Unraveling a Rare Case of Epidural Extramedullary Hematopoiesis in a Patient With Transfusion-Dependent Beta Thalassemia Presenting With Spinal Cord Compression.

Thalassemia is known to induce extramedullary hematopoiesis (EMH), which is a compensatory mechanism in which the body forms blood cells outside the bone marrow. While EMH typically affects organs such as the spleen and liver, there are rare instances where it leads to spinal cord compression (SCC) in the epidural space. A 31-year-old male patient with transfusion-dependent beta thalassemia presented with numbness and bilateral limb weakness due to EMH. Neurological examination revealed increased tone in both legs, reduced power, loss of crude touch and pain sensation, and increased deep tendon reflexes. Magnetic resonance imaging (MRI) indicated a lobulated soft tissue structure in the posterior dural intrathecal space causing SCC. Laminectomy of the T2-T8 vertebrae was done, after which the lesion was identified and completely removed. Post-surgery, significant neurological improvements were observed in both motor and sensory functions. Thalassemia patients presenting with symptoms of SCC should be investigated for the presence of epidural EMH. Treatment options include decompressive surgery, blood transfusions, hydroxyurea, and radiotherapy.

Factor VII Deficiency in an End-Stage Renal Disease Patient With Recurrent Thrombosis: A Case Report.

Congenital factor VII deficiency is a rare bleeding disorder with variable presentations. Thromboembolism is a well-established complication of this heterogeneous disease. As it is a rare disease, there is no information regarding its treatment when it is present with other comorbidities such as end-stage renal disease. This study describes a 47-year-old male with multiple comorbidities who was recently diagnosed with end-stage renal disease. He had recurrent admissions to the hospital due to thrombotic arteriovenous access failure as well as acute coronary syndrome, despite a high international normalized ratio that was resistant to replacement therapy. Eventually, apixaban became his main treatment regimen. This case needs to be reported because it is rare in terms of including a factor VII deficiency patient with end-stage renal disease, as well as to emphasize the unclear recommendations available for patients with factor VII deficiency and end-stage renal disease. International collaboration may be the best course of action to study enough patients and come up with effective recommendations.

Energy drinks and waterpipe smoking associated with disordered eating habits among male Palestinian refugees.

This cross-sectional study highlights the concerning relationship between stimulants, alcohol use, and weight-related problems among Palestinian refugee men in the West Bank. Self-administered questionnaires were used to gather data on stimulants and alcohol use and eating attitudes and behaviors (EAT-26). The findings revealed that many refugee men were daily cigarette (61.4%) and waterpipe smokers (15.5%), while 30.6% and 2.3% were daily energy drink and alcohol users, respectively. Moreover, most refugee men (67.3%) were obese, and 23.5% were terrified about being obese. They had disordered eating habits, including the impulse to vomit after meals (63.3%). Moreover, 30.7% scored ≥20 using EAT-26 scale, and 44.4% scored at least one positive behavior, including binge eating (40.4%), purging (10.0%), using laxatives or diet pills (8.3%), excessive exercise (30.9%), and losing weight (24.6%). The results of the adjusted binary logistic regression indicated that risk factors associated with self-induced vomiting were daily (OR = 2.71, p-value = 0.004) and weekly energy drink intake (OR = 2.41, p-value = 0.023), weekly alcohol intake (OR = 10.83, p-value = 0.036), and obesity (OR = 2.57, p-value = 0.002), while inversely associated with weekly waterpipe smoking (OR = 0.297, p-value = 0.007). Obesity was inversely associated with daily (OR = 0.146, p-value < 0.01) and weekly waterpipe smoking (OR = 0.259, p-value = 0.002), and weekly cigarette smoking (OR = 0.251, p-value < 0.01). The study underscores the urgent need for community awareness, professional evaluation, and treatment for obesity and disordered eating habits among Palestinian refugee men. It is essential to address the detrimental effects of alcohol and energy drink intake and tobacco smoking to improve the health outcomes of this vulnerable population.

Growing a peritoneal dialysis program in Palestine from zero to 178 patients in 5 years: a single-center experience.

INTRODUCTION: Kidney failure is rapidly rising in Palestine, as the number of patients receiving maintenance dialysis has quadrupled in the last 15 years. In this study, we share an overview of our experience growing a peritoneal dialysis (PD) program from zero to 178 patients in 5 years at An-Najah National University Hospital in Palestine, presenting some challenges and ways to overcome them. METHODS: This was a single-center retrospective study of patients treated with PD from November 2016 to December 2021. Demographic and clinical data were obtained for each patient. In addition, PD discontinuation, peritonitis, and mortality rates were calculated and presented as the primary patient outcomes. RESULTS: A total of 158 patients were eligible for the study. The mean age was 51.8 ± 16.4 years, and 53.8% of patients were male. Diabetic nephropathy was the most common cause of kidney failure. 63 episodes of peritonitis were diagnosed in 48 patients (30.4%) for a rate of 1 episode/ 38.2 patient-months (0.31 episodes/ patient-years). 20 patients had their PD treatment discontinued, mainly due to psychosocial reasons and infectious and mechanical complications. Death was the fate of 27 patients, with cardiovascular disease and COVID-19 being the two main causes. CONCLUSION: The outcomes of this experience proved favorable and showed that PD could serve as a viable option for kidney failure patients in Palestine. Moreover, this study can serve as an example for other places where circumstances are challenging to take the initiative of starting their PD programs.