Minimal intervention for neurofibromatosis type I manifestations: A case report.

INTRODUCTION AND IMPORTANCE: Neurofibromatosis type I (NF1, OMIM: 162200) is a benign, autosomal dominant, tumorigenic predisposing syndrome with variable manifestations. Both neurofibromatosis and soft tissue sarcomas are associated with the formation of hematomas. Moreover, skeletal manifestations of NF1 include focal or generalized forms and expansive or infiltrative growth types. CASE PRESENTATION: A 19-year-old NF1 female patient presented with an expanding post-traumatic facial hematoma that resembled a soft-tissue tumor at initial presentation. A congenital neck mass was noted ipsilateral to her craniofacial skeletal deformities. Multiple imaging modalities were used to aid diagnosis, and urgent surgical intervention of the expanding facial lesion was performed. Her neck lesion and skeletal deformities were monitored, and her recovery was uneventful at 1-year follow-up, with no progression. CLINICAL DISCUSSION: A palpable, non-pulsatile soft tissue mass is a common clinical presentation with a diverse differential diagnosis. Despite the low incidence of post-traumatic vascular injuries and lesions in the maxillofacial region, neurofibromatosis-associated vasculopathy remains an underestimated and serious manifestation of NF1. The reported zygomatic arch deformity is believed to be unique. However, the NF1 tumor-associated skeletal malformations are not linearly related. CONCLUSION: NF1 is a multisystem disorder necessitating an early multidisciplinary team approach. Minimal intervention can help convert an emergent operation into an urgent one and preclude the need for major surgery. The case illustrated a rare example of simultaneous affection of soft tissue and jaw bones in NF1 patients.

Mediterranean Fast Food: A Leading Cause of Hypercholesterolemia among University Students in Northern Jordan.

Background: Consumption of fast food is pervasive among young adults. This research aimed to assess the impact of consuming fast foods on total cholesterol level among university students in Northern Jordan. Methods: Using a cross-sectional design, a blood sample to investigate cholesterol level was drawn from a sample of university students in Northern Jordan. Besides, students' dietary habits and anthropometric measurements were obtained. Results: Out of 201 participants, 57% (n=115) were male and 43% (n=86) were female. More than three quarters of the sample ate shawarma (Mediterranean fast food) at least once per week. About 44% of the study subjects had increased BMI and about 37% had increased serum cholesterol level. Participants' gender, age, marital status, physical activity, BMI, living status, and daily pocket money significantly correlated with cholesterol level (P<0.05). In the regression analysis, eating fast foods and increased BMI were strong predictors of high cholesterol level. Students who ate shawarma more than 3 times a week had more than 8 folds to have hypercholesterolemia (OR=8.4; CI: 2.62-26.72), and obese students were more than 14 folds at higher risk to have hypercholesterolemia compared to those with normal BMI (OR=14.2; CI: 4.80-42.29). In addition, male students had doubled odds for having abnormal cholesterol level compared to females (OR=2.1; CI: 1.10-4.44). Conclusion: Fast food consumption among university students in Jordan was significantly associated with increased total cholesterol level. Encouraging healthy diet and lifestyle are the basis for prevention of dyslipidemia.

Fast Food Consumption, Liver Functions, and Change in Body Weight Among University Students: A Cross-Sectional Study.

BACKGROUND: Over the past decades, the consumption of fast foods has increased worldwide and became favored by people of most age groups. The objective of this research was to assess the impact of fast foods on liver enzyme levels and body weight. METHODS: A cross-sectional study was conducted at Yarmouk University/Jordan using survey questionnaire and enquired university students about their dietary habits, in addition to laboratory investigations of liver enzymes. RESULTS: In the cross-tabulation analysis, only age and body mass index (BMI) were significantly associated with alanine aminotransferase (ALT) enzyme level. However, all differences between aspartate aminotransferase (AST) level and other variables were statistically insignificant. The AST/ALT ratio was calculated and revealed significant statistical association with BMI of participants (P = 0.001). Change in body weight during one year was significantly associated with eating fast food (P = 0.031), drinking beverages with fast food meals (P = 0.001), and ALT level (P = 0.026). However, this association was statistically insignificant with AST level. CONCLUSIONS: Fast food consumption among university students in Jordan was not significantly associated with increasing levels of ALT and AST liver enzymes. However, eating fast food and drinking soft drinks were associated with increasing body weight, which is expected to have adverse effect on liver functions in the long term.

The diversity and outcome of post-covid mucormycosis: A case report.

INTRODUCTION AND IMPORTANCE: The impact of Covid-19 pandemic on the incidence and pattern of Mucormycosis (the black fungus), has increased sharply and is featured as an epidemic within a pandemic. The majority of cases were detected at late stages, which decreases the chances of survival. CASE PRESENTATION: The authors present a case of an immunocompetent male patient diagnosed with left orbital apex syndrome post covid-19 infection, which necessitated orbital exenteration. He was later hospitalized in a quarantine facility and an area of skin breakdown on his left cheek was noted and surgical debridement performed. Later, He presented to our institution with left hemifacial skin loss, exposing the underlying diseased bone. A multidisciplinary team examined the patient clinically and radiographically, reaching a primitive diagnosis of secondary cutaneous Mucormycosis due to rhino-orbital Mucormycosis, with no cavernous sinus thrombosis nor cranial extension. Radical surgical and medical treatments were given and he had an uneventful recovery. Unfortunately, he died 5 days after the reconstructive surgery with Anterolateral Thigh (ALT) flap. CLINICAL DISCUSSION: The dual effect of both covid-19 and its' associated Mucormycosis, predispose patients to increased risk of pressure injuries including Medical device related pressure injuries. Survivors of Mucormycosis are high-risk patients, and planning their reconstruction by free flaps is challenging. However, delayed reconstruction is recommended. CONCLUSION: Early diagnosis and management of covid-19 associated Mucormycosis should be prioritized. Moreover, surgical debridement of necrotic tissues should not be delayed due to an unavailable or negative histopathology.

Malignant transformation of oral squamous cell papilloma: a case report.

INTRODUCTION: Oral squamous papilloma is a benign tumor, but its potential for malignant transformation has yet to be studied. The authors report an unusual case presentation of an oral squamous cell carcinoma (SCC) arising from a squamous cell papilloma (SCP). CASE PRESENTATION: A 61 years old immunocompromised female patient complained of an asymptomatic white mass on the buccal mucosa. The diagnosis of squamous cell papilloma (SCP) was made, and the benign nature of the lesion was confirmed by two biopsies. The lesion suddenly increased in size, and the third biopsy revealed a malignant squamous cell carcinoma (SCC) grade II. At this stage, radical surgical intervention was the treatment of choice, and reconstruction with a combination of the pectoralis major and deltopectoral flaps was performed. DISCUSSION: Clinical and histopathological diagnosis of oral squamous papilloma is challenging. Reconstruction of composite head and neck defects is another challenge, especially in elderly and immunocompromised patients. The whole process of diagnosis and progress of the presented case might provide useful knowledge regarding the nature of the lesion and its future management. CONCLUSION: The authors emphasize the need for establishing a clear understanding of potentially malignant oral lesions. Close observation, multiple biopsies, early detection, precise diagnosis, and a multidisciplinary team approach are all of paramount importance.

Two Cases of Pituitary Stalk Interruption Syndrome in Syrian Children.

Pituitary stalk interruption syndrome (PSIS) is an extremely rare cause of growth failure and delayed puberty. It can be diagnosed by magnetic resonance imaging (MRI) of the hypothalamus and pituitary gland, showing an ectopic or absent posterior pituitary, an absent or interrupted pituitary stalk, or small anterior pituitary, in combination with growth hormone or other pituitary hormone deficiencies. The exact etiology of PSIS is unknown. In this article, we describe two cases of PSIS in Syria which are, as far as we know, the first published cases.

Undiagnosed impacted knife blade from a penetrative orbital injury: A case report.

INTRODUCTION: Impacted foreign bodies in the complex maxillofacial region is uncommon and their safe removal is a challenge. CASE PRESENTATION: The authors report an unusual case of a 41 year old male patient who suffered from violence-related orbital trauma with a knife. The presence of this foreign body was not diagnosed for a period of 20 months. After proper clinical and radiologic examination it was localized and extracted in the theater in a safe controlled manner. Although the tip of the blade was left in situ, the patient had a rapid uneventful recovery and follow up. DISCUSSION: The path of penetration of the foreign body in presented case didn't follow the predicted patterns of orbital injury described in literature. A dilemma exists as to how aggressive such injuries should be managed. Thus the surgical approach implemented for retrieving the current foreign body was highlighted. CONCLUSION: Radiographs are a crucial element for early diagnosis and proper management of foreign body injuries. Rapid postoperative recovery can be achieved with simple safe surgical retrieval maneuvers.

"There Is Zero Regulation on the Selling of Alcohol": The Voice of the Youth on the Context and Determinants of Alcohol Drinking in Lebanon.

Alcohol-related research from the Arab world has rarely touched on the experiences or views of Arab adolescents. In this article, we present an in-depth analysis of youth alcohol drinking patterns and determinants derived from focus group discussions completed with more than 100 Lebanese high school/vocational students (15-19 years). The social ecology of alcohol use framework guided our research and analysis. Findings reveal that alcohol drinking is perceived as a pervasive and serious public health problem, triggered by a complex web of social relations, and facilitated by lax policies. Recommendations to curb heavy/harmful alcohol drinking among adolescents include regulating the role of alcohol industry, providing alternative recreational spaces/pass-times, educating about alcohol-related harms, and promoting more research on alcohol and its harms. Findings confirm the social ecology of alcohol use framework, and suggest the addition of the macro level of influence to this model, namely, a comprehensive alcohol harm reduction policy.

A 5-year survey of biopsy proven kidney diseases in Lebanon: significant variation in prevalence of primary glomerular diseases by age, population structure and consanguinity.

BACKGROUND: Differences in epidemiology of kidney disease across the Middle East may arise from variations in indication for biopsy, environmental exposure and socio-economic status. The Lebanese population is composed of different ethnicities, with distinct ancestry and religion, enabling comparison of their effect on the prevalence of kidney disease within a confined geographic setting and uniform practices. Here we report 5 years' detailed epidemiology of renal diseases, based on histological diagnosis, in a sample from three large pathology centres in Lebanon. METHODS: Records of renal biopsies analysed at the American University of Beirut Medical Center, Hotel Dieu de France Hospital and the Institut National de Pathologie from January 2003 till December 2007 were retrospectively examined. We recorded the following data for each patient: age, gender, indication for renal biopsy and histopathological diagnosis. Religious affiliation and parents' consanguinity were recorded when feasible. RESULTS: The mean age at renal biopsy was 36.76 ± 20 years (range 1-84). The most common diagnosis was mesangioproliferative glomerulonephritis (GN; 20%), followed by focal segmental glomerulosclerosis (13.2%). While there were no differences in age, gender or indications for biopsy among different religious affiliations, mesangioproliferative GN was significantly more frequent among Muslims (P = 0.039) and offspring of consanguineous unions (P = 0.036). On the other hand, focal segmental glomerulosclerosis was most prevalent in Christians (P < 0.001). CONCLUSIONS: Variation in the distribution of diagnoses between Muslim and Christian groups likely reflects differences in population structure and ancestry. In particular, the increased prevalence of mesangioproliferative GN among offspring of consanguineous unions in Muslims suggests a recessive genetic component to this disease which may be identified via homozygosity mapping. These findings have important implications for formulating renal health policies and designing research studies in this population.