Acute myeloid leukemia (AML) is rarely associated with central diabetes insipidus (CDI) with unclear underlying pathophysiological mechanisms. The most commonly reported cytogenetic abnormality in cases of AML-associated CDI is monosomy 7, followed by chromosome 3 abnormalities. We report a case of a woman with newly diagnosed AML with 9q34 deletion (ABL1 gene region), who developed symptoms of polyuria and polydipsia with an investigation confirming CDI. This is the first reported case of cytogenetic abnormality of 9q34 deletion (ABL1 gene region) in AML with CDI.
Keywords:Central Diabetes Insipidus; Acute Myeloid Leukemia; Polyuria; Polydipsia; Cytogenetics; United Arab Emirates.
Objectives: Research indicates that active smokers are at risk of cognitive impairment. However, the correlation between chronic passive smoking and the risk of cognitive impairment remains underexplored. This study aimed to determine the association between smoking, passive smoking, and cognitive impairment and examined the dose-response effect. Methods: This population-based two-year survey was conducted in four rural public health centers from 2021 to 2023 in Central Java, Indonesia, each center caters to approximately 30 000 people. The participants were selected using simple random sampling from the health center visitors aged 30–60 years. Smoking and passive smoking were determined by self-assessment. Mini-Mental State Examination was used to evaluate cognitive impairment. The potential impact of confounding variables such as lifestyle, sociodemographic factors, and chronic diseases were considered and excluded during statistical analysis. Results: The participants were 409 individuals aged 30–60 years. The majority were men (264; 64.5%). Among them, 308 (75.3%) were active smokers, 271 (66.3%) were passive smokers, and 138 (33.7%) were not exposed to tobacco smoke. There was a significant relationship between cognitive impairment and increasing pack years of active smoking. The highest and most significant risk was observed in those who smoked ≥ 20 pack-years with an adjusted odds ratio (aOR) of 1.61 and 95% CI: 0.98–2.31. Passive smokers had a slightly lower risk of cognitive impairment than those who did not smoke and never smoked (aOR = 2.01; 95% CI: 1.37–2.70). They were comparable with OR of 10–19 pack-years total exposure to active smoking (aOR = 1.86; 95% CI: 1.24–2.42). Conclusions: There was a dose-response relationship between smoking and cognitive impairment with a significant effect on ≥ 20 pack-years of exposure. Passive smoking also indicated a significant risk of cognitive impairment equivalent to an estimated 10–19 pack-years of active smoking.
Keywords:Neurodegenerative Diseases; Cognitive Impairments; Dementia; Smoking; Epidemiology; Indonesia.
Objectives: This study was performed to assess the accuracy of standard electrocardiographic criteria in diagnosing of right ventricular (RV) involvement in patients with inferior myocardial infarction (IMI). Methods: This was a retrospective analysis of patients admitted with an IMI. Proximal occlusion of the right coronary artery before the origin of the RV branch on angiography was considered diagnostic of RV involvement. Results: The subjects were 129 patients (mean age = 55.8±13.1 years; 81.4% male) with inferior ST-elevation myocardial infarction. The most sensitive indicators of RV involvement were an ST elevation in V4R (72.9%) and a higher ST elevation in lead III than in lead II (80.4%). The most specific indicators were ST elevation in V1 (88.7%) and ST elevation in V1 with ST depression in V2 (97.1%). Combining all the criteria improved sensitivity to 85.7% but reduced specificity to 21.2%. Conclusions: No single electrocardiogram criterion was able to identify all cases of RV involvement in patients with IMI. Combining the different criteria helped pick up more cases at the cost of increasing false positives.
Keywords:Right Ventricular Infarction; Right Ventricular Involvement; Inferior Myocardial Infarction; Electrocardiogram; Oman.
Objectives: We sought to report the frequency of non-typhoidal Salmonella (SNT) and Shigella spp. diarrhea and the antibiotic sensitivity in children. Methods: We conducted a retrospective study of children with bloody diarrhea seen at Rustaq Hospital between 1 June 2019 and 31 June 2023. We collected data related to demographic characteristics, symptoms, blood investigations, stool bacterial culture, and antimicrobial sensitivity. Stool samples were tested for Salmonella and Shigella growth. Results: Out of 1160 children with diarrhea, 153 (13.2%) had bloody diarrhea of which 129 (84.3%) were under five. Ninety-two (60.1%) children were positive for either Salmonella or Shigella. Among the positive cultures, 58 (63.0%) children had SNT, while 34 (37.0%) had Shigella infection. Three children had bacteremia, all under one year old. SNT demonstrated high sensitivity primarily to ceftriaxone (n = 41; 70.7%), ampicillin (n = 53; 91.4%), and ciprofloxacin (n = 54; 93.1%). In contrast, Shigella showed high resistance to ceftriaxone and only 15 (46.9%) patients showed sensitivity. Additionally, 29 children had Entamoeba histolytica trophozoites co-infection with Salmonella on stool microscopy. Conclusions: Salmonella is more prevalent than Shigella in children under five years, while Shigella is more common in children over five. Salmonella is sensitive to both ceftriaxone and ampicillin. Shigella demonstrates resistance to multiple antibiotics, including ciprofloxacin. It is recommended that children under the age of one be admitted and treated empirically with either ceftriaxone or ampicillin. In older children, antibiotic therapy should be guided by stool culture results. Ciprofloxacin is not a good empirical choice for Shigella in our population due to its high resistance and is contraindicated in patients with glucose-6-phosphate dehydrogenase.
Keywords:Salmonella; Shigella; Diarrhea; Infant; Child, Preschool; Retrospective Studies; Oman.
Gigantomastia is a rare benign disorder characterized by excessive breast enlargement. Although a standard definition has yet to be established, it is generally known as an excess of approximately 1.5 kg tissue per breast that requires reduction. We report a case of a 10-year-old girl who presented with enlarged breasts. The hormonal assay was normal. Breast ultrasound revealed increased fibroglandular breast tissue with an area of interstitial fluid, prominent vascularity, and dilated veins. There was no evidence of focal masses or collections, ductal ectasia, or axillary lymphadenopathy. Magnetic resonance imaging revealed extremely dense breasts with more than 75% fibroglandular tissue, consistent with juvenile breast hypertrophy. Bilateral reduction mammoplasty with nipple-areola complex graft was performed. The histopathological report confirmed benign gigantomastia.
Keywords:Breasts; Juvenile Gigantomastia; Mammoplasty; Breast Diseases; Bahrain.
The superior cornu of the thyroid cartilage is a versatile structure, and anatomical variations can lead to diverse clinical presentations. We describe a case of a patient with a medialized superior part of the thyroid cartilage caused by pressure from a large thyroid mass, detected during laryngoscopy before thyroidectomy. A neck computed tomography scan revealed an elongated and medially displaced superior cornu of the right thyroid cartilage, resulting from the push exerted by the right thyroid mass. As the patient remained asymptomatic and refused surgical intervention, no further consideration was given to surgically addressing the medialized superior thyroid cornu.
Keywords:Thyroid Cartilage; Laryngeal Cartilage; Thyroid Nodule.
Objectives: We sought to explore the clinical characteristics of corneal ectasia and provide insights on related factors, including demography, ocular health, and the management trends in the Saudi population. Methods: We conducted a retrospective hospital-based chart review of patients with corneal ectasia in multiple medical centers in Saudi Arabia between 1 January and 31 December 2018. Eye care professionals diagnosed these patients based on their medical history, physical examination, and the use of Pentacam. The severity of the condition was assessed using the k median index from the Pentacam map following the modified Krumeich grading system. Results: We reviewed the medical records of 430 eyes of 215 patients with corneal ectasia. The majority (98.6%) of patients had bilateral corneal ectasia, with 202 (94.0%) having keratoconus and 13 (6.0%) having post-laser in situ keratomileusis ectasia. Males and age groups between 14 and 45 years were more affected. The mean age of onset was 7.1 years, ranging from 2–32 years, which was higher among patients from the western region. Regarding severity, 230 (53.5%) eyes presented in the initial stages, while 36 (8.4%) were in the severe stage with no significant difference between the regions studied. No significant differences were observed in mean central corneal thickness and power between patients from the central and western regions. Corneal rigid gas permeable contact lens was most used in treatment of 176 (40.9%) eyes followed by glasses in155 (36. 0%), while corneal cross-linking was the common surgical intervention (10.9%), followed by penetrating keratoplasty (3.0%). Conclusions: Most keratoconus patients had a bilateral mild stage of the disease and were in their third decade. This high rate of bilaterality of diseases during diagnosis may be due to misdiagnosis in the initial stages, which highlights the importance of community and eye care professionals’ awareness of comprehensive eye examinations and regular follow-up, including corneal topography assessments of both eyes.
Keywords:Keratoconus; Corneal Topography; Keratoplasty, Penetrating; Corneal Cross-Linking; Saudi Arabia.
The symptoms of malignant pleural mesothelioma can be mimicked by some other malignancies, clinically and radiologically. We describe a case of a 57-year-old man whose clinical and radiological findings were consistent with malignant pleural mesothelioma; however, a pleural biopsy showed undifferentiated epithelioid malignant neoplasm.
Keywords:Malignant Pleural Effusion; Malignancy; Oman.
Objectives: Systemic fungal infections (SFIs) account for 12% of all late-onset sepsis among very low birth weight (VLBW) infants and result in adverse long-term neurodevelopmental outcomes among survivors. This study compared the prophylactic efficacies of systemic fluconazole or oral nystatin prophylaxis to prevent SFI in VLBW infants. Methods: In a randomized controlled clinical trial, 120 neonates with gestational age < 32 weeks and birth weight < 1500 g were randomly allocated in two groups. Patients in group A received fluconazole 3 mg/kg intravenously twice weekly from the first 72 hours of life. Patients in group B were administered oral nystatin 1 mL (100 000 units) every eight hours. The primary endpoint was SFI and its associated mortality rate during hospital stay. Results: The mean gestational age of the enrolled infants was 28.2±1.4 weeks. Demographic characteristics were similar in both groups. SFI was detected in six (5.0%) infants with three cases from each group. Three (2.5%) patients died, two of whom were in group B. Four (6.7%) patients in group B and one (1.7%) in group A were treated for retinopathy of prematurity (p = 0.040). Intraventricular hemorrhage was detected in brain ultrasound examination in three (5.0%) neonates in group B and seven (11.7%) in group A (p = 0.020). Conclusions: The intravenous fluconazole and oral nystatin were similarly effective in preventing SFIs in VLBW infants. Future studies are recommended with a larger number of patients before routine administration of nystatin prophylaxis.
Keywords:Candidiasis; Fluconazole; Nystatin; Prophylaxis; Very Low Birth Weight Infants; Iran.
ISSN:2070-5204 (Electronic)