Aplastic anemia secondary to adjuvant Osimertinib therapy: a case report and a review of literature.

Aplastic anemia is a rare hematological disorder characterized by suppressed hematopoiesis and pancytopenia. Although several drugs have been associated with aplastic anemia, its occurrence in response to Osimertinib, a third-generation epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI), is extremely rare. We present a case report of a 63-year-old patient with locally advanced non-small cell lung cancer (NSCLC) who developed aplastic anemia following adjuvant treatment with Osimertinib. Extensive investigations ruled out infectious etiology, and the absence of bone marrow involvement or other identifiable causes suggested a drug-induced etiology, specifically Osimertinib. This case report emphasizes the importance of recognizing this adverse event and considering it as a potential complication of Osimertinib therapy. Vigilant monitoring and prompt management are essential for optimizing patient outcomes. Further studies are needed to better understand the risk factors, underlying mechanisms, and management strategies for Osimertinib-induced aplastic anemia in the adjuvant settings.

A primary squamous cell carcinoma of the sigmoid colon in a young patient: A case report and literature review.

Colon cancer is among the most common types of cancer with adenocarcinomas being the most common type. Herein we report a young patient who presented with primary colonic squamous cell carcinoma without risk factors. To the best of our knowledge, this is the youngest patient with such diagnosis worldwide.

Risk Factors, Clinical Presentation, Diagnosis, and Treatment Outcomes of Portal Vein Thrombosis: A Five-Year Hospital-Based Study From Qatar.

Background: There is a lack of robust epidemiological information on portal vein thrombosis (PVT) in Qatar. This study aimed to describe the risk factors, clinical presentation, diagnosis, and treatment outcomes of PVT in patients with and without liver cirrhosis admitted to Hamad General Hospital. Methods: This retrospective observational study was conducted at Hamad General Hospital, Doha, Qatar. Consecutive patients with PVT between January 1, 2015 and December 31, 2019 were included in this study. Results: We included 363 cases representing 0.05% of all inpatients admitted to our hospital during the study period. Their mean age was 47.79 ± 14.48 years. There were 258 (71.1%) males and 105 (28.9%) females. Abdominal pain was the most common presenting symptom (160 (44.1%)), while splenomegaly was the most common presenting sign (158 (43.5%)). Liver cirrhosis was the most frequent risk factor for PVT (147 (40.5%)), while no risk factors were identified in 49 (13.5%) patients. Anticoagulant therapy was given to 171/207 (82.6%) patients with acute PVT and 19/156 (12.2%) patients with chronic PVT. The options used for anticoagulation treatment were: low molecular weight heparin (LMWH) or unfractionated heparin alone, LMWH/unfractionated heparin followed by warfarin, and direct-acting oral anticoagulants (rivaroxaban). Out of the 262 patients in whom PVT recanalization was assessed, 43.8% of the cases had recanalization after anticoagulation treatment, while 12.6% of them had spontaneous recanalization without such therapy. A comparison between different anticoagulants used in this study showed no significant difference in the effectiveness of the three regimens used. The 30-day mortality was recorded for 71 patients (19.5%). The major risk factors for 30-day mortality were: age over 45 years, male sex, hepatic failure, malignancies, and bilirubin > 34 µmol/L. Conclusion: PVT is a rare clinical entity in Qatar with liver cirrhosis being the most common risk factor. Early administration of anticoagulation therapy is associated with a significant recanalization, while age > 45 years, male sex, hepatic failure, malignancies, and bilirubin > 34 µmol/L are independent risk factors for 30-day mortality.

Helicobacter pylori infection manifesting as Hypereosinophilic syndrome and immune thrombocytopenia complicated by portal vein thrombosis and ischemic colitis.

Hypereosinophilic syndromes (HES) are a group of uncommon disorders characterized by persistent eosinophils overproduction which can lead to tissue damage and organs dysfunction secondary to eosinophils tissue infiltration and inflammatory mediators' release. Causes of secondary HES include parasitic infection, some solid tumors, underlying connective tissue disease, allergic conditions and T cell lymphoma. Helicobacter pylori (H. pylori) has been reported only once as a cause of secondary HES in the literature. We report the second case of H. pylori infection in 29-year-old male patient who presents with HES and secondary Immune thrombocytopenic purpura (ITP). This case is different from the first reported case by the presence of HES complication on presentation manifesting as portal vein thrombosis, which was further complicated by ischemic colitis. H, pylori eradication therapy alone was successful in a resolution of hypereosinophilia and platelets recovery without the need of corticosteroids or any other treatment.

The Role of Post-Bronchoscopy Sputum Examination in Screening for Active Tuberculosis.

Early diagnosis is a fundamental component of global tuberculosis control. The objective of this study was to evaluate the diagnostic yield of post-bronchoscopy sputum (PBS) testing as part of a tuberculosis diagnostic work-up. All new residents in the State of Qatar undergo a tuberculosis (TB) screening program. Those with abnormal chest radiology, negative sputum acid-fast bacilli (AFB) smears, and nucleic acid amplification testing (NAAT) for M. tuberculosis, undergo an additional bronchoscopic evaluation for TB. We prospectively enrolled individuals who were going to undergo bronchoscopy to provide two PBS samples for AFB smears and mycobacterial cultures between 18 September 2018 and 12 March 2021. A total of 495 individuals, with a median age of 31 years, were included. The majority of the patients were males (329, 66.5%). The most frequent country of origin was India (131, 26.5%) followed by the Philippines (123, 24.8%). The addition of PBS to bronchoalveolar lavage (BAL) testing allowed microbiological confirmation of tuberculosis in an additional 13 patients (3.9%), resulting in improved sensitivity (from 77.9% to 81.9%), negative predictive value (from 69.2% to 73.2%), and negative likelihood ratio (from 0.22 to 0.18). Where resources are available, the incorporation of routine PBS examination as part of tuberculosis diagnostic work-up can enhance the diagnostic yield.

Frequency of Acute Kidney Injury in Patient Receiving Piperacillin - Tazobactam: A Hospital-based Study from Qatar.

BACKGROUND: several studies have been reported piperacillin-tazobactam (TAZ / PIPC)-associated AKI with various frequencies. The aim of this study was to determine the frequency of TAZ/PIPC- associated AKI among our patients and to identify the risk factors for this clinical entity. METHODS: this retrospective cross-sectional study was conducted at Hamad General Hospital; it involved adult patients who were admitted from January 2017 to December 2017. RESULTS: we involved 917 patients, of whom 635 (69.25%) were males and 282 (30.75%) were females. The mean age of the patients was 52 (SD 19) years, and 98 (10.7%) patients were diagnosed with AKI. The patients with AKI were significantly older than without AKI [59.71 (SD 19.79) versus 51.06 (SD 18.67); P <0.001]. After TAZ/PIPC initiation, the mean creatinine level in the AKI group was higher than the mean creatinine level in the non-AKI group, [158.91 (SD 81.93) versus 66.78 (SD 21.42); P<001]. The mean time of onset of AKI after PIPC/TAZ initiation was 4.46 (SD 3.20) (1-12 days). AKI was significantly associated with low mean serum albumin (P<0.001), high mean fasting blood glucose (P<0.001), coronary artery diseases (P<0.001), heart failure (P<0.001), liver diseases (P=0.047), diabetes mellitus (P=0.021) and hypertension (P<0.001). The in-hospital mortality was significantly higher in the AKI group [38.78% versus 5.13% in the non-AKI group; P<0.001], and only advanced age and heart failure were found as independent risk factors for TAZ/PIPC-associated AKI. CONCLUSION: TAZ/PIPC was significantly associated with AKI. Advanced age and heart failure were identified as independent risk factors for TAZ/PIPC-associated AKI.

SGLT-2 inhibitors associated euglycemic and hyperglycemic DKA in a multicentric cohort.

Euglycemic diabetic ketoacidosis (EuDKA) secondary to Sodium-glucose co-transporter-2 inhibitors (SGLT2i) in type 2 diabetes mellitus (T2D) is a rare but increasingly reported phenomenon. Not much is known about the burden of EuDKA in patients on SGLT2i or the associated factors. This retrospective cohort study tries to delineate the differences in factors associated with the development of EuDKA as compared to hyperglycemic DKA. We conducted a multicentre, retrospective study across three tertiary care centers under Weill Cornell affiliated-Hamad Medical Corporation, Qatar. The cohort comprised of T2D patients on SGLT2i who developed DKA between January 2015 to December 2020. The differences between the subjects who developed EuDKA or hyperglycaemic DKA (hDKA) were analyzed. A total of 9940 T2D patients were on SGLT2i during 2015-2020, out of which 43 developed DKA (0.43%). 25 developed EuKDA, whereas 18 had hDKA. The point prevalence of EuDKA in our cohort was 58.1%. EuDKA was most common in patients using canagliflozin, followed by empagliflozin and Dapagliflozin (100%, 77%, and 48.3%, respectively). Overall, infection (32.6%) was the most common trigger for DKA, followed by insulin non-compliance (13.7%). Infection was the only risk factor with a significant point estimate between the two groups, being more common in hDKA patients (p-value 0.006, RR 2.53, 95% CI 1.07-5.98). Canagliflozin had the strongest association with the development of EuDKA and was associated with the highest medical intensive care unit (MICU) admission rates (66.6%). In T2D patients on SGLT2i, infection is probably associated with an increased risk of developing EuDKA. The differential role of individual SGLT2i analogs is less clear and will need exploration by more extensive prospective studies.

Pleural Effusion Revealing a Diagnosis of Ewing Sarcoma.

Pleural effusion can rarely present as an initial manifestation of Ewing sarcoma. We illustrate a case of a young male adult who was admitted with pleural effusion that led to the diagnosis of Ewing sarcoma.

Can COVID 19 present like appendicitis?

Coronavirus disease -19 is a novel pandemic contagious respiratory infection that frequently presents with fever and dry cough. However, it can present with other rare symptoms. As this disease is a new disease, the full picture of the disease presentation is not yet clear, and it might present with symptoms and signs of other common diseases. Here, we report a 40 year old female who presented with acute onset nausea, vomiting, loss of appetite and vague abdominal pain as a clinical picture of appendicitis, but her CT abdomen image showed normal appendix, bilateral patchy peripheral lung basal consolidation, and ground-glass attenuation, so she was tested for coronavirus disease-19, which was positive.

Parathyroid Adenoma as a Rare Cause of Persistent Hypercalcemia in a Female with Polycythemia Vera.

Polycythemia vera is one of the myeloproliferative neoplasms that is distinguished by the uncontrolled production of blood cells and an increased red cell mass due to acquired JAK2 mutation. It has many complications and it might increase the risk of other tumors. However, it does not cause hypercalcemia and is rarely associated with parathyroid adenoma. Here, we report on a 64-year-old female with polycythemia vera found to have hypercalcemia due to parathyroid adenoma.

Confirmed Coronavirus Disease-19 (COVID-19) in a Male with Chronic Myeloid Leukemia Complicated by Febrile Neutropenia and Acute Respiratory Distress Syndrome.

Coronavirus disease-19 is a respiratory viral disease that commonly presents with mild symptoms. However, it can cause serious complications such as acute respiratory disease, especially in patients with comorbidities. As it is a new disease, the full picture of the disease and its complications are not yet fully understood. Moreover, the patients at risk of complications are not well identified; and the data about the risk in patients with hematological malignancies is limited. Here, we report a 65-year-old male with accelerated phase chronic myeloid leukemia, on dasatinib, tested positive for coronavirus disease-19, then complicated with febrile neutropenia acute respiratory distress syndrome.

Primary Bone Lymphoma in Axial Skeleton in a Middle-Aged Female Presented as Recurrent Anemia.

Primary bone lymphoma (PBL) is a peculiar extranodal presentation of non-Hodgkin's lymphoma. Primary bone diffuse large B-cell lymphoma (DLBCL) is the most common pathological type, comprising about 80% of PBL. The diagnosis of PBL depends on the combined clinical examination and imaging studies and is confirmed with immunohistochemical examination. Due to the rarity of this disease, more relative studies and case reports are needed to provide insight into this obscure lymphoproliferative malignancy. Here, we report one rare case of primary bone DLBCL involving the axial skeleton in a 37-year-old female.