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INTRODUCTION: Immune checkpoint inhibitors (ICIs) are approved to treat several types of cancer, but they may cause an exaggerated immune response. This can lead to immune-related adverse events such as endocrinopathies, which mostly affect the thyroid and pituitary gland. METHODS: A retrospective analysis was conducted on 125 cancer patients receiving ICIs (pembrolizumab, nivolumab, and ipilimumab) between July 2018 and July 2022. The study reviewed hormone test results and the clinical perspectives of patients to identify and characterize endocrine adverse events associated with ICI therapy in cancer patients. RESULTS: Among the 125 patients who were examined, a total of 26 patients (20.8%) encountered endocrine-related adverse effects. A total of 25 patients had thyroid dysfunction. Hypophysitis was detected in a limited cohort of two patients, along with primary hypothyroidism. A case of newly diagnosed type 1 diabetes mellitus was seen in a single patient. None of the patients had primary adrenal insufficiency or parathyroid dysfunction. The administration of pembrolizumab was shown to be associated with the occurrence of thyroid dysfunction in 18 cases, as well as two cases of hypophysitis. In contrast, nivolumab was responsible for inducing thyroid dysfunction in four cases. The remaining occurrences were attributable to combination treatment. CONCLUSION: The study found an increased risk of thyroid dysfunction among cancer patients receiving ICIs, while pituitary dysfunction was a less frequent adverse effect. It is recommended that an endocrine assessment be conducted before therapy initiation and periodically afterward.
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Coronavirus disease 2019 (COVID-19) is associated with significant thromboembolic risk. Extensive deep vein thrombosis can infrequently progress to phlegmasia cerulea dolens that carries high morbidity and mortality rates. We report a case of a middle-aged male presenting with phlegmasia cerulea dolens in the context of COVID-19 and underlying May-Thurner syndrome, associated with transiently positive antiphospholipid antibodies.
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PURPOSE: Dental anxiety is a barrier to dental care utilization and is associated with poor oral health outcomes. The aim of the study was to assess the relationship between dental anxiety of mothers and dental caries of their children in the Eastern Province, Saudi Arabia. METHODOLOGY: A cross-sectional study was conducted on a sample of mother-child pairs (N= 199) in Dammam, AlKhobar, and Dhahran, Saudi Arabia. Dental caries experience among children was determined using dmft/DMFT indexes following the World Health Organization's guidelines. Maternal dental anxiety was assessed by using the Modified Dental Anxiety Scale (MDAS). RESULTS: The mean ages of mothers and children were 33.98 ± 5.41 and 6.74 ± 2.29 years, respectively. The mean dmft score was 4.3 ± 3.99 in primary dentition and the mean maternal dental anxiety score was 13.89 ± 5.33. Ninety-two percent of mothers had low to extreme dental anxiety and only 8% reported no dental anxiety. Dental caries experience in primary teeth was higher in children of dentally anxious mothers (mean dmft 4.45 ± 3.92) than the children of mothers who were non-anxious (mean dmft 2.56 ± 4.59) (P=0.07). The mean maternal anxiety score was significantly higher in children with untreated decay in primary dentition (14.49 ± 5.08) than those with sound primary dentition (12.24 ± 5.67) (P = 0.008). The study also found a statistically significant correlation between maternal dental anxiety and untreated decay in the primary dentition (Pearson's r =0.171, P = 0.015). CONCLUSION: Dental anxiety was highly prevalent among mothers in the present study. There was a significant relationship between maternal dental anxiety and untreated decay in the primary dentition. Awareness should be raised among dentally anxious mothers to reduce the burden of dental caries in their children.