coastal state of Malaysia. Methods: This cross-sectional study included 214 patients with knee osteoarthritis. A universal sampling method was applied to patients who attended the outpatient clinic in Hospital Universiti Sains Malaysia from May 2013 to October 2013. Participants were given a questionnaire to determine their sociodemographic information and a validated Bahasa Malaysia version of the Western Ontario and McMaster Universities Arthritis Index (WOMAC). This questionnaire was used to assess the severity of knee osteoarthritis (i.e., pain, stiffness, and disturbances in daily activity). Results: Over half (57.9%) of patients reported using TCM to treat knee osteoarthritis. Factors associated with TCM use were gender (odd ratio (OR) = 2.47; 95% confidence interval (CI): 1.28–4.77), duration of knee osteoarthritis (OR = 1.51; 95% CI: 1.03–2.23), and the severity of knee pain (OR = 2.56; 95% CI: 1.71–3.86). Conclusions: The prevalence of TCM use among eastern Malaysian patients with knee osteoarthritis was high. Physicians caring for these patients should be aware of these findings so that inquiries regarding TCM use can be made and patients can be appropriately counseled.

Objectives: To identify the perceptions towards spirituality and spiritual care among nurses at tertiary care hospitals in Riyadh, Saudi Arabia. Methods: A cross-sectional study was conducted on nurses at five tertiary care hospitals in Riyadh. The data were collected using the Spirituality and Spiritual Care Rating Scale (SSCRS). Results: We recruited 978 nurses, of which 896 (91.6%) were female. The mean SSCRS score was 3.8±0.5 (the spirituality and spiritual care statements fell within the ‘agree’ category). A statistically significant difference was found only between perceptions of spirituality and spiritual care among nurses and their nursing experience duration. Conclusions: The findings of this study revealed that nurses were oriented to spirituality, and respected the importance of providing spiritual care to their patients. The nurses believed that spirituality exists in all religions and spiritual care means showing concern while treating the patients by focusing on respecting patients’ religious beliefs.

Extraskeletal myxoid chondrosarcoma (ESMC) is an extremely rare variant of chondrosarcoma accounting for less than 10% cases. It affects mainly the soft tissues of the proximal end of long bones. Its incidence in the head and neck region is less than 5%. This case presented in the nasopharynx, an exceedingly unusual site for ESMC in a 60-year-old female with left-sided nasal obstruction and occasional epistaxis of one-year duration. Biopsy from the nasopharyngeal mass was suggestive of low-grade chondrosarcoma. She underwent endoscopic resection of the tumor. Postoperative histopathology confirmed the diagnosis as myxoid chondrosarcoma of nasopharynx after performing a battery of immunohistochemical markers to rule out other possible differential diagnoses. We treated her with conformal adjuvant radiotherapy to a dose of 66 Gray in 33 fractions given residual disease to which she responded well with significant symptomatic and radiological improvement. The patient has been on regular follow-up for over two years without any evidence of recurrence or distant metastasis. This case is presented to highlight the extreme rarity, the clinicopathological findings of this disease, and to emphasize the role of radiotherapy as the primary adjuvant treatment affecting the final prognosis. A thorough review of the literature reveals that our case may be the second case of myxoid chondrosarcoma of nasopharynx ever reported in the world literature to date.

Ovarian tumors are a common form of neoplasm in women. Mature cystic teratoma is the most common type, with a bilateral incidence of 8–15%. However, few cases are reported as bilateral and multiple. A rare case of bilateral multiple dermoid cysts in a 19-year-old female patient presented with abdominal pain of one-day duration. Her medical history was unremarkable. Ultrasonography showed multiple bilateral ovarian cystic masses. The patient underwent laparotomy. The masses were excised while preserving the remaining ovarian tissue. Histopathology confirmed the diagnosis of multiple mature cystic teratomas with no presence of malignant tissue.

Langerhans cell histiocytosis (LCH) is a rare proliferative disorder, which commonly arises in the bone and may involve other systems. To date, the diagnosis of temporal bone LCH remains a challenge as it may masquerade as a common ear infection. We report a case of a child who presented to us with persistent bilateral ear discharge for four months and was not responding to treatment. Her condition subsequently worsened, with clinical features and radiological findings suggestive of mastoid cellulitis. Nevertheless, further histopathology study revealed LCH.

Abdominal pregnancy is a rare, life-threatening condition defined as pregnancy in the peritoneal cavity exclusive of tubal, ovarian, or intraligamentary locations. It can be primarily located in the peritoneal cavity or secondary to a ruptured ectopic pregnancy or tubal abortion. We present two cases of abdominal pregnancy, one primary and another secondary, both diagnosed and successfully managed in our institution. The first patient, a para 2 at 14 weeks gestation, presented with abdominal pain, distension, and dizziness, which had started four days prior. The initial radiological scan reported an intrauterine pregnancy with ascites, but a bedside ultrasound revealed an empty uterus and a viable pregnancy located in the Pouch of Douglas (POD). This was a secondary abdominal pregnancy managed successfully by laparotomy. The second patient, a para 3 + 4 miscarriages with seven weeks amenorrhea was admitted with an initial diagnosis of pregnancy of unknown location. She had a beta human chorionic gonadotropin level of 14 444 mIU/mL. Diagnostic laparoscopy revealed a hemoperitoneum, bulky uterus, normal looking right and left adnexa, and a dense irregular bleeding tissue of around 3 × 4 cm firmly attached to the POD. The histopathology report of the tissue retrieved from the POD confirmed products of conception. This case report supports the importance of awareness and high clinical suspicion for such a life-threatening condition to avoid maternal morbidity and mortality. To the best of our knowledge, no previous cases of abdominal pregnancy have been reported in the UAE to date.