Fibrous Pericardial Mass Signifying the Importance of Advanced Cardiovascular Imaging: A Case Report.

Background: Pericardial masses are an extremely rare group of diseases which can be classified based on etiology. The presentation of pericardial masses varies considerably from one individual to another, ranging from an asymptomatic presentation with an incidental finding on imaging, to presenting with non-specific signs and symptoms. Due to the enigmatic nature and presentation of pericardial masses, diagnostic imaging is mandatory. Case Presentation: A 69-year-old patient presented to our cardiology clinic complaining of intermittent shortness of breath upon moderate exertion in the absence of chest pain, paroxysmal nocturnal dyspnea, orthopnea, dizziness, palpitations, or lower limb edema. The patient's past medical history was significant because of his history of pericarditis associated with pericardial effusion 6 years prior to presentation at our clinic. Despite adequate medical treatment, the patient complained of a relapsing and remitting pattern of symptoms that mandated the performance of advanced cardiovascular imaging, namely, cardiac magnetic resonance imaging, which revealed the presence of a profound pericardial mass. Conclusion: Despite the fact that relapsing pericarditis is a well-established complication following acute pericarditis, the presentation of a complication such as a fibrous pericardial mass evident on cardiac MRI has essentially been unreported in the literature previously.

From Diabetes to Oncology: Glucagon-like Peptide-1 (GLP-1) Receptor Agonist's Dual Role in Prostate Cancer.

Glucagon-like peptide-1 (GLP-1), an incretin hormone renowned for its role in post-meal blood sugar regulation and glucose-dependent insulin secretion, has gained attention as a novel treatment for diabetes through GLP-1 receptor agonists (GLP-1-RA). Despite their efficacy, concerns have been raised regarding the potential associations between GLP-1-RA and certain malignancies, including medullary thyroid cancer. However, evidence of its association with prostate cancer (PCa) remains inconclusive. This review delves into the intricate relationship between GLP-1-RA and PCa, exploring the mechanisms through which GLP-1-Rs may impact PCa cells. We discuss the potential pathways involving cAMP, ERK, AMPK, mTOR, and P27. Furthermore, we underscore the imperative for additional research to elucidate the impact of GLP-1-RA treatment on PCa progression, patient outcomes, and potential interactions with existing therapies. Translational studies and clinical trials are crucial for a comprehensive understanding of the role of GLP-1-RA in PCa management.

Gender inequality in genitourinary malignancies clinical trials leadership.

BACKGROUND: Over the past 2 decades, there has been a growing interest in the significance of gender roles in healthcare and several efforts and initiatives have focused on increasing female representation in the medical field. Clinical trials play a very important role in shaping medical practice; moreover, the leaders of clinical trials often represent the upper echelon of researchers in any designated field. Presently, there is no data regarding women's representation in urological oncology clinical trials leadership. Therefore, the aim of this study is to examine the extent of female representation in leading urological clinical trials. METHODOLOGY: To thoroughly examine the representation of females as principal investigators (PIs) in urological cancer clinical trials between 2000 and 2020, we conducted a comprehensive search of completed trials focused on kidney, prostate, and bladder cancer on ClinicalTrials.gov. We extracted relevant information regarding the PIs and analyzed the data using univariate analyses to identify any significant differences between male and female PIs. RESULTS: A total of 9145 cancer clinical trials were conducted over the last 2 decades, and 11.3% (n = 1033) of them were urological cancer clinical trials. We were able to obtain detailed information about the principal investigators (PI) in 79.0% (n = 816) of the clinical trials, and we found that 16.8% (n = 137) of them were led by female investigators. Upon evaluating the characteristics of the PIs, female PIs had a significantly lower median age and median total citations as compared to male PIs (55.0 vs 59.0 and 5333 vs 7902; p-value < 0.001 and 0.006, respectively). However, there was no statistically significant difference between the termination rate, publication rate, funding source, cancer type, and the subject of conducting the clinical trials between male and female PIs. CONCLUSION: Between 2000 and 2020, only 16.8% of urological cancer clinical trials were led by a female PI, perhaps reflective of a low percentage of senior female researchers in the fields of urology, oncology and radiation oncology. Universities, research institutes and funding agencies should work to improve mentorship, representation and opportunities for female investigators to encourage more involvement for female researchers in these clinical trials.

The Risk of Developing Osteosarcoma After Teriparatide Use: A Systematic Review.

Teriparatide is a recombinant human parathyroid hormone analog with anabolic mechanism of action utilized in the treatment of osteoporosis with well-established clinical efficacy. Its use is significantly hindered due to label warnings resulting from pre-clinical rat studies demonstrating an increased risk of osteosarcoma. However, clinical trials and post-marketing surveillance studies did not demonstrate any increased risk of osteosarcoma, even after prolonged periods of surveillance reaching up to 15 years, with most of the identified cases of osteosarcomas being solitary and predominantly attributed to other factors. This systematic review provides a comprehensive overview of the currently available literature and provides the highest level of clinical evidence towards demonstrating the lack of any substantial evidence towards osteosarcoma development in patients utilizing TPTD.

Comparing the characteristics of positional and nonpositional sleep apnea patients among the Jordanian population.

BACKGROUND: Obstructive sleep apnea (OSA) is a common cause of sleep-disordered breathing with a large proportion of the patients exhibiting positional OSA (POSA). In this study, we aimed to evaluate the differences in the demographics, comorbidities, and polysomnographic features between POSA and non-POSA (NPOSA) in a Jordanian sample to further discern the propulsive elements for each group. METHODS: In this study, we evaluated 1037 adult patients with OSA. POSA was defined as an overall apnea and hypopnea index (AHI) >5, an overall AHI severity at least 1.4 times the nonsupine severity (overall/NS-AHI), and a minimum amount of time (i.e., 20 min) in the supine and nonsupine positions. To compare the clinical characteristics between POSA and NPOSA patients, statistical analyses were performed. RESULTS: The prevalence of POSA was 41.7%. In comparison to NPOSA patients, POSA patients had higher female sex prevalence, milder OSA, lower body mass index, lower hypertension prevalence, and lower hemoglobin A1C levels compared to NPOSA patients. Moreover, sleep efficiency, total sleep time, and supine sleep time were significantly higher in POSA patients. Nonsupine sleep time, total AHI, rapid eye movement (REM) AHI, non-REM (NREM) AHI, supine AHI, nonsupine AHI, left and right AHI, mean oxyhemoglobin saturation (SpO2) awake, mean REM and NREM SpO2, SpO2 nadir, and time SpO2 below 90% were significantly lower among POSA patients. The multivariate regression analysis showed that only female gender and hypertension were significantly associated with POSA. CONCLUSION: POSA is common among OSA patients and demonstrates different clinical characteristics in comparison to NPOSA. Future prospective studies are needed to better characterize the POSA patients and investigate the benefit of positional therapy.

Surgical Management of Aneurysmal Bone Cyst of the Pubis: A Case Report and Review of Literature.

Introduction: Aneurysmal bone cysts (ABC) are expansile, lytic, and benign but locally aggressive lesions. Pelvic ABCs are rare and sometimes difficult to manage surgically. Case Report: A 17-year-old female presented with progressive pain and swelling in the right inguinal region. Pelvis radiograph showed a lytic expansile lesion of the superior pubic ramus. A multiloculated cystic lesion was evident on magnetic resonance imaging, and postoperative histopathological evaluation confirmed the diagnosis of ABC. The patient was treated successfully with an intralesional curettage and bone grafting. The postoperative course was uncomplicated with complete healing and no recurrence after 14 months of follow-up. Conclusion: ABC of the pubic ramus is a rare entity. Complete intralesional curettage and bone grafting is an effective treatment for pubic ABC. An individualized management approach considering the surgical team expertise, tumor size, and proximity to neighboring structures is recommended. .

Generation of a human induced pluripotent stem cell (iPSC) line (JUCTCi019-A) from a patient with Charcot-Marie-Tooth disease type 2A2 (CMT2A2) due to a heterozygous missense substitution c.2119C > T (p.Arg707Trp) in MFN2 gene.

Charcot-Marie-Tooth disease (CMT) is an inherited neurological disorder characterized by the progressive damage of the peripheral nerves. We generated a human induced pluripotent stem cell (iPSC) line JUCTCi019-A using dermal fibroblasts-derived from a 50-year-old CMT2A2 patient carrying a heterozygous missense substitution c.2119C > T (p.Arg707Trp) in the MFN2 gene. Fibroblasts were reprogrammed by Sendai viruses encoding for the reprogramming factors: OCT4, SOX2, KLF4 and c-MYC. Characterization showed normal iPSC morphology and karyotype, expression of pluripotency markers and differentiation into three-germ layers. This iPSC line represents an ideal source for disease modelling and drug development of CMT2A2 disease.

Does Red Cell Distribution Width Predict Hip Fracture Mortality Among the Arab Population? A Single-Center Retrospective Cohort Study.

BACKGROUND: Hip fractures impose significant morbidity and mortality. Red cell distribution width (RDW) appears to be an emerging tool in predicting mortality following hip fractures. Several factors can influence the RDW value including genetic factors and ethnicity. The purpose of the study was to assess the relation between RDW level at admission and hip fracture mortality within 6 months among Arab/Middle East populations. METHODS: We conducted a single-center retrospective cohort study including 549 patients (274 female and 275 male) diagnosed with a hip fracture undergoing surgery from February 2016 to December 2019. All included patients shared the same country of origin which is Arab Middle East country. Statistical analysis, including binary regression, was performed to assess the relationship between RDW and mortality within 6 months of admission. Other predictors of mortality following hip fracture surgery were also assessed. RESULTS: The mean age was 76.42 (±9.19) years. Seventy (12.8%) of participants died within 6 months. No statistically significant association (P=0.053) between RDW level at admission and mortality within 6 months of surgery was found. Binary regression demonstrated that the only independent predictors of mortality were age (P= 0.003, odds ratio 1.048 with 95% CI 1.016 to 1.080) and male gender (P= 0.021, odds ratio 1.872 with 95% CI 1.100 to 3.185). CONCLUSION: Although the previous studies reported that RDW is one of the predictors of mortality in hip fracture patients, our study found no relation in the Arab population. This finding may confirm the influence of genetic factors and ethnicity on RDW value. We recommend further large-scale multicenter studies to solidly establish the relationship between RDW and hip fracture mortality among the Arab/Middle East population.

Cervical Myelopathy Due to Ochronosis: An Intraoperative Suspicion.

BACKGROUND Alkaptonuria (AKU) is a rare metabolic disease caused by a deficiency in homogentisic acid oxidase, which leads to the accumulation of homogentisic acid dark pigments in tissues such as bones, ligaments, and tendons. Long-term duration of this condition, termed ochronosis, can result in degenerative arthropathy involving the spine and large joints. CASE REPORT This report describes a 55-year-old Jordanian woman presenting with chronic neck and lower back pain. History, physical examination, and radiological imaging indicated cervical myelopathy and lumbar spine degeneration. Two-level anterior cervical discectomy and fusion was performed successfully. Intra-operatively, the cervical discs were observed to be black, suggesting a diagnosis of alkaptonuria, which was later confirmed by genetic testing. A detailed history and physical examination revealed the absence of classical features of AKU. CONCLUSIONS Intraoperative detection of black disc material suggests the need for further tests to diagnose AKU, especially in indolent patients who did not have classical clinical features. Surgical management may improve outcomes in patients with cervical myelopathy due to ochronosis.