Saudi Journal of Medicine & Medical Sciences|المجلة السعودية للطب والعلوم الطبية

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A case of digital autoamputation with concurrent Sjogren's syndrome, antiphospholipid syndrome, and ovarian cancer
(2022) Keles, Esra; Kabaca, Canan; Akis, Serkan; Celik, Zeynep
Sjogren's syndrome (SS) is a chronic autoimmune disease that is characterized by focal lymphocytic infiltration of the exocrine glands. SS mostly affects middle-aged women, and results in an increased risk of developing malignant neoplasm, particularly hematologic malignancies. The concurrent occurrence of SS, ovarian cancer, and autoimmune disease is very rare. Here, we present a case with postoperative digital autoamputation in a young Sjogren's patient diagnosed with high-grade serous ovarian cancer. The patient was later also diagnosed with antiphospholipid syndrome. Clinicians should note that female genital tract malignancies might occur in autoimmune diseases. In addition, when planning for surgery, they should also be aware of the possibility of another autoimmune disease and different patterns of postoperative complications such as venous thromboembolism and thrombophlebitis. A multidisciplinary approach is required to achieve successful management. To the best of the authors' knowledge, this is the second case with concurrent SS and ovarian cancer and the first case with concurrent SS, antiphospholipid syndrome, and ovarian cancer.
A Case of Panic Disorder Misdiagnosed as Epilepsy for 9 Years in a Young Male
(2023) Alyami, Hussain
Panic disorder can be misdiagnosed as epilepsy and vice versa, which, in turn, can impact the patient, their family, and the healthcare system. Here, we describe a rare case of a 22-year-old male with a 9-year history of misdiagnosed drug-resistant epilepsy. On presentation to our hospital, the patient’s physical examination and other investigations were unremarkable. The attacks were reported to last for about 5–10 minutes and were related to interfamilial distress. He reported feeling anxious about having an attack, experiencing palpitations and sweating before and during episodes, feeling chest tightness, derealization, and fearing loss of control, based on which a diagnosis of panic disorder was made. The patient was treated with 12 sessions of cognitive behavioral therapy, following which all his antiepileptic medications were stopped over 8 weeks. The dose of sertraline was increased and maintained at 200 mg once daily and was gradually stopped after 6 months of remission. This case highlights that panic disorder should be considered as a differential diagnosis of epilepsy. This can be done through a cross-specialty referral, especially given that the clinical manifestations of hyperventilation syndrome can be diagnosed differently by neurologists, psychiatrists, and other specialists.
A rare case of xanthomatous meningioma
(2022) Altindag, Sultan; Cakalagaoglu, Fulya; Karaca, Gokay; Yuceer, Nurullah
Xanthomatous meningioma is an extremely rare subtype of metaplastic meningiomas with few cases reported in the literature. Histopathologically, it is composed of oval-shaped cells that have central nuclei and cytoplasm with lipid-filled vacuoles, resembling macrophages. Here, the authors present a case of xanthomatous meningioma and discuss the hypotheses related to its origin and the differential diagnosis. A 40-year-old woman presented with an increased headache complaint over the past month. A computed tomography scan revealed a heterogeneous mass on the right parietal lobe, following which a right craniotomy was done. Microscopic examination showed neoplastic meningothelial cells with whorl formation and areas of xanthomatous changes. Both meningothelial and xanthomatous cells were positive with vimentin, progesterone, and epithelial membrane antigen. CD68 and lysozyme were expressed only in the xanthomatous component, and there was no expression with periodic acid-Schiff (PAS) stain and PAS–diastase. As the diagnostic criteria of atypical meningioma were not observed, a diagnosis of xanthomatous meningioma, WHO grade I, was made. Owing to the characteristic xanthomatous changes, its differential diagnosis includes grade II clear cell meningioma, Rosai–Dorfman disease, and hemangioblastoma. To avoid misidentifying these cells as macrophages, a high degree of awareness of this unique subtype of meningioma is required.
Abstracts of "Institute for Research and Medical Consultations (IRMC) - Summer Research Program for Undergraduate Students – 2019" presented at Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia, on October 6, 2019
(2020)
Background: Doxorubicin is an antineoplastic commonly used in chemotherapy. Its major side effect is the cumulative resultant cardiomyopathy. Polycaprolactone (PCL) is a compatible, degradable, core-shell polymer. PCL nanoparticles <600 nm have shown the ability to accumulate in solid tumors in comparison to healthy tissues, possibly because of their defective vasculature. Objectives: The aim of this study is to prepare PCL nanoparticles loaded with doxorubicin and study the effect of encapsulation on the drug’s efficacy, solubility and anticancer activity against MCF-7 cells. Materials and methods: The single emulsion method was used to prepare PCL nanoparticles; doxorubicin was incorporated during the synthesis. Nanoparticles were characterized by SEM to determine the size and morphology and by FTIR to confirm encapsulation. UV spectrophotometer was used for study the drug release. ELISA microplate reader was used to study the anticancer activity against MCF-7 (American Type Culture Collection, USA) cell line at different concentrations. Results: SEM showed uniform microspheres with a size 3 µm. FTIR showed defined bands for PCL and doxorubicin at 3400, 3000, 1650, 1450 and 1100 cm−1. Drug release was slow because of the insolubility of PCL in PBS. MTT assay showed a 49% decrease in cell viability at 100 µM. Conclusion: Polycaprolactone nanoparticles are potentially useful carriers for doxorubicin. The single emulsion method was not effective for nano-size particle preparation and different methods could be used to obtain a smaller particle size. PCL may be copolymerized with a hydrophilic polymer to increase the drug release rate.
Acetabular Remodeling after Closed Reduction of Developmental Dysplasia of the Hip
(2018) Al Shehri, Hayazi; Mahmoud, Asim; Ateeq, Saleh; Alamrani, Amal
Objectives: This study aims to assess the radiographic development of the acetabulum after closed reduction of developmental dysplasia of the hip in patients with different follow-up periods. Methods: The authors undertook a retrospective review of clinical records and radiographs of children who were diagnosed with developmental dysplasia of the hip and underwent closed reduction (mean age at closed reduction: 8.6 months) at King Khalid Civil Hospital, Tabuk, Saudi Arabia. Patients with a follow-up period <12 months were excluded from the study. Acetabular index angles for anteroposterior pelvic radiograph before treatment and at the final follow-up were used to assess acetabular development. Patients were divided into four groups according to the follow-up period and then the acetabular index was compared. Results: A total of 64 dislocated hips of 40 patients were included in the study. The average follow-up period was 33.9 months (range: 12–82 months). Mean acetabular index before closed reduction was 34.37° (range: 25–46°), whereas the mean acetabular index after closed reduction was 23.8° (range: 10–37°). All groups showed improvement in the acetabular coverage and the acetabular index was significantly higher in groups with a longer follow-up period. Conclusions: This study found that successful closed reduction of congenitally dislocated hips within the recommended age results in better acetabular development (coverage) and this improvement is more evident in patients with a longer follow-up period. Further studies can consolidate these results and help define the criteria for deciding early acetabuloplasty.
Acquired Protein S Deficiency in a Patient with Lupus Nephritis
(2019) Meriam, Hajji; Soumaya, Beji; Lamia, Rais; Karim, Zouaghi
Abstract Not Available(Letter to the Editor)
Acute back pain: A survey of primary health care physicians' awareness and knowledge of "red flag" signs
(2016) Alluhaidan, Abdullah; Chaudhry, Habib; Alrefayi, Hesham; Alsaleh, Khalid; Algarni, Nizar; Alsaran, YazeedShakoor, Zahid
The failure to detect "red flag" signs in patients presenting with acute low back pain can adversely affect the outcome of management. This can seriously affect the quality of life and productivity of the patient. Objective: The present questionnaire-based study was performed to assess the knowledge and awareness of red flag signs among primary health care physicians managing patients with acute back pain in Riyadh, Saudi Arabia. Materials and Methods: The study sample size was comprised of 80 subjects. The level of knowledge was assessed by means of a new structured self-administered questionnaire. The design of this questionnaire was based on the Agency for Health Care Research and Policy (AHCRP) guidelines for detection of red flag signs. Physicians were asked about red flag signs that indicate the presence of tumor, infection, spinal fracture, or cauda equina syndrome. Results: Sixty-eight (85% of total) physicians were aware of red flag signs. Of the 68 physicians who were aware of the red flag signs, 58 (72%) were aware of neurological deficit, 36 (45% of total) were aware of extremes of age (<10 years and >50 years), and 33 (41% of total) were aware of and routinely inquired about the history of spinal trauma, whereas only 24 (30% of total) were aware of and inquired about constitutional symptoms in their patients with acute back pain. Conclusion: Although low back pain is extremely common, knowledge and awareness of red flag signs of primary health care physicians managing patients with acute back pain in Riyadh appear to be inadequate. This indicates a lack of adherence to the international guidelines. Specific educational programs should target these deficiencies and increase awareness.
Acute bacterial endophthalmitis following dexamethasone intravitreal implant: A case report
(2019) Al Zamil, Waseem; Yassin, Sanaa
A 54-year-old male presented to our ophthalmology clinic with a diagnosis of the right central retinal vein occlusion with macular edema. The patient was treated with dexamethasone intravitreal implant. Three days after the implant insertion, the patient experienced pain, redness and blurred vision in the same eye. With a provisional diagnosis of acute endophthalmitis, a combination of ceftazidime 2.25 mg/0.1 ml and vancomycin 1 mg/0.1 ml was injected intravitreally. One week after the treatment, endophthalmitis signs and symptoms subsided. This report presents a case of endophthalmitis following dexamethasone intravitreal implant, with a favorable outcome after treatment with intravitreal antibiotic injection without removal of the implant.
Acute fatty liver of pregnancy mimicking puerperal sepsis: Report of a case with literature review
(2016) Wani, Abdullah; Al-Lehibi, Abed; Alqutub, AdelMasoodi, Ibrahim
Puerperal pyrexia is defined as fever in a woman within 6 weeks of giving birth, which is ≥38°C. We describe the clinical scenario of fever and progressive jaundice in a 32-year-old female in the postpartum period. The laboratory data showed normal leukocytic counts and all her septic screen was noncontributory. While in the hospital, her bilirubin levels progressively increased and showed a mild elevation of liver enzymes. There was no evidence of biliary obstruction. A liver biopsy clinched the diagnosis of acute fatty liver. Acute fatty liver of pregnancy is a rare but serious complication of pregnancy. It typically presents in the third trimester and can lead to multi-organ failure and death. This report highlights the importance of liver biopsy and an atypical presentation of fatty liver of pregnancy.
Acute generalized exanthematous pustulosis in a patient with plaque psoriasis
(2014) Al Raddadi, Ali; Alharbi, Aymen; Jan, Hawazin; Al Hawsawi, Khalid; Al Jabri, MazinSatti, Mohammed
Acute generalized exanthematous pustulosis (AGEP) is an acute febrile drug eruption characterized by sudden occurrence of numerous, non-follicular, pinhead-sized pustules. This usually occurs 3-5 days after the commencement of treatment. Development of pustular eruptions in patient with plaque psoriasis raises the differential diagnosis of AGEP versus pustular psoriasis of the Von Zumbusch type. Herein, we report a 56-year-old male who came into hospital with history of vomiting fresh blood. The patient was then admitted for management of hematemesis. He is a known case of psoriasis vulgaris, which was still present during admission. During admission, the patient developed pustular skin eruptions associated with fever 4 days after using clindamycin and ceftriaxone. Laboratory investigations revealed leukocytosis and neutrophilia. Histopathological examination showed sub-corneal neutrophilic collection and eosinophils in the papillary dermis. The pustular eruption disappeared completely within ten days after stopping clindamycin and ceftriaxone, confirming the diagnosis of AGEP.
Acute lower abdominal pain in a young female patient
(2014) Al-Mulhim, Abdulmohsen; Al-Saffar, Ali; Aldhafery, Bander; Al-Bisher, HassanAl-Saleem, Hassan
Acute painful polyneuropathy after bariatric surgery
(2016) Al-Sulaiman, Abdulla
The prevalence of morbid obesity is increasing worldwide, which over the past decade, has resulted in an increase in the number of obese patients undergoing bariatric surgery. All surgical procedures carry a varying degree of risk; however, bariatric surgery is specifically associated with a number of metabolic, nutritional, and neurological complications. The neurological complications include encephalopathy, peripheral neuropathy, myelopathy, plexopathy, and radiculoneuropathy. This case report involves an 18-year-old female who underwent successful bariatric surgery for morbid obesity. Postoperatively, the patient developed severe painful weakness of the lower limbs and was found to have diffused sensory motor polyneuropathy. It was concluded that sensory-motor polyneuropathy was the most likely cause of the patient's weakness. Reporting this case is important as the author believes that the consequences of bariatric surgery may not be well-known to both patients and surgeons.
Adhesive Small Bowel Obstruction Due to Pelvic Inflammatory Disease: A Case Report
(2018) Al-Ghassab, Razan; Tanveer, Shumaila; Al-Lababidi, Noor; Zakaria, Hazem; Al-Mulhim, Abdulmohsen
We report a rare case of a 32-year-old woman with adhesive small bowel obstruction due to pelvic inflammatory disease. She had no history of abdominal surgery, gynecological complaints or constitutional symptoms of chronic illness. The diagnosis was based on the laparoscopic findings of small bowel adhesions, free peritoneal fluid, “violin string” adhesions of Fitz-Hugh–Curtis syndrome and left hydrosalpinx. Laparoscopic adhesiolysis was performed successfully, and the patient had an uneventful postoperative course. The authors conclude that pelvic inflammatory disease should be included as a cause of adhesive small bowel obstruction in sexually active young women with no history of abdominal surgery or constitutional symptoms of chronic disease. When performed by experienced surgeons, laparoscopy in such patients is feasible and safe.
Adrenal insufficiency and mild rhabdomyolysis revealing a human immunodeficiency virus infection: A case report
(2016) Berkhli, Hayat; Haddiya, Intissar; Hamaz, SihamBentata, Yassamine
The spectrum of human immunodeficiency virus (HIV) endocrinopathy is large. Adrenal insufficiency (AI) is common in both early and late stages of HIV syndrome, resulting in significant morbidity and mortality. However, rhabdomyolysis is a muscle disease in which striated muscle fibers disintegrate, excreting myoglobin in the urine, leading to acute kidney failure. It is currently reported that rhabdomyolysis may be a direct result of the HIV infection, especially in the advanced stages of HIV/AIDS disease. This case study reports AI and a mild rhabdomyolysis in a patient with no medical history and no medicine or toxic intake. Laboratory assessment revealed HIV infection.
Adult desmoplastic medulloblastoma
(2017) Al Anazi, Abdulrahman; Hendam, Ahmed; Al Nemer, Areej; Al Anazi, Rawan
Medulloblastoma is more common in young age and rare in adult age. Some characteristics that characterize medulloblastoma in adults compared with children: Lateral cerebellar location, heterogeneous signal intensity on magnetic resonance imaging, desmoplastic histological variant and more favorable prognosis. Preoperative diagnosis is important for correct management of these patients. However, because of the low incidence of medulloblastoma in adults, preoperative diagnosis still challenging and prognostic factors and best treatment options are still controversial. We report a case of a 31-year-old male patient who presented with a rare case of posterior fossa medulloblastoma.
Adult intussusception
(2017) Almaghrabi, Ahmad; Alddin, Aiman; Alzamzami, AbdulrahmanSalih, Mohamed
Adult intussusception is rare. We report the case of an elderly female patient with an ileocecal intussusception who underwent resection and ileocolic anastomosis. The histology revealed chronic inflammation of the ileum and cecum and there was no evidence of malignancy. There was no evidence of malignancy. The appendix showed fibrous obliteration of the lumen.
Advances in CGRP Monoclonal Antibodies as Migraine Therapy: A Narrative Review
(2023) Aditya, Suruchi; Rattan, Aditya
Migraine is a potentially disabling disorder, yet it remains underdiagnosed and undertreated. The release of the neuropeptide calcitonin gene-related peptide (CGRP) in the trigemino-cerebrovascular system plays a vital role in the evolution of migraine. It enhances peripheral sensitization by mediating neurogenic inflammation and also influences central sensitization. The majority of the drug classes available for migraine prophylaxis are nonspecific and associated with numerous side effects and drug interactions. Anti-CGRP monoclonal antibodies (mAb) are an innovative therapeutic class that fulfills the need for more efficacious and tolerable preventive therapy. While erenumab is a mAb to the CGRP receptor, eptinezumab, fremanezumab, and galcanezumab bind to the CGRP molecule. They decrease the number of headache days and improve disability. Upper respiratory tract infection, nausea, constipation, pain at the site of injection, and fatigue are the associated side effects. CGRP mAbs are an excellent advancement in translational research and are a promising addition in migraine therapy. This article discusses the recent advances in the development of the CGRP mAbs.
Alterations of mitochondria and related metabolic pathways in leukemia: A narrative review
(2020) Al Ageeli, Essam
Dysregulation of mitochondrial function often precedes malignant transformation of hematopoietic stem cells (HSCs). Mitochondria have a direct role in the maintenance of HSC functions. For example, D-2-hydroxyglutarate, generated due to the activity of mutated mitochondrial isocitrate dehydrogenase (IDH), has been implicated in the pathogenesis of leukemia. Furthermore, disturbances in the fatty acid breakdown and pyruvate oxidation are often seen in leukemic cells. These and other abnormalities expedite leukemogenesis and chemoresistance of leukemic cells. However, it needs to be elucidated whether these aberrations are the result or cause of leukemogenesis. Accordingly, for this review, a search was carried out in PubMed and Google Scholar databases until June 2019 to assess the relationship between metabolic pathways in altered mitochondria and leukemia development. In the present review, an overview of mitochondria-related mechanisms and their abnormalities in leukemia is presented, with mitochondrial pathways and factors, such as mitophagy, intermediary metabolism enzymes, oncometabolites and reactive oxygen species' generation, discussed as potential diagnostic and therapeutic targets in leukemia.
Amyloid goiter: A case report and review of the literature
(2020) Jakubovic-Cickusic, Amra; Hasukić, Begzada; Sulejmanović, Maja; Čičkušić, Alma; Hasukić, Šefik
Amyloid goiter is a very rare manifestation of amyloidosis. Here, we describe the case of a 40-year-old male, who presented with upper airway obstructive symptoms including hoarseness and breathing difficulty, to highlight the clinical and pathological features of secondary amyloidosis of the thyroid gland and the difficulties in making a preoperative diagnosis. The patient had previously been wounded in the war in Bosnia, which resulted in the right kidney being surgically removed. Further, he had undergone two surgical interventions on both hips due to osteomyelitis and was on a chronic dialysis program due to a progressively poor left kidney function that had eventually resulted in complete loss of renal function. Thyroid function tests were normal, and the patient clinically was euthyroid; biochemical investigations were within normal limits. Results from sonography, computed tomography scan of the neck, scintigraphy and fine-needle aspiration cytology were nondiagnostic. Therefore, a thyroid biopsy was carried out, and amyloid deposits were found. After preoperative work-up, total thyroidectomy was performed with no complications. We conclude that amyloid goiter may have no major impact on thyroid function even when a substantial amount of amyloid has replaced the normal thyroid parenchyma, as was the case in our patient. Amyloid goiter should be suspected in all patients with a progressive, rapidly growing bilateral thyroid enlargement with concomitant inflammatory processes or in patients undergoing hemodialysis treatment.
An extremely rare case of Bonneau syndrome with novel cardiac and eye manifestations
(2022) Aburawi, Elhadi; Dakilah, Fozi

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