A perplexing case report of concomitant multiple sclerosis and myasthenia gravis.

Introduction and importance: The co-occurrence of multiple sclerosis (MS) and myasthenia gravis (MG) within the Middle East and North African Region (MENA) has been scarcely reported in current literature. This rare case report explores the pathophysiological mechanisms and potential avenues of treatment modalities. Such insights can potentially facilitate the development of more efficacious and targeted treatment modalities and perhaps pave the way for disease prevention. Case description: Twenty-nine-year-old female patient presented with diplopia of two weeks duration associated with occasional blurred vision in the left eye. On physical examination, she was discovered to have marked left eye ptosis. A visual evoked potential (VEP) test was performed, which revealed asymmetrical delay. MRI imaging revealed a few white matter hyperintense foci noted at both periventricular regions and the corpus callosum with the characteristic appearance of Dawson's fingers, and thus MS was diagnosed. An anti-acetylcholine receptor antibody test returned positive, confirming the diagnosis of concurrent MG. Clinical discussion: Proposed pathophysiological mechanisms underlying the concurrent manifestation of both diseases include, among others, the involvement of HLA haplotype and non-HLA genotypes, as well as the immunogenetic influence of specific transcription factors. Notable HLA haplotype genes include DRB1 and HLA-DQ5 genes. In contrast, non-HLA genes include the interleukin-4 receptor (IL4RA) and factor forkhead box P3 (FOXP3). Conclusion: Considering the similar immunological background of the two diseases, ideally, a single therapeutic modality could be used for management. This will hopefully simplify the patient's treatment regimen and may ultimately reduce the treatment cost and patient burden.

Factors influencing gender preference towards surgeons among Jordanian adults: an investigation of healthcare bias.

Studies investigating gender bias against female surgeons yielded conflicting results ranging from neutrality to a clear preference towards male surgeons. Yet, such bias remains understudied within Middle Eastern nations. We aimed to assess preferences of surgeons' gender among Jordanians and explore reasons for possible gender bias across different surgical specialties. A total of 1708 respondents were examined using a cross-sectional, self-administered questionnaire to evaluate the gender preferences of surgeons, characteristics associated with preferred surgeon's gender, and surgeon's preference in certain specialties. Nearly 52.0% of participants had no gender preference for surgeons. Among those with a preference, 75.7% preferred male surgeons while 24.3% preferred female surgeons. Reputation, knowledge, and experience were the most important factors when choosing a surgeon. Male surgeons were viewed as more trustworthy, knowledgeable, experienced, and communicative. Female surgeons were dominantly perceived as more compassionate, cooperative, and prone to listen. Male respondents were 5 times more likely to choose a surgeon of similar gender (OR 5.687; CI 3.791-8.531). Male surgeons were favored for cardiovascular and orthopedic surgeries. Similarly, female surgeons were favored in gynecological and obstetric surgeries, plastic surgeries, and breast surgeries. Female gender (OR 6.193; CI 4.077-9.408), living outside Amman (OR 1.517; CI 1.066-2.160), and being married (OR 2.504; CI 1.601-3.917) were all significant positive predictors of preferring female surgeons. Our findings highlight differences in gender preference and perception of surgeons among Jordanian adults.

Current Awareness Status of and Recommendations for Polycystic Ovarian Syndrome: A National Cross-Sectional Investigation of Central Jordan.

Polycystic ovary syndrome (PCOS) is a common reproductive disorder that is related to a number of health issues and has an influence on a variety of metabolic processes. Despite its burden on the health of females, PCOS is significantly underdiagnosed, which is associated with lack of disease knowledge among females. Therefore, we aimed to gauge the awareness of PCOS in both the male and female population in Jordan. A descriptive cross-sectional study was conducted, targeting individuals over the age of 18 from Jordan's central region. Participants were recruited through stratified random sampling. The questionnaire consisted of two domains, including demographics and knowledge of PCOS domains. A total of 1532 respondents participated in this study. The findings revealed that participants have overall adequate knowledge regarding PCOS's risk factors, etiology, clinical presentation, and outcomes. However, participants demonstrated subpar familiarity of the association between PCOS and other comorbidities and the effect of genetics on PCOS. Women had more knowledge than men about PCOS (57.5 ± 6.06 vs. 54.1 ± 6.71, p = 0.019). In addition, older, employed, and higher-income populations showed significantly better knowledge than younger, unemployed, self-employed, and lower-income populations. In conclusion, we demonstrated that Jordanian women demonstrate an acceptable yet incomplete level of knowledge towards PCOS. We recommend establishing educational programs by specialists for the general population as well as medical personnel to spread accurate medical information and clarify common misconceptions about signs, symptoms, management, and treatment of PCOS, and nutritional knowledge.

PAX5 and TDT-Negative B-Acute Lymphoblastic Leukemia with Unusual Genetic Mutations: A Case Report.

B-acute lymphoblastic leukemia (B-ALL) is commonly encountered in clinical practice. Patients present with increased percentage of lymphoblasts in bone marrow and/or peripheral blood. Immunophenotypic study by flow cytometry or immunohistochemistry is essential to establish the diagnosis. Paired box-5 (PAX5) is a B cell lineage protein and terminal deoxynucleotidyl transferase (TDT) is an immature marker, both of which are routinely tested in the pathologic workup of acute leukemia. In this report, we describe a case of B-ALL in a 37-year-old woman in which both PAX5 and TDT were negative. Next-generation sequencing test detected mutations in DNA methyltransferase 3 α and Fms related receptor tyrosine kinase 3 genes, which are frequently mutated in acute myeloid leukemia rather than B-ALL. The constellation of these rare findings in a single case signifies the importance of examining a wide panel of markers when the diagnosis of ALL is suspected.