An infrequent case of adult nasopharynx rhabdomyosarcoma with bony involvement: A case report.

Rhabdomyosarcoma is a rare and highly aggressive malignancy arising from the striated skeletal muscle fibre. It is commonly a childhood tumour and rarely seen in adults. The most predominant part commonly involved is head and neck. We are reporting a rare case of a 54 year old adult male with Rhabdomyosarcoma of nasopharynx with a non specific presentation of weight loss for past four months, fever, a perianal abscess and backache since 10 days. The haematological and biochemical parameters were within normal limits however C reactive protein and erythrocyte sedimentation rate were raised. An MRI for the pelvis, which was done for the extension of perianal abscess, also displayed some heterogeneous marrow signal, which raised the suspicion of some infiltrative process. Later, a bone scan, PET scan, and a biopsy of the nasopharaynx was done. The biopsy confirmed the findings of Rhabdomyosarcoma by showing marked pleomorphism with strong positive desmin and myogin stain. The patient was then referred to the oncology department for further management.

LOW BONE MINERAL DENSITY AMONG PATIENTS WITH NEWLY DIAGNOSED RHEUMATOID ARTHRITIS.

BACKGROUND: Osteoporosis is an early and common feature in rheumatoid arthritis. Apart from other manifestations, Osteoporosis is an extra-articular manifestation of rheumatoid arthritis whichmay result in increased risk of fractures, morbidity mortality, and associated healthcare costs. This study evaluates bone mineral density changes in patients withrheumatoid arthritis of recent-onset. METHODS: This cross sectional descriptive study was conducted in the Rheumatology Department of a tertiary care hospital in Karachi. Data was collected from 76 patients presenting with seropositive or seronegative rheumatoid arthritis. Bone mineral density of these patients measured at lumbar spine and hip by using dual energy x-ray absorptiometrys can. Variables like age, gender, BMI, menstrual status, disease duration, erythrocyte sedimentation rate, vitamin D level, clinical disease activity index and seropositivity for rheumatoid arthritis were measured along with outcome variables. RESULTS: A total of 104 patients fulfilling inclusion criteria were registered with 28 excluded from study. A mong the remaining 76 patients, 68 (89.50%) were female, with mean age of patients (with low bone mineral density) as 50.95 ± 7.87 years. Nineteen (25%) patients had low bone mineral density, 68.52% had low BMD at spine while 10.52% at hip and 21.05% at spine and hip both. Low bone mineral density was found higher in patients with seronegative 7 (50%) as compared to seropositive patients 12 (19.4%) (p-value 0.017), whereas low bone mineral d ensity was found higher 12 (70.6%) among post-menopausal women. CONCLUSION: Low BMD was found in 25% of patients at earlier stage of the rheumatoid arthritis with seropositivity, age and menopausal status as significant risk factors.

Axial Spondyloarthritis In Patients With Chronic Backache Using Assessment Of Spondyloarthritis International Society Criteria For Axial Spondyloarthritis.

BACKGROUND: Low back pain (LBP) is considered as one of the most frequent health problems which is responsible for forming a huge worldwide burden. This study was conducted with the aim to determine the frequency of axial-Spondyloarthropathy (axSpA) in patients presenting with chronic backache using Assessment of Spondyloarthritis International Society (ASAS) Criteria for axSpA. METHODS: A total of 231 participants of either gender were enrolled with complaint of backache of more than or equal to 3 months duration and younger than 45 years. In the first stage, patients were interviewed and examined using standard questionnaire. In the second stage after going through laboratory investigations and imaging patients were classified into either axSpA (those meeting ASAS Criteria for axSpA) or non-SpA. RESULTS: There were 65 males and 166 females. Mean age was 36.26 years. Eighty-nine (39%) patients were found to have axSpA as per ASAS Criteria. Majority of patients 70 (78.6%) in the imaging arm of ASAS Criteria were picked via MRI of sacroiliac joints. Peripheral arthritis was seen in 57 (64%) and Enthesitis in 52 (58.4%). CONCLUSIONS: MRI performed exceptionally to reveal sacroiliitis highlighting the importance of this imaging modality in axSpA, which we recommend to be included in diagnostic algorithm in evaluating patients with chronic backache under 45 years age.