Lobular capillary hemangioma post-chemotherapy for T-cell leukemia treated with an antibiotic: a case report.

Background: Lobular capillary hemangioma, also known as pyogenic granuloma (PG), is a relatively common benign rapidly growing friable vascular tumor of the skin and mucus membranes. Although the exact pathogenesis of PG is unknown, many theories discussed the potential of an angiogenic stimulus and an imbalance of inducers and inhibitors triggering the hyperplastic and neovascular response. The most frequently used modality for treatment of PG is surgical treatment. The proposed case represents an unexpected evolution to a possible therapeutic measure. Case Description: We represent a case of a 32-year-old male, known to have T-cell acute lymphoblastic leukemia treated successfully with chemotherapy, currently maintained on methotrexate (MTX) 40 mg and 6-mercaptopurine, 100 mg, presented with 1-month history of painful rapidly growing ulcerated nodules on his right-hand palm and middle finger. Both skin lesions developed approximately 3 months following patient initiation of maintenance treatment. Physical examination revealed two crusted nodules. A proximal lesion was observed over the palmar aspect between the second and third fingers, with the other one occurring alongside the distal phalanx of the third finger, measuring 2.5 cm × 1.5 cm, and 2.5 cm × 3.5 cm respectively. Skin biopsy was obtained from both lesions. The results of the histologic examination both revealed inflamed PG. Tissue cultures of both specimens tested positive for Pseudomonas aeruginosa growth while no fungal and tuberculosis were cultured. Ciprofloxacin 500 mg twice daily, a 2-week course was started. Both lesions completely resolved at 10th-day of antibiotic course with no recurrence. Conclusions: This is a case of a patient with lobular capillary hemangioma of the hand treated successfully with no recurrence using an oral antibiotic. The proposed case represents an unexpected evolution to a possible therapeutic measure. The unexpected role of a conservative measure rather than the conventional surgical method in treating vascular tumors has been highlighted. Moreover, the contribution to an excellent cosmetic outcome has also been demonstrated.

Exploring pH levels and environmental impacts on handwash products in Riyadh, Saudi Arabia: A cross-sectional study.

Background: The human skin, with a pH of 4 to 6, serves as a barrier against external pathogens. Alkaline handwash products (HWPs) can compromise this barrier and are widely used following the Coronavirus disease-2019 (COVID-19) pandemic. This study aims to determine the pH of a sample of HWPs in Riyadh, Saudi Arabia, and assess the effect of environmental factors on their pH. Methods: This is a cross-sectional, descriptive, observational study carried out in Riyadh, Saudi Arabia. The study involved a convenience sample of 33 liquid soaps, soap bars, and synthetic detergents (Syndets) from various brands. The pH of the handwash products was measured using laboratory-validated techniques. Data analysis was conducted using RStudio 2022 software. Results: Of the HWPs, 16 (48.5%) had a highly alkaline pH (≥10), while 14 (42.4%) had an acidic pH (4.0-6.9). Most liquid soaps were acidic (84.6%), with a mean pH of 5.9, whereas soap bars had a mean pH of 10.3. Syndets had a mean pH of 6.0. Conclusions: On average, liquid soaps and syndets offered a more physiological pH than soap bars. Liquid soaps were more affordable than synthetic detergents, making them a better value option among the three types of HWPs. Environmental factors such as exposure to hot weather did not have a significant impact on HWPs.

Generalized morphea induced by the COVID-19 vaccine in a patient with chronic urticaria.

Adverse events following vaccinations have been noted for centuries, but as of recently, discussions concerning these adverse effects have increased due to the COVID-19 pandemic and the consequent delivery of vaccinations. Through presenting new cases of such adverse events and reviewing the literature, we aim to facilitate the recognition of COVID-19 vaccine-induced autoimmune diseases that may occur in the years after the pandemic has been contained. We report on a case of biopsy-proven morphea after the COVID-19 vaccine, in which case the patient developed diffuse skin lesions all over her body. The patient was known to have chronic urticaria and received two doses of the Pfizer-BioNTech COVID-19 vaccines (BioNTech, Fosun Pharma, Pfizer, New York City, USA). The patient started to notice itchy lesions on her arms two months after taking her second dose of the vaccine. This is the first case reported of generalized morphea following COVID-19 vaccination with another autoimmune disease and represents the first case of generalized morphea reported in the Middle East.

UPLC‒ESI‒MS/MS profiling of active polyphenolics in Morinda coreia leaf extract and in vitro antioxidant and antibacterial activity.

In this study, aqueous and methanol extracts of Morinda coreia (MC) leaves were tested for antioxidant and antibacterial activity under in vitro conditions. Phytochemical analysis using UPLC-ESI-MS revealed the presence of phenolics, flavonoids, alkaloids, glycosides, amino acids, proteins, saponins, and tannins. Under in vitro conditions, antioxidant test using DPPH, ABTS, and reducing power demonstrated that the plant leaves play a crucial role in antioxidant activity compared to the commercial antioxidant butylated hydroxytoluene (BHT). The ABTS and DPPH free radical scavenging activities showed that the IC50 values of the M. coreia methanol extract were 26.35 µg/mL and 200.23 µg/mL, respectively. The methanol extract of M. coreia contained higher levels of total phenols and flavonoids and higher free radical scavenging capacity than the aqueous extract. FTIR analysis of the methanol extract showed a substantial number of phenols in the functional groups of M. coreia leaves. The well diffusion assay using the methanolic extract of M. coreia (200 µg/mL) leaves showed antibacterial activity against Pseudomonas aeruginosa (19 ± 0.85 mm), Proteus sp. (20 ± 0.97 mm), Streptococcus sp. (21 ± 1.29 mm), and Enterobacter sp. (17 ± 0.2 mm). Thus, the present study revealed that the antibacterial and antioxidant activity of M. coreia leaf extract was due to the presence of 18 unknown and 15 primary known polyphenols.

Cochlear Implant Induced Labyrinthine Ossificans in Mondini Malformation: A Case Series.

Cochlear implantation is relatively a safe procedure with a favorable outcome. Labyrinthine ossification is one of the rare complications that has been observed in some occasions post-cochlear implantation. This paper report two cases of Mondini inner ear malformation cochlear implant failure associated with labyrinthine ossification, mandating revision surgery, and a literature review focusing on the reported cases, risk factors, surgical and non-surgical measures to mitigate this complication and to improve overall cochlear implant outcomes.

Hearing loss among patients with type 2 diabetes mellitus: a cross-sectional study.

BACKGROUND: Hearing loss is an underestimated comorbid condition in type 2 diabetes. OBJECTIVES: Investigate hearing loss as a comorbidity associated with type 2 diabetes mellitus and evaluate the factors associated with hearing loss. DESIGN: Cross-sectional. SETTING: Tertiary care center, diabetes clinic. PATIENTS AND METHODS: Patients with type 2 diabetes, aged 30 to 60 years, were randomly selected to participate. All patients underwent clinical ear examinations and were referred for full audiological evaluation. Otoacoustic emission was used to assess inner function, tympanometry to assess middle-ear function, and pure tone air/bone audiometry to assess hearing sensitivity. Risk factors for hearing loss were assessed by multivariate logistic regression. MAIN OUTCOME MEASURE: Frequency, severity and risk factors for hearing loss. SAMPLE SIZE: 157 RESULTS: Of the 157 patients, 77 had hearing loss in both ears (49.0%), 13 in the right ear only (8.3%), 14 in the left ear only (8.9%), and 53 (33.8%) had normal hearing. In the 181 ears with sensorineural hearing loss, 90 had mild loss (49.7%), 69 moderate loss (38.2%), 16 severe loss (8.8%) and 6 had profound loss (3.3%). Disabling hearing loss was observed in 46 (29%) patients. A higher frequency of hearing loss was present in patients with glycated hemoglobin levels ≥8%. In the multivariate logistic regression analysis, the most important factors associated with hearing loss were longer diabetes duration, poor glycemic control and the presence of hypertension. CONCLUSIONS: Hearing loss is an underestimated comorbid condition in type 2 diabetes that warrants frequent hearing assessments and management. Strict glycemic and hypertension control is essential for the minimization of the effects of diabetes on hearing sensitivity. LIMITATIONS: Small sample size, limited age window (30-60 years), which was chosen to eliminate the natural aging effect on hearing. Cross-sectional nature was not ideal for the assessment of causality. CONFLICT OF INTEREST: None.

Prevalence of Alopecia Areata in Saudi Arabia: Cross-Sectional Descriptive Study.

Background Alopecia areata (AA) is a common autoimmune disorder worldwide that affects the hair. Population differences have been observed in disease prevalence and clinical features, but no studies have examined AA prevalence at a large scale. In Saudi Arabia, information is lacking about AA characteristics. Objectives A quantitative, observational, cross-sectional study was conducted to assess AA prevalence, characteristics, and gender differences in Saudi Arabia. Materials and methods The study has used a validated Arabic questionnaire that targeted Saudi Arabia residents with a history of AA. A validated Arabic questionnaire was used to target Saudi Arabia residents with a history of AA, and the data collection instrument and written informed consent were distributed on Twitter and Facebook after permission from the Institutional Review Board. Prior to the study, accuracy validation for correct diagnosis by participants was performed in a 50-volunteer pilot test, which indicated an acceptable level of 96% accuracy. The questionnaire included high-quality images of different AA types and the collected data focused on variables such as the age of onset, affected body parts, treatment type, and family history of AA. Results A total of 5,362 participants returned completed questionnaires, of whom 741 (13.8%) had experienced AA at least once in their lives. Most were aged 11-30 years (69%), and the mean age of diagnosis was 18.6 years. Thirty-six percent (36%) of those with AA reported having a first-degree relative with the disease, and cross-sectional prevalence was 5.2%. Three-hundred fifty-nine (359; 18.9%) males and 382 (11%) females had AA. Twenty-nine point four percent (29.4%) of AA patients recovered in less than three months of AA onset, and 59.4% recovered in less than one year. Conclusion AA prevalence in Saudi Arabia is higher than in Western countries with a lower age of onset than in the former. AA affected males more than females and the mean age of onset was lower in the latter. Both male gender and young age of onset implied a worse prognosis.

Comorbid psychiatric disorders among patients with narcolepsy.

PURPOSE: This case-control study assessed the prevalence of psychiatric disorders in Arab (Saudi) patients with narcolepsy using a structured clinical interview. METHODS: The study included 74 adult patients with narcolepsy and 265 controls matched for age and sex. Narcolepsy diagnosis was made according to the International Classification of Sleep Disorders-Third Edition. Psychiatric disorders were diagnosed via using a validated Arabic version of the Mini International Neuropsychiatric Interview DSM-IV (MINI version 6). A multivariate logistic regression model was used to assess the potential influence of narcolepsy on the comorbidity of psychiatric disorders. RESULTS: The mean age of the patients was 29.4 ± 10.2 years, and males accounted for 81% of the study sample. Forty-four patients (60%) were diagnosed with narcolepsy type-1 (NT1) and 30 (40%) with narcolepsy type-2 (NT2). Psychiatric disorders were diagnosed in 45% of patients with narcolepsy compared with 15% of the controls (p < 0.001). The multivariate logistic regression models demonstrated that compared with the controls, patients with narcolepsy were more likely to have major depressive disorders (OR, 4.3 [CI, 2.2-8.2]), and generalized anxiety disorders (OR, 9.5 [CI, 1.8-50.2]). No difference was detected between the prevalence of various psychiatric disorders in patients with NT1 and NT2. CONCLUSION: Comorbid psychiatric disorders are common among Arab (Saudi) patients with narcolepsy compared with the general population. Therefore, clinicians should be aware of the comorbidity of narcolepsy and psychiatric disorders, particularly depression.