Giant Coronary Artery Aneurysms Presenting As Posterior Myocardial Infarction.

A coronary artery aneurysm (CAA) is defined as the dilatation of a vessel with a diameter of ≥1.5 times that of the adjacent normal vessel. Occasionally, aneurysms can be large enough to be characterized as giant CAAs, but there is no universally accepted definition. We discuss the case of a 45-year-old male patient who presented to the hospital with substernal chest pain. His ECG revealed ST depression and T wave inversions in precordial leads. Cardiac biomarkers were within normal limits. Due to concerns about coronary artery disease, cardiac catheterization was done, which revealed CAAs in the distribution of the right coronary artery (RCA), left anterior descending (LAD) and left circumflex (LCX) artery. The patient was at high risk for surgical intervention given coexisting severe pulmonary hypertension. Therefore, medical treatment was initiated with beta-blockers, high-intensity statin, and anticoagulation with warfarin. In a two-month follow-up, the patient remained asymptomatic without any residual symptoms. A CAA can present as an acute coronary syndrome. The treatment still evolves, involving medical management and/or percutaneous or surgical interventions.

Risk of Thromboembolism With Eltrombopag: A Case Report of Deep Vein Thrombosis and Bilateral Pulmonary Embolism.

Eltrombopag is a second-line therapy for refractory thrombocytopenia from immune thrombocytopenic purpura (ITP). The medication is generally well tolerated but can lead to adverse thromboembolic complications in rare instances. We present a case of lower extremity deep vein thrombosis with bilateral pulmonary embolism in an ITP patient receiving eltrombopag. The patient underwent catheter-directed thrombolysis for pulmonary embolism. Eltrombopag was stopped on discharge, considering the potential cause of venous thrombosis.

Prevalence of Musculoskeletal Disorders among General and Technical Secondary School Students in Egypt.

(1) Background: Children spend a lot of time within schools. The school setting generally has many ergonomic hazards and reinforced behavior patterns which put children at greater risk of environmental hazards than adults during their critical developmental stages. (2) Objective: The aim of the current study was to investigate the prevalence of musculoskeletal disorders (MSDs) and detect spinal deformities amongst general and technical secondary school students. (3) Methods: A total of 418 students from the second grade of secondary school in Shaquira governorate, Egypt participated in this cross-sectional study. Each student in the study was screened via Nordic Musculoskeletal Questionnaire (NMQ) and had their upper limb posture measured via RULA (Rapid Upper Limb assessment), and the deviation in their thoracic curve was measured using a scoliometer. (4) Results: There was a prevalence of MSDs amongst students as there were 69.7% of general school students and 83.8% of the technical school students suffering from MSDs with a statistically significant difference between both technical and general school students in RULA score and musculoskeletal complaints, whereas there were non-statistical differences in the scoliometer scale in both general and technical education students. (5) Conclusions: Musculoskeletal problems are prevalent among Egyptian secondary school students, with higher prevalence between technical school students. Therefore, preventive measures and strategies are recommended to overcome the future complications of these musculoskeletal disorders.

Sarcoid-like reaction: a unique response to immunotherapy in malignant melanoma.

In recent years, immunotherapy has revolutionised the treatment landscape for oncology patients with improved survival rates in cancers which previously had a dismissal prognosis. These agents target specific pathways of inhibition such as programmed cell death -1 (PD-1), PD ligand-1 and cytotoxic T-lymphocyte-associated antigen 4 resulting in stimulation of T cell activity. This results in enabling an individual's own immune system to fight against cancer, a different modality of treatment when compared with traditional chemotherapy. While attacking the tumour cells, there is an increased chance of host tissue immune reactions.We report a case of a patient who received immunotherapy for metastatic malignant melanoma. During the course of the treatment, development of a sarcoid-like reaction was histologically confirmed in the mediastinal lymph nodes. The patient had no respiratory symptoms and continued on the immunotherapy treatment with good clinical and radiological response.