Hidden intruder: Plasmacytoma causing uncontrolled epistaxis in an elderly patient

Extramedullary plasmacytoma (EMP) is an uncommon tumor marked by the monoclonal growth of plasma cells without the characteristics of multiple myeloma. EMP represents 3% of all plasma cell tumors. An 89-year-old male patient with hypertension was admitted to our tertiary care hospital with uncontrolled unilateral epistaxis. After a year and a half of recurring epistaxis, the patient's bleeding became more frequent and could no longer be controlled with nasal packing. Angiofibroma was suspected as the initial differential diagnosis, and angiofibroma embolization was performed. The patient experienced difficulty swallowing and slurred speech and was diagnosed with an ischemic stroke. However, antiplatelet and tranexamic acid medications were contraindicated due to bleeding risks. The patient underwent functional endoscopic sinus surgery, and unexpectedly, histology results revealed a plasmacytoma. After surgery, the patient remained stable and was discharged for further management.

Imaging reveals a fifth heart chamber: Diagnosing and treating a massive left atrial appendage aneurysm

In this case report, a 33-year-old male with a history of smoking presented with recurrent palpitations and chest discomfort. Holter monitoring revealed atrial flutter, and imaging showed a giant left atrial appendage aneurysm. Due to the risk of arrhythmias and thromboembolic events, surgical resection was performed successfully. This case underscores the importance of considering uncommon structural cardiac abnormalities in the evaluation of arrhythmia symptoms in young patients.

Wandering Spleen Torsion: A Diagnostic Challenge

Wandering spleen, or hypermobile spleen, arises from the elongation or maldevelopment of the spleen's suspensory ligaments. This condition is a rare clinical entity, primarily affecting children, with a higher prevalence among adult females in the active reproductive age group. Manifestations may include an asymptomatic abdominal mass or intermittent abdominal discomfort due to the torsion and subsequent spontaneous detorsion of the spleen. This case report details the presentation of a 14-year-old female initially misdiagnosed as having gastroenteritis who later experienced acute abdomen. Subsequent ultrasonography and computed tomography scan revealed splenic torsion, confirmed during exploratory laparotomy, which demonstrated an infarcted spleen. The definitive therapeutic intervention was a total splenectomy. This clinical entity should be taken into account in the differential diagnosis of acute abdominal pain in order to aid in early diagnosis and management. This could allow us to avoid splenectomy whenever possible and instead do splenopexy, especially in pediatric cases, as the spleen plays a crucial role in the reticuloendothelial system.

Bilateral Dacryoadenitis As the First Presentation in an Undiagnosed Sarcoidosis Patient

Sarcoidosis is an idiopathic multisystem disorder associated with hilar lymphadenopathy and noncaseating granulomas that can affect any organ. Ocular involvement is less common; however, sarcoidosis is a known cause of uveitis, dry eye, and conjunctival nodules. We report a case of a 36-year-old male with an occupational history of dust exposure presenting to the ophthalmology clinic with bilateral painless upper eyelid swelling of one-week duration. The diagnosis of sarcoidosis was suspected based on clinical examination, laboratory analysis, and imaging showing mediastinal lymphadenopathy, further confirmed by pathologic examination showing noncaseating granulomas with the presence of some asteroid and Schaumann bodies. A treatment plan consisting of prednisone, folic acid, and azathioprine was effective for the patient, though azathioprine was eventually changed to methotrexate due to an allergic reaction. The patient is on a maintenance dose of methotrexate and is asymptomatic after a year of careful management and follow-up. This case emphasizes the significance of considering sarcoidosis as a differential diagnosis in patients presenting with bilateral dacryoadenitis.

Abnormal Presentation and Challenging Diagnosis of Mediastinal Lymphoma: A Case Report

We describe a rare case of classical Hodgkin lymphoma (HL) in a 20-year-old female patient. She presented to our hospital with chest wall swelling after months of post-chest trauma management. The swelling was initially treated as an infected hematoma, and the patient was referred for surgical evacuation. During the surgery, the swelling was found to be a mass that extended to the mediastinum. A biopsy was taken, which later resulted in the diagnosis of a granular cell tumor (GCT). A decision on surgical resection by video-assisted thoracoscopic surgery (VATS) was taken after discussion with the multidisciplinary team of surgery, cardiothoracic surgery, oncology, pathology, and radiology. During the surgery, a frozen section biopsy was taken, which showed no features of lymphoma or granular cell tumors. The surgery was followed by a midline sternotomy to control the bleeding from an accidentally injured major vessel. The bleeding was controlled, and the mass was dissected and sent for histopathological examination. The histopathology showed nodular classical HL features, and the patient was referred for chemotherapy. In our case, the patient was initially diagnosed with GCT, but with complete resection and an adequate biopsy, the mass was found to be a classical HL. Possible cross-cellularity is questioned, and the possible correlation between the two findings encouraged us to report this case.

Impact of dapagliflozin on cardiac function following anterior myocardial infarction in non-diabetic patients - DACAMI (a randomized controlled clinical trial)

BACKGROUND

The role of Sodium-glucose co-transporter 2 inhibitors (SGLT2i) in heart failure is established. Early data also suggests their favorable role in patients with acute coronary syndromes, but more evidence is still needed.

METHODS

In this dual center, double-blinded randomized controlled trial, non-diabetic patients (N = 100) who presented with anterior ST- elevation myocardial infarction (STEMI) & had undergone successful primary percutaneous coronary intervention, but their left ventricular ejection fraction was below 50%, were randomized to dapagliflozin 10 mg or a placebo once daily. The primary endpoint was a change in cardiac function assessed by N-terminal pro-Brain Natriuretic Peptide - NT-proBNP measured at baseline & 12 weeks post the cardiac event &/or echocardiographic parameters (left ventricular ejection fraction, left ventricular diastolic dimension & left ventricular mass index) assessed at baseline, 4-weeks & 12-weeks post the cardiac event.

RESULTS

From October 2021 to April 2022, 100 patients were randomized. The mean drop of NT- proBNP in the study group was more significant compared to the control group by 10.17% (95% CI: -3.28-19.67, p-value 0.034). In addition, the decrease in the left ventricular mass index (LV mass index) was also significant in the study group compared to the control group by 11.46% (95% CI: -19.37 to -3.56, p-value 0.029).

CONCLUSIONS

Dapagliflozin seems to have a role in preventing left ventricular dysfunction & maintaining cardiac function following anterior ST-elevation myocardial infarction. More Large-scale trials need to be done to confirm these findings further. This trial is locally registered at the National Heart Institute, Cairo - Egypt, and Faculty of Medicine, Ain Shams University, with reference numbers CTN1012021 & MS-07/2022, respectively. It is also registered retrospectively at the US National Institutes of Health (ClinicalTrial.gov) with identifier number: NCT05424315 - June 16th,2022.

Metabolic Syndrome Associated with Tobacco and Caffeine Products Use Among Refugee Adolescents: Risk of Dyslipidemia

INTRODUCTION

Due to their stressful lives, Palestinian refugees are prone to use cognitive enhancers (CE) and psychostimulant substances (PS). Recognising health problems associated with CE/PS use can indicate how preventive programs should be directed towards adolescents. Unfortunately, research has not thoroughly investigated the health problems related to tobacco and caffeine products, the most socially acceptable CE/PS among Palestinian refugee adolescents.

METHODOLOGY

In 2021, schoolchildren from five Palestinian refugee camps (N=271) aged 12-<16 years agreed to give blood samples and to be interviewed to address the association between metabolic syndrome (MetS) and tobacco smoking, coffee, energy drinks (ED), black tea, and chocolate consumption. MetS was diagnosed based on International Diabetic Federation Criteria. To address the association, we used binary logistic regression models adjusted to age, gender, BMI, and central obesity.

RESULTS

The prevalence of MetS was [17 (6.3%)]; (7.4%) in males, (5.1%) in females. The prevalence of substance use was as follows: ED [163 (48.9%)], coffee [255 (76.6%)], black tea [295 (89.1%)], cigarette [35 (10.5%)], waterpipe [59 (17.7%)], and chocolate [309 (93.6%)], with male predominance. Cigarette smokers have increased central obesity (p-value=0.024), and decreased HDL-cholesterol (p-value=0.015) than non-smokers. Similar results were observed for waterpipe smokers besides the increased levels of triglycerides (p-value=0.01). ED consumers have increased central obesity (p-value=0.03) and fast blood sugar (p-value=0.003) than non-consumers. Chocolate consumers have decreased central obesity (p-value=0.008) and increased HDL levels (p-value=0.04) than non-consumers. ED consumers were significantly at higher risk of MetS (OR=9.97, p-value=0.019) than non-consumers and chocolate consumers were at lower risk of MetS (OR=0.14, p-value=0.046) than non-consumers. Waterpipe smokers were at a higher risk of having increased plasma triglycerides than non-consumers (OR=3.4, p-value=0.03).

CONCLUSION

The high prevalence of ED consumption and waterpipe smoking in Palestinian refugee adolescents is problematic. Their use was associated with higher odds of MetS, dyslipidemia, and central obesity, which justifies greater attention.

Scanning x-ray microanalysis of root canal sealers

Seven commercially available root canal sealer powders were analyzed by scanning x-ray microanalysis to identify constituent elements in each. Analysis showed that strongly cytotoxic sealers in vitro contained lead or magnesium, while those materials which exhibited mild or moderate cytotoxicity in vitro contained bismuth, zinc, calcium, or silicone.

Enamel decalcification in orthodontic treatment

One hundred twenty previously extracted premolar teeth were used in this study. Teeth were divided into five groups of twenty-four each. The first group was treated with Copalite, the second with Portrait Veneer, the third with a polymeric adhesive coating material (Protecto), the fourth group with Nuva-Seal, and the fifth group served as a control. Orthodontic bands were selected and cemented to each tooth. The cement seal was then broken and teeth were thermocycled to simulate an in vivo condition. All teeth were then submerged in a decalcifying gelatin for 21 weeks. Every group was further broken into three equal subdivisions. Division A was to be submerged for 7 weeks, Division B in each group was to be submerged for 14 weeks, and Division C was to be submerged for 21 weeks. At each time interval, teeth were cleaned and examined for decalcification. Data were recorded and analyzed by means of the chi-square test. It was found that acid-etching materials protect the teeth against decalcification best. Among the acid-etching materials used, Nuva-Seal proved to be the best at protecting the teeth against decalcification for 21 weeks with this experimental design.

Cytotoxicity evaluation of root canal sealers by the tissue culture--agar overlay technique

Ten commercially available root canal sealers were tested for cytotoxicity by the tissue culture--agar overlay method for periods of 0, 24, 48, 72, and 96 hours. All sealers manifested evidence of toxicity at every stage of testing. Some sealers which were markedly toxic at 0 hour showed reducing levels of toxicity out to 96 hours. Others remained highly toxic throughout the entirety of the experimental period.

Permeability and wetting properties of four cavity liners

Four commercially available cavity liners were evaluated as to their permeability characteristics. The contact angle measurement of each liner also was calculated. S. S. White liner was found to have the lowest contact angle and permeability values with a better wetting property. Copalite, on the other hand, was found to have the highest contact angle and permeability values with a poor wetting property. Caulk varnish and Polyvar had values lying between the two materials. Copalite is the preferred material in decreasing marginal leakage because of its high contact angle, whereas the S. S. White liner is preferred in pulpal and axial surface protection because of its good wetting properties.

The effects of sterilization techniques on the properties of intracanal instruments

Three common sterilization techniques, namely, autoclaving (15 and 25 minutes at 250 degrees F.), salt sterilization (5 and 10 seconds at 480 degrees F.), and dry heat (one hour at 340 degrees F.), were used to sterilize 420 root canal reamers and files, both carbon and stainless steel. These intracanal instruments were then tested in tension. An extra eighty-four intracanal instruments were tested without being subjected to any sterilization techniques and served as controls. It was found that carbon steel intracanal instruments were affected more by the different modes of sterilization than were the stainless steel instruments. Time of sterilization did not seem to have an effect on the properties of either instrument.

Leakage of different root canal sealants

One hundred five single-rooted teeth were prepared and filled with ten commercially available root canal paste sealers. Five teeth were filled with only gutta-percha points, fifty teeth were filled with a particular cement alone, and the rest of the teeth were filled with a particular cement in conjunction with gutta-percha points. It was found that the gutta-percha point alone is not sufficient for sealing the periapical foramen; nor are N2 (Sargenti), Riebler's paste, and the iodoform paste. In general, it was found that the combination of gutta-percha and cement is more effective in sealing the periapical foramen. Polycarboxylate cement used in this investigation, although it does not meet all the requirements of a good root canal sealant, was found to yield promising results.

Initiation of cracks in dental amalgam

The force required to initiate cracks in dental amalgam beams was measured and related to the microstructure. The force measured was dependent on age and on the distribution of phases on the tension side of the beam. The Ag-Cu phase is most resistant to failure in Dispersalloy and an experimental alloy.