Ultrasound Assessment of Facial and Neck Aging: A Noninvasive Approach to a Minimally Invasive Treatment.

This technical note explores the diagnostic potential of ultrasound in assessing age-related changes in the soft tissues of the lower face and neck, with a primary focus on identifying causes of contour deformities and guiding minimally invasive rejuvenation procedures. Seventeen clinical patients with various age-related soft-tissue changes were subjected to ultrasound assessments, targeting issues such as soft-tissue sagging, supra- and subplatysmal adipose tissue excess, platysma thickness, and localization of ptotic platysma strands. The ultrasound examinations successfully identified specific anatomical features contributing to age-related soft-tissue changes in all 17 patients. This information guided tailored treatment plans, resulting in remarkable esthetic improvements in each case. The discussion emphasizes ultrasound's invaluable role as a diagnostic tool for precisely identifying soft-tissue alterations in the lower face and neck. The noninvasive nature and high spatial resolution of ultrasound make it particularly effective for this purpose. The corrective methods guided by ultrasound findings proved to be minimally invasive and yielded successful outcomes in all cases, promoting high levels of patient satisfaction. The study highlights the underutilization of ultrasound's diagnostic potential in clinical practice and highlights the importance of its incorporation into routine assessments. Ultrasound emerges as a cost-effective, noninvasive, and accessible means of accurately diagnosing age-related soft-tissue changes, empowering clinicians to tailor rejuvenation procedures to each patient's unique needs. The hope is that by emphasizing its utility, this study encourages the broader adoption of ultrasound in clinical practice.

Management of Renal Artery Aneurysms and an Arteriovenous Shunt in a Hemophilic Patient: A Case Report.

This case report details the management of a 66-year-old male with hemophilia A (HA) who presented with recurrent hematuria, and was found to have renal artery aneurysms and was subsequently diagnosed with a renal arteriovenous (AV) shunt. While the primary focus centers on the successful endovascular coil embolization of renal artery aneurysms, the concomitant presence of the AV shunt accentuates the significance of this case. Imaging techniques were crucial in the discovery of renal aneurysms and the diagnosis of the AV shunt malformation of the renal artery. This included an ultrasound, CT-angiography and digital subtraction angiography. The treatment approach employed prioritized endovascular coil embolization for its efficacy and reduced morbidity. Following the initial successful embolization, the identification of the AV shunt during subsequent embolization led to its targeted treatment. The case was also complicated by acute prostatitis that was treated medically. The patient's HA required careful administration of coagulation factor replacement therapy to control bleeding throughout the process. This case highlights the importance of reporting on the management of rare and complex pathologies to better understand and guide future treatments, especially involving this rare combination of renal AV shunts and hemophilia A.

Citalopram & escitalopram: Mechanisms of cardiotoxicity, toxicology predisposition and risks of use in geriatric & hemodialysis populations.

The selective serotonin reuptake inhibitors (SSRIs) citalopram and escitalopram are extensively prescribed for various psychopathies. Despite their reputation for safety compared to older antidepressants, concerns have arisen regarding their cardiotoxic potential, notably in prolonging the QTc interval. In this comprehensive review, we investigate the intricate mechanisms of cardiotoxicity induction by citalopram/escitalopram, with a special focus on their interactions with ion channels like Kv11.1, Nav1.5, and Cav1.2 which may contribute to QTc-prolongation, increasing the risk of life-threatening arrhythmias such as Torsades de Pointes (TdP). Moreover, we explore the predisposing factors to their associated cardiotoxicity along with an investigation of the QRS/QTc ratio as a potential biomarker for identifying patients at risk of ventricular arrhythmias, taking into consideration the impact of genetic variations and drug interactions, especially those involving the liver CYP2C19 metabolism. Our review extends to the geriatric population's use of citalopram and escitalopram, emphasizing the significance of assessing a patient's medical history and cumulative drug use to evaluate their susceptibility to cardiac adverse events. Finally, we scrutinize the compound relationship between QTc-prolongation, proton pump inhibitors (PPIs) and serum-to-dialysate potassium gradients in influencing the proarrhythmic potential of citalopram/escitalopram in hemodialysis patients.

Complex Presentation of Multicentric Castleman Disease with Coexisting HIV, HHV-8, and Other Opportunistic Infections.

Castleman disease (CD) is a rare lymphoproliferative disorder characterized by benign lymph node enlargement. We present the case of a 43-year-old male with a complex medical history, including Crohn's disease treated with Adalimumab and later complicated with tuberculosis (TB) infection. Subsequently, in May 2021, he was diagnosed with human immunodeficiency virus (HIV) and started on antiretroviral therapy (efavirez, emricitabine, and tenofovir). Despite stropping adalimumab, anti-Tb, and antiviral therapy, he experienced persistent fever, neurological symptoms, and lymphadenopathy. Toxoplasmosis, Cytomegalovirus (CMV), and Human Herpesvirus-8 (HHV-8) were diagnosed and then treated. Furthermore, the patient displayed intermittent febrile episodes, pancytopenia, altered coagulation parameters, hypoalbuminemia, edema, and generalized abdominal pain, as well as radiological evidence of hepatosplenomegaly and pulmonary infiltrates. Left axillary lymph node biopsy (ALNB) was done and confirmed multicentric castleman disease (MCD). Moreover, the bone marrow aspirate showed plasmocytes. His treatment included chemotherapy with doxorubicin and rituximab while continuing his anti-Tb and antiretroviral therapy. This complex case highlights the diagnostic challenges of managing CD in the presence of multiple coexisting conditions, emphasizing the need for comprehensive evaluation in complex clinical presentations.

The effect of resection of gliomas of the primary motor and sensory cortex on functional recovery and seizure outcome: A 10-year retrospective study.

Background: Gliomas, the most common primary brain tumors, pose surgical challenges in eloquent cortex regions due to potential deficits affecting patients' quality of life (QOL) and increased mortality risk. This study investigates motor and sensory recovery postresection of Rolandic cortex gliomas in 40 patients, alongside seizure outcomes and the efficacy of intraoperative techniques such as awake craniotomy. Methods: This was a 10-year monocentric retrospective study based on the experience of a neurosurgeon in the resection of Rolandic gliomas and its impact on 40 patients' QOL in a period from 2011 to 2020. The primary outcomes were tumor recurrence and the efficacy of the surgery defined as survival status, seizure status, and sensory and motor neurological deficits. Data collection included demographic, tumor, and surgical outcome variables. The extent of resection (EOR) was classified as gross total resection (GTR) (EOR ≥95%) or subtotal resection (EOR <95%). Statistical analysis involved descriptive statistics and inferential tests for outcome comparisons. Results: Patients were aged an average of 42.3 ± 14 years and distributed between 72.5% of males and 27.5% of females. The most common presentation was seizures (65%). The tumor was located in the frontal lobe at 65%, the motor at 75%, and the top tumor pathology was oligodendroglioma (42.5%). The recurrence rate in the study was 20% (8 of 40), and the 1-year survival rate was 92.5%. After the resection, significant improvement was shown in Karnofsky's performance status (P = 0.007), in normal daily activities (P = 0.001), in fine motor skills (P = 0.020), and work hobbies (P = 0.046). No statistically significant improvement was shown in seizures and deficit rates. Recurrence was not associated with the demographic characteristics, clinical presentation, tumor-related characteristics (location, area, side, and mutation), tumor resection, and adjuvant treatment (P > 0.05). Conclusion: GTR of Rolandic gliomas can be achieved with the use of meticulous stimulation mapping, and complete functional recovery is attainable despite common belief.

Hydroxychloroquine and the associated risk of arrhythmias.

Hydroxychloroquine (HCQ), which was initially used as an antimalarial drug, is now being used to treat other illnesses, especially rheumatic autoimmune disorders  such as systemic lupus erythematosus, primary Sjögren's syndrome, and rheumatoid arthritis, because it is safe, effective, and cost efficient. This drug has shown high efficacy and has become the first-line treatment for many of these diseases. Although HCQ has many therapeutic effects, it has unfortunately shown some complications, especially with its long-term use. One of these side effects is arrhythmia through prolongation of the QT interval. This narrative literature review focuses on the effects of HCQ on the QT interval in patients with rheumatologic diseases who have been prescribed this drug. In particular, we will focus on the increased risk of arrhythmia when HCQ is administered with other drugs, such as azithromycin and many others, along with drug-drug interactions. In addition, we investigated the safety of this drug in pregnant women.

Association of Prostate-Specific Antigen With Age, Digital Rectal Examination, and Lower Urinary Tract Symptoms in the Lebanese Population: A Cross-Sectional Study.

BACKGROUND: Prostate cancer (PCa) is a leading cause of mortality in men worldwide. Prostate-specific antigen (PSA) testing is a standard method for PCa detection, yet its association with age, digital rectal examination (DRE) results, and lower urinary tract symptoms (LUTS) remains understudied, particularly in the Lebanese population. OBJECTIVE: This study aimed to investigate the association of PSA levels with age, DRE results, and LUTS severity among Lebanese men. METHODS: A total of 725 men aged 55-70 years were recruited from a men's health campaign at Saint George Hospital University Medical Center in Lebanon. PSA levels, DRE results, and International Prostate Symptom Score (IPSS) were assessed. Statistical analysis included Kruskal-Wallis tests and Spearman's rho correlation coefficient. RESULTS: Participants exhibited a significant correlation between age and PSA levels (r = 0.138, p < 0.01). PSA levels varied significantly across age groups (p = 0.029), with higher mean PSA levels observed in older age groups. IPSS status correlated positively with PSA levels (r = 0.23, p < 0.001), indicating higher PSA levels associated with increased LUTS severity. Abnormal DRE findings were significantly associated with elevated PSA levels (p < 0.00), suggesting their potential as an indicator of prostate abnormalities. CONCLUSION: This study highlights the importance of age-specific reference ranges for PSA levels in the Lebanese population. Elevated PSA levels were associated with older age, increased LUTS severity, and abnormal DRE findings. These findings highlight the significance of integrating PSA testing with clinical assessments for PCa detection and risk stratification in Lebanon.

Resection of Retroperitoneal Extra-Adrenal Pheochromocytoma: A Case Report.

Extra-adrenal pheochromocytomas are rare catecholamine-producing tumors that arise from chromaffin cells outside the adrenal glands. We report on the case of a 62-year-old male who initially presented with upper respiratory tract symptoms and was found to have a suprapubic pelvic mass and an asymptomatic right inguinal hernia. The diagnostic evaluation involved an abdominal ultrasound, a CT scan, followed by an MRI, which revealed a well-marginated large mass whose characteristics indicated a retroperitoneal sarcoma. Upon successful surgical resection, the mass was found to be encapsulated and no peripheral structure invasion was present; the right inguinal hernia was repaired, and a double J-stent was placed. Histopathological examination revealed extra-adrenal pheochromocytoma. This case report sheds light on diagnostic and therapeutic challenges when dealing with extra-adrenal pheochromocytomas and the importance of considering them as a differential diagnosis when presented with a case of retroperitoneal mass.

Bilateral Urinary Stones in a Transgender Woman: A Case Report in Lebanon.

This case report presents a 38-year-old transgender woman, assigned male at birth, who presented with severe right flank pain associated with nausea and hematuria. After previously undergoing gender-affirming surgeries, including abdominoplasty, liposuction, breast augmentation, and reconstructive vaginal surgery, the patient developed bilateral ureteral and kidney stones leading to significant hydronephrosis. Bilateral double J insertion was performed following a computed tomography (CT) Uroscan. This was followed by flexible ureteroscopy and laser fragmentation of the stone bilaterally. The patient's anatomy was remarkable for the presence of neovagina and prostate. This case highlights the unique challenges and considerations in managing genitourinary complications in transgender individuals. The literature is limited in the Middle East concerning transgender individuals, hence the need to conduct further research and compile comprehensive case reports on transgender individuals in the Middle East in order to establish a robust database and draw meaningful epidemiological conclusions.