SOXC Transcription Factors as Diagnostic Biomarkers and Therapeutic Targets for Arthritis.

Osteoarthritis (OA) and rheumatoid arthritis (RA) are two common disorders that disrupt the quality of life of millions of people. These two chronic diseases cause damage to the joint cartilage and surrounding tissues of more than 220 million people worldwide. Sex-determining region Y-related (SRY) high-mobility group (HMG) box C, SOXC, is a superfamily of transcription factors that have been recently shown to be involved in various physiological and pathological processes. These include embryonic development, cell differentiation, fate determination, and autoimmune diseases, as well as carcinogenesis and tumor progression. The SOXC superfamily includes SOX4, SOX11, and SOX12, all have a similar DNA-binding domain, i.e., HMG. Herein, we summarize the current knowledge about the role of SOXC transcription factors during arthritis progression and their potential utilization as diagnostic biomarkers and therapeutic targets. The involved mechanistic processes and signaling molecules are discussed. SOX12 appears to have no role in arthritis, however SOX11 is dysregulated and promotes arthritic progression according to some studies but supports joint maintenance and protects cartilage and bone cells according to others. On the other hand, SOX4 upregulation during OA and RA was documented in almost all studies including preclinical and clinical models. Molecular details have indicated that SOX4 can autoregulate its own expression besides regulating the expression of SOX11, a characteristic associated with the transcription factors that protects their abundance and activity. From analyzing the currently available data, SOX4 seems to be a potential diagnostic biomarker and therapeutic target of arthritis.

Consumption of reused vegetable oil intensifies BRCA1 mutations.

Breast cancer (BC) is a foremost type of cancer in women globally with an increased mortality rate in developing countries. Information regarding hereditary factors, lifestyle, work environment, food habits, and personal history could be useful in diagnosing breast cancer. Among such food habits, the reuse of edible oil for preparing food is a common practice in any developing country. The repeated heating of oils enhances the oxidative degradation of oil to produce polyaromatic hydrocarbons (PAH) which could disrupt the redox balance and generate reactive oxygen species. These reactive toxic intermediates can lead to BRCA1 mutations that are responsible for breast cancer. Mutations in DNA are the main cause for the conversion of proto-oncogenes into oncogenes which leads to change in expression and an increase in cell proliferation wherein a normal cell gets transformed into a malignant neoplastic cell. This review summarizes the possible mechanism involved in the induction of breast cancer due to repeated heating of edible.

Effects of polyphenols on ncRNAs in cancer-An update.

In recent years, oncotherapy has received considerable attention concerning plant polyphenols. Increasing evidence suggests that because of the efficiency of polyphenols, they may have anti-tumour effects in various cancers. However, their regulatory structures remain elusive. Long non-coding RNAs (lncRNAs) have been identified in the regulation of various forms of tumorigenesis and tumour development. Long non-coding RNAs have recently emerged as regulatory eukaryotic transcripts and therapeutic targets with important and diverse functions in health and diseases. LncRNAs may be associated with the initiation, development, and progression of cancer. This review summarizes the research on the modulatory effects of IncRNAs and their roles in mediating cellular processes. The mechanisms of action of polyphenols underlying their therapeutic effects on cancers are also discussed. Based on our review, polyphenols might facilitate a significant epigenetic modification as part of their tissue- and/or cell-related biological effects. This finding may be attributed to their interaction with cellular signalling pathways involved in chronic diseases. Certain lncRNAs might be the target of specific polyphenols, and some critical signalling processes involved in the intervention of cancers might mediate the therapeutic roles of polyphenols.

Pinocembrin attenuates benzo(a)pyrene-induced CYP1A1 expression through multiple pathways: An in vitro and in vivo study.

Benzo(a)pyrene [B(a)P], which is a carcinogen, is a substance most typically known in cigarette smoke and considered as an important intermediary of lung cancer. The enzyme CYP1A1 is crucial for the metabolic conversion of B(a)P into the intermediates that induce carcinogenesis. Stimulation of the aryl hydrocarbon receptor, which is regulated by B(a)P, is thought to induce numerous signaling cascades. Interruption in the mitogen-activated protein kinase (MAPK) pathway causes changes in cellular processes and may alter the AhR pathway. The aim of this investigation is to examine the potential ability of a flavonoid pinocembrin (PCB) to alleviate B(a)P toxicity and analyze the underlying molecular mechanisms. We found that PCB inhibited DNA adduct formation by attenuating CYP1A1 expression through the suppression of the AhR/Src/ERK pathways. PCB mitigated the B(a)P-stimulated DNA damage, inhibited Src and ERK1/2 expression, decreased CYP1A1 expression, and reduced the B(a)P-induced stimulation of NF-κB and MAPK signaling in lung epithelial cells. Finally, the activity of CYP1A1 and Src in lung tissues from mice supplemented with PCB was noticeably decreased and lower than that in lung tissues from mice supplemented with B(a)P alone. Collectively, these data suggest that PCB may alleviate the toxic effects of PAHs, which are important environmental pollutants.

Epidemiology of pediatric sepsis in the pediatric intensive care unit of king Abdulaziz Medical City, Jeddah, Saudi Arabia.

BACKGROUND: Pediatric sepsis remains a significant cause of morbidity and mortality worldwide. This study aimed to identify the incidence of sepsis and septic shock among patients admitted to the pediatric intensive care unit (PICU) of a tertiary center in Saudi Arabia.  Patients' demographics and risk factors associated with sepsis-related mortality were also investigated. METHODS: A retrospective cohort study was conducted in the PICU of King Abdulaziz Medical City, Jeddah (KAMC-J). KAMC-J is a tertiary care hospital in the western region of Saudi Arabia. A total of 2389 patients admitted to the PICU of KAMC-J between January 1, 2013 and December 31, 2017 were screened and evaluated for sepsis using The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). RESULTS: Of the 2389 total admissions to the PICU, 113 patients (4.9%) met the definition of Sepsis-3; 50.4% of the 113 patients met the definition of septic shock. Most patients (66.3%) were less than 6 years old, and 52.2% were male. Eight-five patients (75.2%) had underlying comorbidities. The respiratory system was the most common primary site of infection (57.5%). Bacterial and viral infections were the most common infectious etiology with reported rates of 29.2 and 21.2%, respectively. The median duration of PICU stay was 8 days and the 28-day PICU mortality rate was 23.9%. A Pediatric Sequential Organ Failure Assessment (pSOFA) Score greater than four and a pre-existing percutaneous central venous catheter were associated with a significant increase in mortality, with adjusted odds ratios of 3.6 (95% confidence interval: 1.30-9.93) and 9.27 (95% confidence interval: 1.28-67.29), respectively. CONCLUSIONS: The incidence of sepsis in our institution is comparable to that reported internationally; however, the mortality rate is higher than that of developed countries. Nationwide studies identifying sepsis epidemiology are needed to improve the outcome of pediatric sepsis. Following international guidelines for central-line insertion and maintenance is of paramount importance.

The impact of Ramadan on visits related to diabetes emergencies at a tertiary care center.

BACKGROUND: Ramadan is the ninth month of the Islamic calendar were Muslims fast from dawn until sunset. This prolonged fasting period might have an impact on patients with diabetes and their disease control. This study aimed to determine the variation in visits at the Emergency Room department (ER) during Ramadan in comparison with other lunar months at a tertiary care hospital in Jeddah city in relation to the diabetes emergencies. METHODOLOGY: A retrospective cross-sectional study was conducted using electronic medical record review of patients with diabetes emergencies who visited ER of a Military hospital, from 9th to 11th lunar months during 2017-2018. Diabetes patients who visited ER and aged more than 18 years old were included. Frequency of ER visits, sociodemographic characteristics and clinical features were determined. Chi-square test, Student 's t-test and one-way ANOVA at p < 0.05 were used in assessing associations between variables. RESULTS: Within the selected study period, a total of 24,498 admissions were recorded in ER. The prevalence of diabetes emergencies visits was only 0.84%. Based on inclusion criteria, a total of 133 subjects were included in the study (54.1% men, 45.9% women). Majority of whom (73.7%) were on insulin therapy, and more than half of whom (51.9%) were type 2 diabetes. There was a significant difference (p = 0.001) in the prevalence of diabetes emergencies visits between the three lunar months Shaban, Ramadan and Shawal, 7, 5 and 4%, respectively. However, the highest prevalence was not in Ramadan. Despite some correlations were identified, the study found no significant differences between frequency of ER visits and various demographic, clinical factors and diabetes profile between Ramadan and other both preceding and succeeding lunar month. CONCLUSION: In contrary with previous studies, a downward trend of prevalence, from Shaban to Ramadan, to Shawal was found. This indicated that fasting during month of Ramadan does not impact negatively on the diabetes emergencies in comparison with other months. Hyperglycemia among type 2 diabetes and insulin treated patients were recorded the highest feature of diabetes emergences visits during the three months studied with no significant differences between the months. These findings highlight the need of type 2 and insulin treated patients to be thoroughly assess by the Primary Care physicians and in-depth health education and guidance should be given to them.

Cardiac Protective Effect of Kirenol against Doxorubicin-Induced Cardiac Hypertrophy in H9c2 Cells through Nrf2 Signaling via PI3K/AKT Pathways.

Kirenol (KRL) is a biologically active substance extracted from Herba Siegesbeckiae. This natural type of diterpenoid has been widely adopted for its important anti-inflammatory and anti-rheumatic properties. Despite several studies claiming the benefits of KRL, its cardiac effects have not yet been clarified. Cardiotoxicity remains a key concern associated with the long-term administration of doxorubicin (DOX). The generation of reactive oxygen species (ROS) causes oxidative stress, significantly contributing to DOX-induced cardiac damage. The purpose of the current study is to investigate the cardio-protective effects of KRL against apoptosis in H9c2 cells induced by DOX. The analysis of cellular apoptosis was performed using the terminal deoxynucleotidyl transferase dUTP nick-end labeling (TUNEL) staining assay and measuring the modulation in the expression levels of proteins involved in apoptosis and Nrf2 signaling, the oxidative stress markers. Furthermore, Western blotting was used to determine cell survival. KRL treatment, with Nrf2 upregulation and activation, accompanied by activation of PI3K/AKT, could prevent the administration of DOX to induce cardiac oxidative stress, remodeling, and other effects. Additionally, the diterpenoid enhanced the activation of Bcl2 and Bcl-xL, while suppressing apoptosis marker proteins. As a result, KRL is considered a potential agent against hypertrophy resulting from cardiac deterioration. The study results show that KRL not only activates the IGF-IR-dependent p-PI3K/p-AKT and Nrf2 signaling pathway, but also suppresses caspase-dependent apoptosis.

A-769662 stimulates the differentiation of bone marrow-derived mesenchymal stem cells into osteoblasts via AMP-activated protein kinase-dependent mechanism.

AMP-activated protein kinase (AMPK) signaling shows an important role in energy metabolism and has recently been involved in osteogenic and adipogenic differentiation. In this study we aimed to investigate the role of AMPK activator, A-769662, in regulating the differentiation of mesenchymal stem cells derived from bone marrow (BMSCs) into osteoblastic and adipocytic cell lineage. The effect of A-769662 on osteogenesis was assessed by quantitative alkaline phosphatase (ALP) activity, matrix mineralization stained with Alizarin red, and gene expression analysis by quantitative polymerase chain reaction (qPCR). Adipogenesis was determined by Oil Red O staining for fat droplets and qPCR analysis of adipogenic markers. A-769662 activated the phosphorylation of AMPKα1 during the osteogenesis of mBMSCs as revealed by western blot analysis. A-769662 promoted the early stage of the commitment of mouse (m) BMSCs differentiation into osteoblasts, while inhibiting their differentiation into adipocytes in a dose-dependent manner. The effects of A-769662 on stimulating osteogenesis and inhibiting adipogenesis of mBMSCs were significantly eliminated in the presence of either AMPKα1 siRNA or Compound C, an inhibitor of AMPK pathway. In conclusion, we identified A-769662 as a new compound that promotes the commitment of BMSCs into osteoblasts versus adipocytes via AMPK-dependent mechanism. Thus our data show A-769662 as a potential osteo-anabolic drug for treatment of osteoporosis.

Causes of vancomycin dosing error; problem detection and practical solutions; a retrospective, single-center, cross-sectional study.

Vancomycindosing error and inappropriate monitoring is a common problem in hospital daily practice. In King Abdulaziz Medical City (KAMC) in Jeddah, a high percentage of abnormal vancomycin trough levels is still detected despite using the recommended dose. Therefore, the current research objective is to study the major causes of vancomycin dosing errors. This retrospective, single-center, cross-sectional study was carried out at KAMC hospital in Jeddah from January 1st until December 31st 2019. All adult patients (≥15 years) who received vancomycin and had an initial abnormal trough level at the measured steady-state were included in this study. 472 patients have met the study inclusion criteria. The current study evaluated the factors that play a role in causing vancomycin trough level abnormalities such as sampling time, vancomycin dosing, and patient's pharmacokinetic and pharmacodynamic variations. In this study, we found that pharmacokinetic and pharmacodynamic variability was attributed to 65% of vancomycin's abnormal trough level. Also, the result showed a significantly increased odds of the low trough in the non-elderly group (OR 6, 95% CI 2.48 - 14.9, P < 0.001) and febrile neutropenic patients (OR 2.21, 95% CI 1.119 - 4.365, P < 0.05). However, the odds of high trough levels were significantly elevated among patients who have CrCl < 50 ml/min (OR 5, 95% CI 1.262-20.539, P < 0.05). In addition, the present investigation revealed that the occurrence of abnormal vancomycin levels was not affected by daily duty time or working days (p > 0.05). The current study indicated that vancomycin dosing errors were common in KAMC patients; thus, there is an unmet need to evaluate the causes of vancomycin abnormal trough level and optimize a strategy that would enhance the therapeutic effectiveness and minimize the potential toxicity.

Autophagy and senescence: A new insight in selected human diseases.

Senescence and autophagy play important roles in homeostasis. Cellular senescence and autophagy commonly cause several degenerative processes, including oxidative stress, DNA damage, telomere shortening, and oncogenic stress; hence, both events are known to be interrelated. Autophagy is well known for its disruptive effect on human diseases, and it is currently proposed to have a direct effect on triggering senescence and quiescence. However, it is yet to be proven whether autophagy has a positive or negative impact on senescence. It is known that elevated levels of autophagy induce cell death, whereas inadequate autophagy can trigger cellular senescence. Both have important roles in human diseases such as aging, renal degeneration, neurodegenerative disorders, and cancer. Therefore, this review aims to highlight the relevance of senescence and autophagy in selected human ailments through a summary of recent findings on the connection and effects of autophagy and senescence in these diseases.

A simple and reliable protocol for long-term culture of murine bone marrow stromal (mesenchymal) stem cells that retained their in vitro and in vivo stemness in long-term culture.

BACKGROUND: Bone marrow derived stromal stem cells (BMSCs) are a clonogenic cell population that is characterized by self-renewal capacity and differentiation potential into osteoblasts, and other mesenchymal cell types. Mouse BMSCs (mBMSCs) are difficult to be cultured and propagated in vitro due to their replicative senescent phenotype, heterogeneity and high contamination with plastic adherent hematopoietic progenitors (HPCs). In this study, we described long-term culture of homogenous population of mBMSCs using simple and highly reproducible approach based on frequent subculturing (FS) at fixed split ratio in the presence of basic fibroblast growth factor (bFGF). RESULTS: Cultured mBMSCs using this protocol (mBMSCs-FS) showed long-term survival in culture > 70 population doubling (PD) and retained their characteristic surface markers and differentiation capacity into osteoblast and adipocyte lineages. When compared to the clonal bone marrow-derived cell line ST2, mBMSCs-FS displayed more enhanced osteoblast differentiation potential and responsiveness to osteogenic factors including BMPs, IGF-1, PDGF, TGFß1,3, FGF, cAMP, Wnt3a and VEGF. In addition, unlike ST2 cells, mBMSCs-FS maintained capacity to form ectopic bone and bone marrow stroma upon in vivo transplantation in immune-compromising mice, even at high PD levels. Interestingly, by applying the same FS + bFGF protocol, we succeeded to obtain long-term cultures of primary neonatal calvarial osteoprogenitor cells (OBs) that were cultured for more than 70 PD and maintained in vitro and in vivo osteoblast differentiation capacities. CONCLUSIONS: Our data provide a simple and reliable protocol for generating long-term cultures of mBMSCs and OBs with retained high in vitro and in vivo osteoblast differentiation capacities for use in pre-clinical and molecular mechanism studies.

Spinosad Induces Antioxidative Response and Ultrastructure Changes in Males of Red Palm Weevil Rhynchophorus ferrugineus (Coleoptera: Dryophthoridae).

The red palm weevil, Rhynchophorus ferrugineus, is of great concern worldwide, especially in the Middle East, where dates are a strategic crop. Despite their ecological hazard, insecticides remain the most effective means of control. A bioinsecticide of bacterial origin, spinosad is effective against several pests, and its efficacy against male R. ferrugineus was assessed in the present study. The antioxidative responses of key enzymes including catalase (CAT), superoxide dismutase (SOD), and glutathione-S-transferase (GST) to spinosad were investigated in the midgut and testes, and the effects of this insecticide on the cell ultrastructure of the midgut, Malpighian tubules, and testes were also determined. The lethal concentration 50 of spinosad was measured at 58.8 ppm, and the insecticide inhibited the activities of CAT, SOD, and GST in the midgut. However, no significant changes in the activities of these enzymes were observed in the testes. Spinosad treatment resulted in concentration-dependent changes in the cellular organelles of the midgut, Malpighian tubules, and testes of R. ferrugineus, and some of these effects were similar to those exerted by other xenobiotics. However, specific changes were observed as a result of spinosad treatment, including an increase in the number and size of concretions in Malpighian tubule cells and the occasional absence of the central pair of microtubules in the axonemes of sperm tails. This study introduces spinosad for potential use as an insecticide within an integrated control program against male red palm weevils. Additionally, the study provides biochemical and ultrastructural evidence for use in the development of bioindicators.

Ellagic acid alleviates adjuvant induced arthritis by modulation of pro- and anti-inflammatory cytokines.

Rheumatoid arthritis (RA) is a chronic inflammatory disease of unknown aetiology, but it is now clear that pro-inflammatory cytokines play a central role in its pathogenesis. Ellagic acid (EA) has a variety of biological activities including anti-oxidant, anti-inflammatory, and anti-cancer properties. The aim of the present study was to evaluate the potential effect of ellagic acid on the prevention and/or treatment of adjuvant induced arthritis (AIA) model in mice. Ellagic acid treatment was started one week before AIA induction and continued for three weeks after induction of AIA. Ellagic acid treatment significantly (p < 0.01) inhibited foot paw oedematous swelling and attenuated AIA-associated pathology. Ellagic acid significantly (p < 0.01) reduced serum levels of pro-inflammatory cytokines: interleukin 1ß (IL-1ß), tumor necrosis factor α (TNF-α), and interleukin 17 (IL-17). However, serum levels of IL-10 and interferon γ (IFN-γ) significantly increased (p < 0.01 and p < 0.05, respectively), while serum level of transforming growth factor ß (TGF-ß) did not significantly alter with EA treatment. In conclusion, these results suggest that EA attenuated AIA-associated pathology in the mouse model by downregulation of pro-inflammatory cytokines and upregulation of anti-inflammatory cytokines.

Comparing Actual and Rounded Serum Creatinine Concentration for Assessing the Accuracy of Vancomycin Dosing in Elderly Patients: A Single-Center Retrospective Study.

Prescribers often face the challenge of predicting creatinine clearance (CrCl) in elderly patients who are 65 years or older and have serum creatinine (SCr) concentrations below 1 mg/dL. Studies have shown that utilizing rounded SCr would underestimate CrCl in this population, which could lead to the under-dosing of some medications like vancomycin. The current study aimed to compare the accuracy of vancomycin dosing using actual SCr versus rounded SCr to 1 mg/dL in elderly patients. A total of 245 patients were included. The therapeutic trough level (10-20 mg/L) was achieved in 138 (56.3%) patients using actual SCr. Sub-therapeutic (<10 mg/L) and supra-therapeutic (>20 mg/L) trough levels were observed in 32 (13.1%) and 75 (30.6%) patients, respectively. The predictive performance of different vancomycin doses based on actual SCr and rounded SCr compared to the targeted maintenance dose (TMD) showed a stronger correlation of dosing based on actual SCr with TMD (r = 0.55 vs. 0.31) compared to rounded SCr dosing; both doses showed similar precision, with ranges of ±552 mg/day for the dosing based on actual SCr and ±691 mg/day for the dosing based on rounded SCr. Furthermore, the dosing based on actual SCr showed a lower error percentage (69%) and a higher accuracy rate (57.6%) within ±10% of the TMD compared to the dosing based on rounded SCr, which had an error percentage of (92.3%) and an accuracy rate of (40%). The prevalence of vancomycin-associated nephrotoxicity (VAN) was seen in 44 (18%) patients. Patients between 75 and 84 years of age, those who were bedridden, and those with vancomycin trough concentrations greater than 20 mg/L had a higher risk of developing VAN. In conclusion, in elderly patients, estimating vancomycin dosing based on actual SCr was more accurate compared to rounded SCr to 1 mg/dL. The efficacy of vancomycin could be negatively affected by rounding up SCr, which could underestimate CrCl and result in the under-dosing of vancomycin.

Evaluating the Knowledge, Attitudes, and Practices of Saudi Arabian Parents Regarding Red Flags in Developmental Milestones.

Background Parents serve a fundamental role in monitoring developmental milestones and identifying potential delays during early childhood, enabling timely interventions. However, previous studies in Saudi Arabia have shown limited awareness among parents regarding age-specific norms and red flags across developmental domains. This knowledge gap can severely impact the detection and management of abnormalities. Hence, a comprehensive understanding of Saudi parental knowledge, attitudes, and practices concerning childhood developmental trajectories is imperative.  Methodology This cross-sectional study assessed developmental milestone awareness, beliefs, and behaviors among Saudi parents. A sample of 1,052 parents completed a validated 38-item questionnaire covering knowledge, attitudes, practices, and demographics. Knowledge was assessed across developmental domains using 22 multiple-choice questions, with scores categorized as excellent (≥75%), good (50%-75%), fair (40%-50%), or poor (≤39%). Attitudes and practices were captured on five-point Likert scales. Descriptive and chi-square analyses were conducted using IBM SPSS Statistics for Windows, Version 28.0 (IBM Corp., Armonk, NY).  Results The majority of participants were females (844, 80.2%), with a mean age of 38.8 years. Serious knowledge inadequacies existed regarding developmental timelines across domains, especially motor milestones like crawling (93, 29.4% correct), sitting unsupported (45, 27.6%), pointing at objects (278, 26.4%), and responding to names (440, 41.8%). Overall, 2 (0.2%) participants showed excellent and 281 (26.7%) showed good understanding, while 490 (46.6%) had poor knowledge. Significant sociodemographic variations were observed, with women and experienced parents demonstrating greater awareness (P < 0.001). Despite knowledge gaps, 542 (51.5%) actively sought developmental information themselves, and over 50% trusted pediatric guidance. Most participants expressed a willingness to undergo screenings if risk factors existed and reported spending a considerable amount of daily interaction time with their children, focusing on developmental needs. Conclusions Critical developmental milestone knowledge shortfalls and selective attitudes persist among Saudi parents, warranting public education and physician-parent communication that enhance interventions to enable impactful developmental monitoring and prompt responses to abnormalities in a timely manner.

Perception and attitude of type 2 diabetic patients toward insulin therapy in the primary care of National Guard for Health Affairs (NGHA) in Jeddah, Saudi Arabia.

Purpose/Background: Our study explores and determines the perception toward insulin among patients with diabetes in the National Guard for Health Affairs (NGHA), Jeddah, the Kingdom of Saudi Arabia (KSA), and aims to gain insight into the causes of refusal. Patients with type 2 diabetes (T2D) are likely to need the use of insulin to keep blood glucose levels within normal range and delay the onset of diabetes-related problems. Individuals with diabetes may be hesitant to begin insulin therapy if they have a negative attitude toward it, which might add to the delay in beginning treatment. Materials and Methods: A cross-sectional study was conducted in the primary healthcare centers of the NGHA in Jeddah, Saudi Arabia. Data were collected through a validated self-administered questionnaire that was divided into three sections, with a total of 32 questions. The first section concerned demographic data, the second part was directed toward insulin users, and the last section was directed toward non-insulin patients. Results and Conclusion: Our study collected 314 responses. Males constituted 54.8% of participants and insulin users resembled 45.7%. According to our study, important deterrents to starting insulin therapy among non-insulin users included the following: the cost of insulin, the pain associated with injections, the difficulty in maintaining food control while on insulin treatment, scarring at the injection site, and the weight gain impact. Factors that were found to influence compliance to insulin therapy among insulin users included fear of weight gain and self-administration of insulin.

A Cosmetic Approach to Cheek and Nasal Hemangioma Utilizing Open Rhinoplasty in a 10-Year-Old Child: A Case Report.

Infantile hemangiomas are characterized as benign tumors of vascular tissue that arise from rapid endothelial cell proliferation followed by gradual involution, affecting 4% to 5% in infants and 2.6% to 9.9% in older children. Most of them resolve by the age of three years, negating the need for surgical intervention. However, intervention should be considered especially in cases with a high risk of recurrence. A female patient, aged 10 years, was referred to plastic surgery by her dermatologist due to the presence of a vascular mass in her face located at the junction between the nose and right cheek that had been present since infancy. The patient was diagnosed with infantile hemangioma based on MRI imaging of the face showing a benign vascular lesion measuring 9 x 12 mm. After the failure of multiple sclerotherapy sessions and informed discussion with the respective family, the patient underwent open rhinoplasty for surgical excision with no facial scarring other than the transcellular scar. This study presents a rare case of utilizing the open rhinoplasty technique in a relapsing facial hemangioma of a 10-year-old child. Results show a positive aesthetic outcome by minimizing facial scars. Considering the limited reported use of this technique, more clinical studies, especially comparing long-term effects across different age populations, are recommended to validate the efficiency and effectiveness of this technique.

Congenital hairy nevus: A case report of long-term follow-up following curettage of the nevus at the age of 6 hrs.

INTRODUCTION: Management of giant hairy nevi depends on various factors including the size and anatomical area. CASE PRESENTATION: We report a case of a giant hairy nevus treated successfully with curettage at the age of 6 hrs after birth. There was partial recurrence of pigmentation and hair on long-term (10 years) follow-up. DISCUSSION: Although curettage is a known method of treating hairy nevi, long term results are lacking when the nevus is treated in the first few hours after birth. CONCLUSION: Following curettage of hairy nevi in the first few hours after birth, recurrence of pigmentation and hair may still occur on long term follow up.

The Association of Cone-shaped Epiphysis and Poland Syndrome.

Poland syndrome is a congenital anomaly with two clinical features: unilateral agenesis of the pectoralis major and ipsilateral hand symbrachydactyly. We report a rare case of bilateral Poland syndrome with several unique features. Poland syndrome is thought to be due to a vascular insult to the subclavian axis around the sixth week of gestation. Our patient has multiple rare and unique features of Poland syndrome. For the first time in the literature, we associate Poland syndrome with cone-shaped epiphysis of the metacarpals of all fingers. Bilaterality, cleft hand deformity, and dextrocardia were also rare features in our patient.

Leiomyoma of the Thumb Mimicking a Ganglion: A Case Report.

Our case report describes the presence of a leiomyoma in the left-hand thumb of a 69-year-old woman, an extremely uncommon location for such a tumor. Leiomyomas are typically benign tumors that arise from smooth muscle, but their occurrence in the hand is unusual. While leiomyomas are more commonly found in the uterus, they may occasionally develop in the extremities, though this is more frequently observed in the lower limbs. These tumors typically present in patients in their third to fourth decades of life, and they are often not diagnosed until surgery because histological pathology is necessary to confirm the diagnosis.