Differences in colorectal cancer awareness between screening eligible vs. ineligible Palestinians: a national cross-sectional study.

BACKGROUND: This study aimed to compare colorectal cancer (CRC) awareness between screening-eligible and ineligible individuals in Palestine. METHODS: Convenience sampling was utilized to recruit Palestinian adults from diverse settings, including hospitals, primary healthcare centers and public spaces across 11 governorates. The evaluation of CRC awareness in terms of signs/symptoms, risk factors and causation myths was conducted using Arabic-translated, modified versions of the validated instruments, the Bowel Cancer Awareness Measure and the Cancer Awareness Measure-Mythical Causes Scale. RESULTS: The final analysis included 2698 participants, with 2158 (80.9%) eligible for CRC screening and 540 (19.1%) ineligible for it. The most recognized CRC sign/symptom was 'lump in the abdomen' in both screening-eligible (n = 386, 71.5%) and ineligible (n = 1582, 73.3%) groups. 'Lack of physical activity' was the most recognized risk factor in both groups (eligible: n = 451, 83.5%; ineligible: n = 1766, 81.8%). The most reported causation myth in both groups was 'having a physical trauma' (eligible: n = 340, 63.0%; ineligible: n = 1353, 62.7%). In the screening-eligible group, only 210 participants (38.9%) demonstrated high awareness of CRC signs/symptoms, 213 participants (39.4%) showed high awareness of CRC risk factors and only 46 participants (8.5%) displayed high awareness of CRC causation myths. There were no significant associations between being eligible for screening colonoscopy and the awareness levels of CRC signs/symptoms, risk factors and causation myths. CONCLUSION: Overall, awareness levels of CRC signs/symptoms, risk factors and causation myths were notably low among screening-eligible participants. There were no differences in awareness levels between individuals eligible for colonoscopy and those who were not.

A rare case of obstructed hemivagina with uterus didelphys and ipsilateral renal anomaly syndrome.

Obstructed hemivagina and ipsilateral renal anomaly syndrome, also known as Herlyn-Werner-Wunderlich syndrome, represents a rare congenital anomaly characterized by the presence of an obstructed hemivagina with uterus didelphys and concomitant ipsilateral renal abnormalities. Typically, the clinical presentation includes cyclical abdominal pain, vaginal discharge, and/or a vaginal mass occurring post-menarche. Accurate diagnosis requires a high index of suspicion among clinicians, coupled with a comprehensive understanding of the distinctive features associated with this anomaly. Herein, we present the case of a 13-year-old female patient who complained of persistent lower abdominal pain. Magnetic resonance imaging confirmed the diagnosis of obstructed hemivagina and ipsilateral renal anomaly syndrome, and the patient was successfully treated with a laparotomy involving blood aspiration and hysterectomy. This case report highlights the significance of clinical awareness, prompt diagnosis, and timely therapeutic interventions to mitigate the adverse effects and optimize outcomes in individuals affected by obstructed hemivagina and ipsilateral renal anomaly syndrome.

Understanding the interplay of colorectal cancer awareness and attitudes among Palestinians: a national cross-sectional study.

BACKGROUND: In Palestine, colorectal cancer (CRC) is the second most common cause of cancer-related mortality after lung cancer. No studies have examined the relationship between CRC awareness and attitudes. This study aimed to investigate the interplay between CRC awareness and attitudes among the Palestinian population. METHODS: A nationwide cross-sectional survey was carried out between July 2019 and March 2020. Convenience sampling was used to collect data from hospitals, primary healthcare facilities, and public areas in 11 governorates. Modified, translated-into-Arabic versions of the validated Bowel Cancer Awareness Measure and Cancer Awareness Measure-Mythical Causes Scale were utilized to assess the awareness of CRC signs/symptoms, risk factors, and causation myths. The cumulative awareness score for each domain was computed and stratified into tertiles. The top tertile denoted 'high' awareness, while the remaining two tertiles denoted 'low' awareness. RESULTS: The final analysis included 4,623 participants; of whom, 3115 (67.4%) reported positive attitudes toward CRC. In total, 1,849 participants (40.0%) had high awareness of CRC signs/symptoms. There was no association between displaying a high awareness of CRC signs/symptoms and having positive attitudes toward CRC. A total of 1,840 participants (38.9%) showed high awareness of CRC risk factors. Participants with high CRC risk factor awareness were more likely to display positive attitudes toward CRC (OR = 1.22, 95% CI: 1.07-1.39). Only 219 participants (4.7%) had high awareness of CRC causation myths. Participants with high awareness of CRC causation myths were more likely to exhibit positive attitudes toward CRC (OR = 2.48, 95% CI: 1.71-3.58). CONCLUSION: A high awareness level of CRC risk factors and causation myths was associated with a greater likelihood of demonstrating positive attitudes toward CRC in terms of perceived susceptibility, importance of early detection, and consequences of developing the disease. Future educational interventions should focus on raising public awareness about CRC, with a particular emphasis on risk factors and causation myths, to maximize the potential for shaping favorable attitudes toward the disease.

Kikuchi-Fujimoto Disease: A Case Report of Prolonged Fever and Lymphadenopathy in a Young Girl.

Kikuchi-Fujimoto disease (KFD) is a benign and self-limited disorder that usually presents with regional cervical lymphadenopathy and fever. We report a case of a 12-year-old female who complained of fever, night sweating, significant weight loss, and tender right cervical lymph node enlargement for 2 months. A full workup including laboratory tests and imaging studies, an excisional biopsy, and histopathological analysis were done, and the diagnosis of KFD was confirmed. The patient was treated with analgesia and oral prednisolone, resulting in good improvement. A high degree of clinical suspicion is imperative for physicians, given the rarity of the disease and the associated diagnostic challenges.

Parieto-occipital scalp arteriovenous malformation with drainage into the posterior superior sagittal sinus: A case report.

This case report presents the unique clinical presentation of an 18-year-old female patient with an 8-year history of a progressively enlarging pulsatile mass in the left parieto-occipital region of her scalp. Remarkably, there was no history of trauma, headache, or other associated neurological deficits. Advanced imaging techniques, including computed tomography angiography and magnetic resonance imaging, revealed a vascular lesion consistent with an arteriovenous malformation beneath the scalp. Notably, the arteriovenous malformation's nidus was primarily supplied by branches of bilateral superficial temporal and occipital arteries, with a more pronounced involvement on the left side. Further magnetic resonance imaging characterization confirmed the diagnosis as a high parieto-occipital arteriovenous malformation/dural arteriovenous fistula. This case underscores the importance of a multidisciplinary approach involving neurosurgery and interventional radiology to the diagnosis and management of complex vascular lesions, particularly when they occur in unusual anatomical locations, like in our patient. The long-term clinical course and outcomes of such cases warrant continued investigation.

Screening Perspectives: The Role of Colorectal Cancer Awareness in Shaping Attitudes Toward Colonoscopy in Palestine.

PURPOSE: To assess colorectal cancer (CRC) awareness and its influence on attitudes toward colonoscopy in Palestine. MATERIALS AND METHODS: Convenience sampling was used to recruit Palestinian adults from hospitals, primary health care centers, and public spaces across 11 governorates. To evaluate the awareness of CRC signs/symptoms, risk factors, and mythical causes, the Bowel Cancer Awareness Measure and Cancer Awareness Measure-Mythical Causes Scale were used after translation into Arabic. For each correctly recognized item, one point was given. The total awareness score of each domain was calculated and categorized into tertiles; the top tertile was considered high awareness, and the other two tertiles were considered low awareness. RESULTS: A total of 4,623 questionnaires were included. Only 1,849 participants (40.0%) exhibited high awareness of CRC signs/symptoms. High awareness of CRC symptoms was associated with higher likelihood of showing positive attitudes toward colonoscopy (odds ratio [OR], 1.21 [95% CI, 1.07 to 1.37]). A total of 1,840 participants (38.9%) demonstrated high awareness of CRC risk factors. Participants with high awareness of CRC risk factors were more likely to display positive attitudes toward colonoscopy (OR, 1.20 [95% CI, 1.07 to 1.37]). Only 219 participants (4.7%) demonstrated high awareness of CRC causation myths. There was no association between awareness of CRC causation myths and positive attitudes toward colonoscopy. CONCLUSION: Awareness of CRC was poor with less than half of the study participants demonstrating high awareness of CRC signs/symptoms and risk factors, and a minority (<5%) displaying high awareness of CRC causation myths. High awareness of CRC signs/symptoms and risk factors was associated with greater likelihood of demonstrating positive attitudes toward colonoscopy. Educational initiatives are needed to address knowledge gaps and dispel misconceptions surrounding CRC.

Differences in Colorectal Cancer Awareness Between Vegetarians and Nonvegetarians: A National Cross-Sectional Study From Palestine.

PURPOSE: To compare colorectal cancer (CRC) awareness between vegetarians and nonvegetarians in Palestine. MATERIALS AND METHODS: The validated Bowel Cancer Awareness Measure and Cancer Awareness Measure-Mythical Causes Scale were translated into Arabic and used to assess awareness of CRC signs/symptoms, risk factors, and mythical causes. The total awareness score of each domain was calculated and categorized into tertiles; the top tertile was considered as good awareness. Multivariable logistic regression analysis was used to examine the association between being a vegetarian and displaying good awareness in each domain. RESULTS: This study included 4,623 participants: 560 vegetarians (12.1%) and 4,063 nonvegetarians (87.9%). Lump in the abdomen was the most recognized CRC sign/symptom among both nonvegetarians (n = 2,969, 73.1%) and vegetarians (n = 452, 80.7%). Vegetarians were less likely than nonvegetarians to display good awareness of CRC signs/symptoms (odds ratio, 0.59 [95% CI, 0.48 to 0.72]). Lack of physical activity was the most identified modifiable CRC risk factor in both nonvegetarians (n = 3,368, 82.9%) and vegetarians (n = 478, 85.4%). Similarly, having a bowel disease was the most identified nonmodifiable risk factor among both nonvegetarians (n = 2,889, 71.1%) and vegetarians (n = 431, 77.0%). There were no associated differences between both groups in the awareness levels of CRC risk factors. The most recognized food-related CRC causation myth in nonvegetarians was drinking from plastic bottles (n = 1,023, 25.2%), whereas it was eating burnt food in vegetarians (n = 176, 31.4%). Having a physical trauma was the most recognized food-unrelated myth in both nonvegetarians (n = 2,356, 58.0%) and vegetarians (n = 396, 70.7%). There were no associated differences in the awareness of CRC causation myths between both groups. CONCLUSION: Awareness of CRC was notably low in both Palestinian vegetarians and nonvegetarians. Particularly, vegetarians demonstrated lower awareness of CRC signs and symptoms.

Myths and Common Misbeliefs About Colorectal Cancer Causation in Palestine: A National Cross-Sectional Study.

PURPOSE: To explore public awareness of myths around colorectal cancer (CRC) causation in Palestine and to examine factors associated with good awareness. MATERIALS AND METHODS: Convenience sampling was used to recruit adult Palestinians from governmental hospitals, primary health care centers, and public spaces. Recognizing 13 myths around CRC causation was assessed using a translated-into-Arabic version of the Cancer Awareness Measure-Mythical Causes Scale. Awareness level was determined based on the number of CRC mythical causes recognized: poor (0-4), fair (5-9), and good (10-13). Multivariable logistic regression was used to examine the association between sociodemographic characteristics and displaying good awareness. It adjusted for age group, sex, education, occupation, monthly income, residence, marital status, having chronic diseases, being a vegetarian, knowing someone with cancer, and site of data collection. RESULTS: Of 5,254 participants approached, 4,877 agreed to participate (response rate, 92.3%). A total of 4,623 questionnaires were included in the final analysis: 2,700 from the West Bank and Jerusalem (WBJ) and 1,923 from the Gaza Strip. Only 219 participants (4.7%) demonstrated good awareness of myths around CRC causation. WBJ participants were twice more likely than those from the Gaza Strip to display good recognition (5.9% v 3.1%). Male sex, living in the WBJ, and visiting hospitals were all associated with an increase in the likelihood of displaying good awareness. Conversely, knowing someone with cancer was associated with a decrease in the likelihood of displaying good awareness. Having a physical trauma was the most recognized CRC causation myth (n = 2,752, 59.5%), whereas eating food containing additives was the least (n = 456, 9.8%). CONCLUSION: Only 4.7% displayed good ability to recognize myths around CRC causation. Future educational interventions are needed to help the public distinguish the evidence-based versus mythical causes of CRC.

Acute Renal Failure Caused by Undiagnosed Pelvic Organ Prolapse in a Postmenopausal Woman: A Diagnosis Not to Be Missed.

Pelvic organ prolapse (POP) is a common condition mainly affecting postmenopausal women, characterized by the descent of pelvic organs through the vaginal canal. While often asymptomatic, POP can manifest with various symptoms such as a painless bulge or pressure sensation, abdominal pain, urinary complaints, and discomfort during intercourse. Severe cases can lead to urinary tract obstruction, hydronephrosis, and renal dysfunction. This case study presents an elderly female with bilateral severe hydronephrosis and pyelonephritis due to undiagnosed POP. Imaging revealed obstructive uropathy resulting from bilateral ureteric compression caused by cystocele and uterine prolapse. The patient's condition improved with antibiotics and supportive management. A vaginal hysterectomy was performed, which led to the resolution of the urinary tract obstruction. This case emphasizes the importance of considering POP in elderly women with urinary symptoms and the need for proactive screening. It highlights the significance of appropriate management to prevent irreversible renal damage. Different treatment modalities, including surgery and pessaries, are discussed, to emphasize the significance of tailoring treatments to individual patient characteristics.

Concurrent Primary Hyperparathyroidism and Sarcoidosis in a Patient With Severe Hypercalcemia.

Hypercalcemia is a common biochemical abnormality caused by various etiologies, with primary hyperparathyroidism (PHPT) and malignancies being the most common culprits. Differentiating between PTH-dependent and PTH-independent hypercalcemia is crucial in clinical practice. However, in certain clinical contexts, it is important to consider the rare occurrence of two separate conditions causing hypercalcemia simultaneously. Herein, we have described the case of a patient who presented with high serum calcium, a normal PTH level, and histopathological evidence of active granulomatous disease, indicating the presence of both PHPT and sarcoidosis. The coexistence of these conditions poses diagnostic challenges due to their biochemical and clinical similarities. This case highlights the importance of individualized management for patients with concurrent conditions contributing to hypercalcemia. It also emphasizes the need for further research to unravel the underlying interactions between PHPT and sarcoidosis in the context of calcium metabolism. A better understanding of these interactions can guide optimal diagnostic and therapeutic strategies for patients with complex presentations of hypercalcemia.

A rare presentation of Zinner syndrome as recurrent epididymitis: A case report.

Zinner syndrome is a rare congenital malformation characterized by ipsilateral renal agenesis, atresia of the ejaculatory duct, and cystic distension of the seminal vesicles. Symptoms typically arise in adolescence or adulthood and may include painful urination, perineal discomfort, and post-ejaculatory pain. Diagnosis, often made between the ages of 20 and 50 years, involves differentiating Zinner syndrome from other cystic disorders using techniques such as cystoscopy, MRI, intravenous urography, and transrectal ultrasound. Treatment varies based on symptom severity, ranging from conservative approaches to invasive surgeries. Regular follow-up is essential to identify complications and preserve fertility. Herein, we present a 27-year-old male with recurrent scrotal swelling and erythema incidentally diagnosed with Zinner syndrome. The patient had a history of recurrent epididymitis and was found to have cystic dilatation of the seminal vesicle, ipsilateral renal agenesis, and obstruction of the left ejaculatory duct on imaging. Given the patient's mild symptoms, he was managed conservatively with antibiotics and pain medication, resulting in significant improvement.

Kindler Syndrome Presenting as Colitis in an Infant.

Kindler syndrome (KS) is an autosomal recessive genodermatosis characterized by skin atrophy, blistering, photosensitivity, and mucosal inflammation. We present a unique case of KS with early and severe neonatal onset in a two-month-old female who presented with severe failure to thrive (FTT) and chronic diarrhea since birth. The infant also had multiple fluid-filled cysts on her foot since birth, which resolved and reappeared at different sites. Anemia, hyponatremia, and coloboma of the right iris were also observed. Whole exome sequencing revealed a homozygous mutation in the FERMT1 gene, confirming the diagnosis of KS. Our case demonstrates a distinct clinical phenotype involving severe colitis and FTT in addition to the typical skin manifestations of KS. This atypical presentation highlights the need for further investigations to gain insights into the impact of the kindlin-1 defect on organs beyond the skin and to explore potential therapeutic approaches for managing severe colitis in affected patients.

A Large Pleural Solitary Fibrous Tumor Successfully Resected Using Uniportal Video-Assisted Thoracoscopic Surgery.

Solitary fibrous tumors (SFTs) are rare neoplasms arising from submesothelial connective tissue. Typically affecting elderly individuals, SFTs can exhibit malignant characteristics despite most cases being benign. Diagnosis often occurs incidentally on routine chest radiographs, and patients are usually asymptomatic unless the tumor causes compression of adjacent structures. While imaging studies aid in identification, confirmation of the diagnosis requires bronchoscopy with tissue sampling and immunohistochemistry. Surgical excision remains the primary treatment for SFTs, with complete resection being associated with a better prognosis. Our case highlights the successful management of a massive SFT using uniportal video-assisted thoracoscopic surgery (VATS). Regular chest computed tomography (CT) follow-up is important for monitoring SFTs and ensuring timely intervention when necessary. We present the case of a 54-year-old female with a massive SFT presenting as a pleural tumor in the right lower lobe. The patient was initially asymptomatic, and the diagnosis was made incidentally during routine chest CT follow-up. Uniportal VATS was successfully performed for the excision of the tumor measuring 10x9x6 cm. Our case highlights the successful application of uniportal VATS for the thoracoscopic removal of a huge pleural solitary fibrous tumor.

Abdominal wall necrotizing fasciitis as a complication of strangulated hernia - an ominous consequence of a preventable scenario.

The incidence rate of abdominal wall necrotizing fasciitis (NF) is low; however, it carries a high mortality rate. It can arise as a complication of a strangulated hernia, where a part of the intestine becomes trapped and deprived of its blood supply. Rarely, this can result in abdominal wall fasciitis, which carries a grim prognosis. Timely debridement, however, has been shown to yield improved outcomes. Here, we report our experience with a 53-y-old morbidly obese patient who presented with colicky abdominal pain lasting for 1 week, progressively worsening and becoming constant. She also exhibited symptoms of fever, constipation, vomiting and anorexia. Furthermore, there was an infected wound measuring 20 cm × 13 cm along the midline of the abdomen. Imaging studies revealed indications of small bowel obstruction. This case describes a unique presentation of strangulated incisional hernia complicated by NF of the anterior abdominal wall, successfully managed with surgery.

Acute Myocardial Infarction as the First Presentation of Systemic Lupus Erythematosus in a 23-Year-Old Patient.

ST-segment elevation myocardial infarction (STEMI) in young adults is a rare occurrence that requires a thorough investigation to determine the underlying cause. Herein, a young female patient presented with dull retrosternal chest pain associated with nausea and left arm numbness. Cardiac-specific troponin was elevated and the electrocardiogram revealed ST-segment elevation in the inferior wall leads indicative of myocardial infarction. The patient was started on dual antiplatelet therapy (DAPT) and emergency coronary angiography was performed, revealing a 20% stenosis in the left circumflex artery and evidence of a thrombotic lesion in the posterolateral branch (PLB), which was deemed unsuitable for intervention. During the diagnostic workup, the patient tested positive for antinuclear antibodies and was ultimately diagnosed with systemic lupus erythematosus (SLE) and antiphospholipid syndrome. This case highlights the rarity of STEMI as an initial presentation of SLE. It emphasizes the importance of considering autoimmune disorders in young patients with acute myocardial infarction and the need for a comprehensive evaluation and appropriate management in such cases.

Tumor Genesis Syndrome Presenting as Severe Hypophosphatemia in a Patient With T-Cell Acute Lymphoblastic Leukemia.

Tumor lysis syndrome (TLS) is a medical emergency that can develop in leukemias and lymphomas as a first presentation or after the initiation of anti-neoplastic regimens. On the other hand, tumor genesis syndrome (TGS) is a rare condition associated with certain malignancies, especially those with a high neoplastic burden characterized by rapid proliferation, leading to avid uptake of phosphorus from the serum and culminating in hypophosphatemia. Interestingly, a combination of TLS and TGS can occur simultaneously in a subset of patients. This leads to the development of hypophosphatemia instead of the hyperphosphatemia commonly associated with TLS. We herein present a case of severe asymptomatic hypophosphatemia in a patient with an incidental finding of T-cell acute lymphoblastic leukemia. The patient was initially diagnosed with TLS with hypophosphatemia, but further investigation revealed that the patient had isolated TGS.

A Very Uncommon Case of Transudative Chylothorax: A Case Report and Literature Review.

The presence of chyle in the pleural cavity is referred to as chylothorax. Exudative chylothorax is usually related to damage or obstruction of the lymphatic vasculature with subsequent leakage into the pleural space. In contrast, transudative chylothorax is related to increased hydrostatic pressure caused by elevated intra-abdominal pressure, which leads to the translocation of chylous fluid into the pleural space. Cirrhosis is the most common cause of transudative chylothorax, commonly presenting with ascites and portal hypertension. To the best of our knowledge, isolated transudative chylothorax as a consequence of cirrhosis is exceptionally rare and has been scarcely reported in the literature. We herein report a female patient in her fifties who presented to our hospital with isolated unilateral transudative hepatic chylothorax, with no clinical evidence of cirrhosis or any stigmata of portal hypertension at the time of presentation.

Diffuse Alveolar Hemorrhage in an Undiagnosed Systemic Lupus Erythematosus Patient.

Systemic lupus erythematosus (SLE) is a chronic multisystem autoimmune disease characterized by a wide range of clinical manifestations affecting multiple organs. While standardized diagnostic criteria are commonly used, the lack of pathognomonic presenting signs and symptoms often makes the diagnosis challenging. Of the many pulmonary manifestations, diffuse alveolar hemorrhage (DAH) is one of the most severe complications caused by the disruption of the capillary alveolar interface. Although this condition is rarely encountered, it has a rapidly progressive course and can be life-threatening, which warrants a prompt diagnostic workup and an aggressive therapeutic approach. We report a case of a 58-year-old female who presented to the emergency department with dyspnea and multiple episodes of hemoptysis. Further investigations revealed anemia, thrombocytopenia, and diffuse bilateral infiltrates on high-resolution computed tomography, consistent with DAH in a patient with undiagnosed SLE.

Rheumatoid Arthritis With Focal Segmental Glomerulosclerosis: A Case Report and Literature Review.

Rheumatoid arthritis (RA) is a chronic systemic autoimmune disease primarily affecting the joints and, to a lesser extent, other systems. Renal involvement in RA is rare and might be due to the presence of systemic inflammation or the toxic effect of the medications used. Of the many types of renal diseases that can affect RA patients, focal segmental glomerulosclerosis (FSGS) is rarely encountered. In this report, we present a rare co-existence of RA and FSGS in a 50-year-old female with RA who was found to have FSGS as a possible cause of proteinuria and an extraarticular manifestation of RA. The patient's RA started as palindromic rheumatism, which progressed later to chronic symmetrical polyarthritis of the small and large joints. Along with the flare of her joint disease, she was found to have lower limb edema. Her workup showed persistent proteinuria of more than one gram per day. Renal biopsy showed unexpected findings of FSGS. Our patient was treated with tapering doses of steroids, methotrexate, candesartan, and a diuretic that controlled joint disease, blood pressure, and proteinuria. Follow-up at two years showed normal kidney function tests, a significant decline in proteinuria, and controlled joint disease. Our case portrays a possible relationship between FSGS as a cause of proteinuria in patients with RA. Physicians should be aware of the possibility of FSGS in RA patients, which can affect the management plan, medication efficacy, and overall prognosis.