Familial Adenomatous Polyposis (FAP) Presenting as Iron Deficiency Anemia in a 33-Year-Old Female: A Case Report.

Iron deficiency anemia is a common clinical concern in women of reproductive age. It presents as microcytic anemia and can be due to a limited number of causes including bleeding, malabsorption, intravascular hemolysis, or a mechanical heart valve. Familial adenomatous polyposis (FAP) is an inherited autosomal dominant disorder due to mutation in the adenomatous polyposis coli (APC) gene that can cause iron deficiency anemia due to GI malignancy, most notably colon cancer. Variation of mutations within the APC gene can cause different forms of FAP, such as Gardner syndrome. This syndrome presents with epidermoid cysts typically in unconventional locations such as the face, scalp, and extremities, as seen in our patient. We report a presentation of FAP in a 33-year-old Caucasian female who initially presented with iron deficiency anemia, hematochezia, and weight loss. Colonoscopy revealed hundreds of polyps within the colon, with two that were biopsied and reported as tubulovillous adenoma. The patient underwent a robotically assisted laparoscopic total proctocolectomy with ileal pouch-anal anastomosis, as well as a diverting loop ileostomy, and was given pain medication. She was referred to genetic counseling for her daughters and herself, which revealed a pathogenic variance in the APC gene.

Shrinkage estimation applied to a semi-nonparametric regression model.

Stein-type shrinkage techniques are applied to the parametric components of a semi-nonparametric regression model recently proposed by (Ma et al. 2015: 285-303). On the basis of an uncertain prior information (restrictions) about the parameters of interest, shrinkage techniques are shown to improve the accuracy of the model. The effectiveness of the proposed estimators are corroborated by a simulation study.

Arachnoid Cyst and Psychosis.

Few case reports discuss suspected psychiatric disturbances secondary to arachnoid cysts. To the best of our knowledge, psychosis from arachnoid cysts has not been reported in the recent literature. This case report discusses our experience with a 55-year-old male patient who manifested multiple psychotic episodes suspected in association with an arachnoid cyst. During the initial examinations, a computed tomography (CT) scan of his head revealed a relatively large left anterior superior arachnoid cyst with a mass effect on the frontal lobe. Despite multiple trials of combinations of mood stabilizers and psychotropic medications, the patient continued to deteriorate. We ordered a repeat CT of his head along with a magnetic resonance image and consulted a neurosurgeon for a possible surgical intervention. The neurosurgeon concluded that the patient's psychiatric symptoms were unrelated to the arachnoid cyst. While we were unable to determine the etiology of our patient's psychosis, we believe that the arachnoid cyst played at least some part, as evidenced by reports in the literature. Future advancements in radiological technology may allow for a better exploration of the causal relationship between psychiatric illnesses and brain lesions.

Acetazolamide: Treatment of Psychogenic Polydipsia.

We are reporting a case of psychogenic polydipsia from a State of Ohio psychiatric hospital. The patient has a known five-year history of psychogenic polydipsia with recurrent hyponatremia and has been diagnosed with schizoaffective disorder bipolar type 1, according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria, for the past two decades. There was a marked improvement with the use of acetazolamide, resulting in a decreased compulsion to drink fluid and improvement of his hyponatremia. The patient was observed for six months. We evaluated the water balance of the patient with diurnal weight measurements (DWG) and a weekly comprehensive metabolic panel (CMP) to monitor Na⁺ levels. His symptoms and hyponatremia were improved with acetazolamide. The treatment was well tolerated without any adverse effects and improved his quality of life.

Chronic obstructive pulmonary disease and low bone mass: A case-control study.

BACKGROUND AND OBJECTIVE: Low bone mass (osteopenia and osteoporosis) is one of the effects associated with chronic obstructive pulmonary disease (COPD). There is very little data from Saudi Arabia on COPD and low bone mass. This retrospective study was done to assess the prevalence of osteoporosis and osteopenia in COPD patients attending King Fahd Hospital of the University (KFHU), Alkhobar. PATIENTS AND METHODS: After obtaining the ethical approval from the research committee, all patients seen between at the King Fahd Hospital of the University between January 2010 and December 2012 were included. The inclusion criteria included a follow up of a minimum 2 years, and the Medical Records should have the details of forced expiratory volume in one second (FEV1), blood bone profile and bone biomarkers and dual-energy X-ray absorptiometry (DEXA) scan. Patients were labeled as osteopenia if the T score was -<1 to <-2.5 and osteoporosis of <-2.5 as per the WHO definition of osteopenia and osteoporosis. RESULTS: Seventy-three patients were being followed in the clinics and 49 patients satisfied the inclusion criteria. The average age was 60.6 ± 10.47 years; males were 43 and females 6. Three (6.1%) were normal and the remaining 46 (93.9%) were with low bone mass. Thirty-two (65.3%) were osteoporotic and 14 (28.57%) were osteopenic. The average duration of COPD was 4.5 ± 6.2 years. Majority (n = 36, 73.4%) of patients were in the Global Initiative for COPD (GOLD) class II and III. FEV1 was significantly lower in the patients with low bone mass 1.66 ± 0.60 versus 3.61 ± 0.58 (P < 0.001). CONCLUSIONS: Our study shows that over 90% of Saudi Arabian patients with COPD suffer from osteopenia and osteoporosis and unfortunately they remain under-diagnosed and undertreated.

Medication administration errors in Eastern Saudi Arabia.

OBJECTIVE: To assess the prevalence and characteristics of medication errors (ME) in patients admitted to King Fahd University Hospital, Alkhobar, Kingdom of Saudi Arabia. METHODS: Medication errors are documented by the nurses and physicians standard reporting forms (Hospital Based Incident Report). The study was carried out in King Fahd University Hospital, Alkhobar, Kingdom of Saudi Arabia and all the incident reports were collected during the period from January 2008 to December 2009. The incident reports were analyzed for age, gender, nationality, nursing unit, and time where ME was reported. The data were analyzed and the statistical significance differences between groups were determined by Student's t-test, and p-values of <0.05 using confidence interval of 95% were considered significant. RESULTS: There were 38 ME reported for the study period. The youngest patient was 5 days and the oldest 70 years. There were 31 Saudis, and 7 non-Saudi patients involved. The most common error was missed medication, which was seen in 15 (39.5%) patients. Over 15 (39.5%) of errors occurred in 2 units (pediatric medicine, and obstetrics and gynecology). Nineteen (50%) of the errors occurred during the 3-11 pm shift. CONCLUSION: Our study shows that the prevalence of ME in our institution is low, in comparison with the world literature. This could be due to under reporting of the errors, and we believe that ME reporting should be made less punitive so that ME can be studied and preventive measures implemented.