A Rare Case of Refractory Nodal Marginal Zone Lymphoma in a Child, Successfully Cured by Allogeneic Stem Cell Transplant: A Case Report.

BACKGROUND: Nodal marginal zone lymphoma (NMZL) is a rare form of non-Hodgkin lymphoma (NHL), accounting for around 2% of all NHL in pediatrics and adults. It is considered the least common subtype of marginal zone lymphoma, which is rarely seen in pediatrics and is usually viewed as a mild disease. In adults, its presentation varies from mild to aggressive disease with multiple lymph node enlargement and systemic symptoms. CASE REPORT: Here, we report an interesting case of a 31-month-old boy who developed refractory EBV-positive NMZL with extensive disease. The tumor did not respond well to conventional chemotherapy and Rituximab. Therefore, we manage the disease with second-line chemotherapy, including bortezomib, followed by an allogeneic hematopoietic stem cell transplant (HSCT) with an excellent outcome. CONCLUSION: Very few cases have been reported for aggressive NMZL children. The tumor was refractory to first line chemotherapy. However, the successful outcome was achieved by allogeneic stem cell transplant with myeloablative conditioning chemotherapy. The significance of this particular case is that this is the first reported case from pediatrics for refractory NMZL, which responded well to allogeneic stem cell transplant.

Rationalisation of laboratory tests ordering and consumption at Armed Forces Hospital, Jazan.

Laboratory testing is one of the major and important component of medical diagnosis. However, unrationalised laboratory test ordering may lead to misdiagnosis of diseases which would delay treatment of the patients. It would also lead to wasting the laboratory resources that adversely impact the hospital budget. The aim of this project was to rationalise laboratory tests ordering and ensure effective utilisation of resources at Armed Forces Hospital Jizan (AFHJ). This study included two major steps: (1) the development and implementation of quality improvement interventions to reduce the unnecessary and abuse of laboratory testing in the AFHJ and (2) evaluation of the effectiveness of these interventions. In order to determine the possible causes of the problem, fishbone diagram was used to structure a brainstorming session. Pareto analysis was used to prioritise the causes so that the emphasis can be laid on most significant one. After interventions implementation, the data analysed and found that there was significant differences between 2019 and 2021 of total patients percentage and distribution that was revealed by box plot, who had a request of Hemoglobin A1c (HbA1c) (p=0.002), Thyroid Stimulating Hormone (TSH) (p=0.002), Free Thyroine (FT4) (p=0.002), Free Triiodothyronine (FT3) (p=0.001), Follicle-Stimulating Hormone (FSH) (p=0.002), Luteinizing Hormone (LH) (p=0.002) and Prolactin (PRL) (p=0.001). We achieved a 33% reduction in total laboratory tests cost and the total laboratory budget decreased from 6 000 000 SR in 2019 to about 4 000 000 Saudi Riyals (SR) in 2021. A change in laboratory resource consumption requires changes in physicians awareness. A modification of the electronic ordering system applied more restrictions to the ordering physicians. Extending these measures to the entire hospital might lead to significant reduction in the healthcare costs.

Uncommon presentation of isolated laryngeal sarcoidosis in a young man.

•Sarcoidosis is a chronic multisystemic granulomatous disease with unknown etiology.•Sarcoidosis affects the head and neck region in only 10%-15% of cases.•Larynx with turban-like thickening should raise high suspicions of laryngeal sarcoidosis.•Sarcoidosis is diagnosed after laboratory, endoscopic, and histopathology findings exclude other differentials.•Isolated laryngeal sarcoidosis is rare, making early diagnosis challenging and rising misdiagnosis.

Utilization of the common functional groups in bioactive molecules: Exploring dual inhibitory potential and computational analysis of keto esters against α-glucosidase and carbonic anhydrase-II enzymes.

Diabetes mellitus, a progressive chronic disease, characterized by the abnormal carbohydrate metabolism is associated with severe health complications including long term dysfunction or failure of several organs, cardiovascular and micro-angiopathic problems (neuropathy, nephropathy, retinopathy). Despite the existence of diverse chemical structural libraries of α-glucosidase inhibitors, the limited diabetic treatment due to the adverse side effects such as abdominal distention, flatulence, diarrhoea, and liver damage associated with these inhibitors encourage the medicinal research community to design and develop new and potent inhibitors of α-glucosidase with better pharmacokinetic properties. In this perspective, we demonstrate the successful integration of common functional groups (ketone & ester) in one combined pharmacophore which is favorable for the formation of hydrogen bonds and other weaker interactions with the target proteins. These keto ester derivatives were screened for their α-glucosidase inhibition potential and the in vitro results revealed compound 3c as the highly active inhibitor with an IC50 value of 12.4 ± 0.16 µM compared to acarbose (IC50 = 942 ± 0.74 µM). This inhibition potency was ~76-fold higher than acarbose. Other potent compounds were 3f (IC50 = 28.0 ± 0.28 µM), 3h (IC50 = 33.9 ± 0.09 µM), 3g (IC50 = 34.1 ± 0.04 µM), and 3d (IC50 = 76.5 ± 2.0 µM). In addition, the emerging use of carbonic anhydrase inhibitors for the treatment of diabetic retinopathy (a leading cause of vision loss) prompted us to screen the keto ester derivatives for the inhibition of carbonic anhydrase-II. Compound 3b was found significantly active against carbonic anhydrase-II with an IC50 of 16.5 ± 0.92 µM (acetazolamide; IC50 = 18.2 ± 1.23 µM). Compound 3a also exhibited comparable potency with an IC50 value of 18.9 ± 1.08 µM. Several structure-activity relationship analyses depicted the influence of the substitution pattern on both the aromatic rings. Molecular docking analysis revealed the formation of several H-bonding interactions through the ester carbonyl and the nitro oxygens of 3c with the side chains of His348, Arg212 and His279 in the active pocket of α-glucosidase whereas 3b interacted with His95, -OH of Thr197, Thr198 and WAT462 in the active site of carbonic anhydrase-II. Furthermore, evaluation of ADME properties suggests the safer pharmacological profile of the tested derivatives.

Reconstruction of facial dermatofibrosarcoma protuberans using an anterolateral thigh flap: a case report and literature review.

Dermatofibrosarcoma protuberans is a rare, locally aggressive cutaneous malignancy with a high rate of recurrence if the head-and-neck region is involved. Treatment is challenging as it is difficult to avoid poor aesthetic and functional outcomes using the standard approach of complete resection with negative margins and subsequent reconstruction. This is especially challenging in cases where the face is involved and the defect is large after resection. There have been few cases of reconstruction using different flaps reported. We present the case of a young lady with a large cheek tumor, which was reconstructed using an anterolateral thigh flap. Excellent functional and aesthetic outcomes were achieved.

Influenza Altmetric Attention Score and its association with the influenza season in the USA.

Background: Altmetrics measure the impact of journal articles by tracking social media, Wikipedia, public policy documents, blogs, and mainstream news activity, after which an overall Altmetric attention score (AAS) is calculated for every journal article. In this study, we aim to assess the AAS for influenza related articles and its relation to the influenza season in the USA. Methods: This study used the openly available Altmetric data from Altmetric.com. First, we retrieved all influenza-related articles using an advanced PubMed search query, then we inputted the resulted query into Altmetric explorer. We then calculated the average AAS for each month during the years 2012-2018. Results : A total of 24,964 PubMed documents were extracted, among them, 12,395 documents had at least one attention. We found a significant difference in mean AAS between February and each of January and March (p< 0.001, mean difference of 117.4 and 460.7, respectively). We found a significant difference between June and each of May and July (p< 0.001, mean difference of 1221.4 and 162.7, respectively). We also found a significant difference between October and each of September and November (p< 0.001, mean difference of 88.8 and 154.8, respectively). Conclusion: We observed a seasonal trend in the attention toward influenza-related research, with three annual peaks that correlated with the beginning, peak, and end of influenza seasons in the USA, according to Centers for Disease Control and Prevention (CDC) data.

The Impact of Funding Insulin Research on Open Access Publishing: A 20-Years Bibliometric Analysis.

BACKGROUND: The recent report of The World Health Organization on diabetes has stressed on the burden of diabetes on low/middle income countries. Recent studies advocated the importance of funding more research on diabetes and insulin in these countries. Recently, the European Research Council advocated the importance of gold Open Access (OA) publishing, where the funded research should be immediately accessible. In this study, we aim to assess funding for insulin research, where we will compare the OA status between funded and unfunded research. METHODS: We used Scopus database to assess insulin research published from January 1st, 1999 to December 31st, 2018. Our bibliometric analysis consisted of three main sections: analysis of all publications on insulin, analysis of funded insulin publications, and analysis of unfunded insulin publications. RESULTS: We found a total of 388,202 publications, of which only 83,180 (21.4%) were funded. USA produced around 30.1% of the total publications, and the National Institute of Health (NIH) was the major funder with 18.6% of all publications. Of the funded publications, 29,143 (35%) were OA publications, compared to 97,347 (31.9%) of the unfunded publications. We didn't find a significant difference in OA status between funded and unfunded research. CONCLUSION: In concordance with the European Research Council's decision to support gold OA publishing model, we found that only 35% of the funded and 31.9% of the unfunded insulin research were OA. Although the funded research is increasing in China, most of it is produced in high income countries. This highlights the importance of allocating more funds to low/middle income countries.

The impact of the open-access status on journal indices: oncology journals.

BACKGROUND: The field of oncology is among the highest productive fields in medicine, with the highest impact journals. The impact of open access (OA) journals is still understudied in the field of oncology. In this study, we aim to study the open-access status of oncology journals and the impact of the open-access status on journal indices. METHODS: We collected data on the included journals from Scopus Source List on 1st of November 2018. We filtered the list for oncology journals for the years from 2011 to 2017. OA journals covered by Scopus are indicated as OA if the journal is listed in the Directory of Open Access Journals (DOAJ) and/or the Directory of Open Access Scholarly Resources (ROAD). RESULTS: There were 318 oncology journals compared to 260 in 2011, an increase by about 24.2%, and the percentage of OA journals has increased from 19.6% to 23.9%. Although non-OA journals have significantly higher scholarly output (P=0.001), percent cited and source normalized impact per paper (SNIP) were higher for OA journals. CONCLUSIONS: Publishing in oncology OA journals will yield more impact, in term of citations, and will reach boarder audience.

Prevalence of metabolic syndrome in dialysis and transplant patients.

Background: Several epidemiological studies have assessed various components of Metabolic Syndrome (MS) in different populations, but only a few compared the prevalence of metabolic syndrome in dialysis and transplant patients. Aim: The aim of this study is to compare the prevalence of MS in dialysis and transplant patients. Two groups of patients were included; hemodialysis patients and patients with transplanted kidneys. Methods: Demographic and clinical history, and lab data were collected. A total of 108 patients were included in this study with a mean age of 52.3 (±16.29) years. Study groups included 61 (56.5%) dialysis patients, and 47 (43.5%) patients with transplanted kidneys. Results: Upon comparing the prevalence of metabolic syndrome between the two study groups, transplant patients had significantly lower prevalence of metabolic syndrome (34%) compared to that of metabolic syndrome in patients on dialysis (55.7%; P=0.016). Conclusion: As metabolic syndrome plays an important role in the pathology of elderly patients, especially those with transplanted kidneys, such findings indicate the need for close monitoring of kidney transplant patients for the manifestations of metabolic syndrome.

Correlation between Xerostomia index, Clinical Oral Dryness Scale, and ESSPRI with different hyposalivation tests.

BACKGROUND AND OBJECTIVE: Xerostomia is a subjective measure of dry mouth, while hyposalivation is an objective measure of reduced saliva flow rate. In this study, we aim to assess the association between commonly used xerostomia scoring systems, with different hyposalivation measures among Sjogren Syndrome (SS) patients. METHODS: In a cohort of SS patients, we assessed xerostomia using Xerostomia index, clinical oral dryness scale (CODS), and the European League Against Rheumatism SS Patient-Reported Index (ESSPRI), and we assessed hyposalivation using unstimulated whole saliva flow (UWS), stimulated whole saliva flow (SWS), and stimulated parotid flow (SPF). We analyzed the association between xerostomia and hyposalivation using association tests in SPSS. RESULTS: We included a total of 49 patients in this study, of which 34 (68%) had primary SS, and 15 (32%) had secondary. CODS was significantly correlated with SWS (P=0.048), with a negative correlation coefficient of 0.216, and with SPF (P=0.009), with a negative correlation coefficient of 0.291. The dryness domain of ESSPRI was significantly correlated with UWS (P=0.031) with a negative correlation coefficient of 0.233. CONCLUSION: CODS is the scoring system with the highest correlation with hyposalivation, particularly SWS and SPF, followed by ESSPRI dry domain, which is correlated with UWS. Xerostomia index is not correlated with hyposalivation.

Polyaspartate extraction of cadmium ions from contaminated soil: Evaluation and optimization using central composite design.

The occurrences of heavy metal contaminated sites and soils and the need for devising environmentally friendly solutions have become global issues of serious concern. In this study, polyaspartate (a highly biodegradable agent) was synthesized using L-Aspartic acid via a new modified thermal procedure and employed for extraction of cadmium ions (Cd) from contaminated soil. Response surface methodology approach using 35 full faced centered central composite design was employed for modeling, evaluating and optimizing the influence of polyaspartate concentration (36-145mM), polyaspartate/soil ratio (5-25), initial heavy metal concentration (100-500mg/kg), initial pH (3-6) and extraction time (6-24h) on Cd ions extracted into the polyaspartate solution and its residual concentration in the treated soil. The Cd extraction efficacy obtained reached up to 98.8%. Increase in Cd extraction efficiency was associated with increase in the polyaspartate and Cd concentration coupled with lower polyaspertate/soil ratio and initial pH. Under the optimal conditions characterized with minimal utilization of the polyaspartate and high Cd ions removal, the extractible Cd in the polyaspartate solution reached up to 84.4mg/L which yielded 85% Cd extraction efficacy. This study demonstrates the suitability of using polyaspartate as an effective environmentally friendly chelating agent for Cd extraction from contaminated soils.