Unmasking the Culprits: A Case of Epstein-Barr Virus-Associated Hemophagocytic Lymphohistiocytosis Presenting With Mouth Ulcers and Nosebleeds.

Hemophagocytic lymphohistiocytosis (HLH) is an aggressive syndrome of excessive immune activation. It usually occurs in children, mainly during the first year of life. Primary hemophagocytic lymphohistiocytosis is more common and usually occurs in immunocompromised patients. Secondary hemophagocytic lymphohistiocytosis, on the other hand, is less common, especially in immunocompetent patients. Here, we intend to present a case of a 55-year-old male patient who had no known immune deficiency, presented with epistaxis, and was found to have Epstein-Barr virus (EBV)-induced hemophagocytic lymphohistiocytosis.

Predictive Factors for Critical Weight Loss in Saudi Head and Neck Cancer Patients Undergoing (Chemo)Radiotherapy.

Weight loss is a significant health problem among patients with head and neck cancer (HNC) that is attributable primarily to the tumor or tumor therapy. Critical weight loss (CWL) is defined as the unintentional loss of ≥5% of weight. Therefore, this study's goal was to investigate and determine the possible factors influencing CWL among patients with HNC who have received radiotherapy or concurrent chemoradiotherapy (CCRT). We conducted a retrospective analysis of 175 patients who received radiotherapy or CCRT as either their primary, adjuvant, or combined treatment at the Oncology Center in King Abdullah Medical City. All patients were ≥18 years of age and diagnosed with HNC with no metastasis. The study results showed that 107 patients (61%) had CWL, while 68 (39%) did not. The following factors were significantly predictive of CWL with a multivariate regression analysis: pretreatment BMI (AOR = 1.1, 95% CI = 1.02-1.17), oral cavity cancer (AOR = 10.36, 95% CI = 1.13-94.55), and male sex (AOR = 3.15, 95% CI = 1.39-7.11). In conclusion, weight loss is highly prevalent among HNC patients during treatment. Accordingly, pretreatment BMI, cancer in the oral cavity, and being male can be considered predictive factors for CWL.

Clinical Characteristics of Sarcoidosis Patients with Self-Reported Lymphoma: A US Nationwide Registry Study.

PURPOSE: Little is known about the association between sarcoidosis and lymphoma. We aim to determine the prevalence of lymphoma in US sarcoidosis patients and compare the clinical characteristics of patients with and without lymphoma. METHODS: Using a national registry-based study investigating 3560 respondents to the Foundation for Sarcoidosis Research Sarcoidosis Advanced Registry for Cures Questionnaire (FSR-SARC) completed between June 2014 and August 2019, we identified patients who reported the diagnosis of lymphoma following sarcoidosis and randomly selected a computer-generated control sample of sarcoidosis patients with no reported lymphoma with a 2:1 ratio. RESULTS: Among 3560 patients with sarcoidosis, 43 (1.2%) reported developing lymphoma following their sarcoidosis diagnosis. Patients with lymphoma were more likely to be diagnosed with sarcoidosis at a younger age (median, IQR) 40 (27-50) vs 45 (34.8-56, p = 0.017) years, were more likely to be African-Americans OR 95% CI 3.9 (1.6-9.6, p = 0.002), and have low annual income (OR 2.7, 1.1-6.4 p = 0.026). The sarcoidosis-lymphoma group were more likely to have salivary gland (16% vs 5%, p = 0.026) (OR 4; 1.1-14.5) and cutaneous (46% vs 23%, p = 0.023) (OR 2.9; 1.1-7.3) sarcoidosis. They also reported more chronic fatigue (42% vs 23%, p = 0.029), chronic pain (37% vs 13%, p = 0.001), and depression (42% vs 22%, p = 0.019). CONCLUSION: The prevalence of lymphoma reported in sarcoidosis patients is higher than the general population which further supports the possible increased risk of lymphoma in sarcoidosis. Diagnosis of sarcoidosis at a younger age, African-American race, cutaneous, and salivary glands sarcoidosis were associated with lymphoma. Sarcoidosis patients who developed lymphoma reported higher disease burden and more non-organ-specific manifestations.

WITHDRAWN: Mechanical ventilation in COVID-19: Is it due to patient or virology factors?

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Factors Associated with Not Breastfeeding and Delaying the Early Initiation of Breastfeeding in Mecca Region, Saudi Arabia.

The objective of the study was to find the determinants related to not breastfeeding (BF) and others related to the delay in the early initiation of BF in the Mecca region, Saudi Arabia. A cross-sectional study in the Maternity and Children Hospital and primary healthcare centers was performed. A questionnaire was filled by dietitians to 814 asymptomatic Saudi mothers. Determinants related to not BF and the delay in the early initiation of BF were determined by binary logistic regression, and the odds ratio (OR) and 95% confidence interval (CI) were determined. Significant factors associated with not BF were not rooming-in infants in the mother's room (OR: 2.37; 95% CI: 1.66-3.41) and using a pacifier (OR: 1.62; 95% CI: 1.13-2.33). The most significant determinant of the early initiation of BF was the initiation of bottle feeding (OR: 18.16; 95% CI: 10.51-31.4), followed by not rooming-in infants in the mother's room (OR: 2.2; 95% CI: 1.52-3.18), initiation of partial feeding (OR: 1.89; 95% CI: 1.3-2.74), uninformed mothers regarding the importance of BF (OR: 1.56; 95% CI: 1.04-2.35), and cesarean sections (OR:1.42; 95% CI: 1.02-1.98). Risk factors affecting BF and the early initiation of BF in Mecca City should be highlighted in national campaigns to increase mothers' awareness and promote BF practice.

Leptin and uric acid as predictors of metabolic syndrome in jordanian adults.

BACKGROUND/OBJECTIVES: Metabolic syndrome (MetS) is a set of interrelated metabolic risk factors that increase the risk of cardiovascular morbidity and mortality. Studies regarding the specificity and sensitivity of serum levels of leptin and uric acid as predictors of MetS are limited. The aim of this study was to evaluate the serum levels of leptin and uric acid in terms of their specificity and sensitivity as predictors of MetS in the studied Jordanian group. SUBJECTS/METHODS: In this cross sectional study, 630 adult subjects (308 men and 322 women) were recruited from the King Hussein Medical Center (Amman, Jordan). The diagnosis of MetS was made according to the 2005 International Diabetes Federation criteria. Receiver operating characteristic curves were used to determine the efficacy of serum levels of leptin and uric acid as predictors of MetS in the studied Jordanian group. RESULTS: Study results showed that for identification of subjects with MetS risk, area under the curve (AUC) for leptin was 0.721 and 0.683 in men and women, respectively. Serum uric acid levels in men showed no significant association with any MetS risk factors and no significant AUC, while uric acid AUC was 0.706 in women. CONCLUSION: Serum leptin levels can be useful biomarkers for evaluation of the risk of MetS independent of baseline obesity in both men and women. On the other hand, serum uric acid levels predicted the risk of MetS only in women.

EVALUATION OF SEVERAL ANTHROPOMETRIC INDICES OF OBESITY AS PREDICTORS OF METABOLIC SYNDROME IN JORDANIAN ADULTS.

INTRODUCTION: anthropometric indices have all been tested for their relation to metabolic syndrome (MetS), but with no consistent cut-off points are yet established among different population group. OBJECTIVE: this study aims to evaluate the predictive power of several anthropometric indices of central obesity as predictors of MetS in a group of Jordanian adults. METHODS: in this cross sectional study, 630 adult subjects (308 men and 322 women) aged between 20-70 years were recruited at the King Hussein Medical Center in Amman (Jordan). The diagnosis of MetS was defined by the International Diabetes Federation criteria. Anthropometric measurements (waist circumference [WC]; waist to hip ratio [WHpR]; waist to height ratio [WHtR]; body mass index [BMI]) were performed and recorded following standard procedures. Receiver operating characteristic (ROC) curves were used to determine the efficacy of anthropometric measurements as predictors of MetS. RESULTS: the results indicated that, in men for identifying subjects with MetS risk, area under curve (AUC) from the ROC curves for WC was 0.851, AUC for WHpR was 0.842, AUC for WHtR was 0.85, and AUC for BMI was 0.83. In women, AUC for WC, WHpR, WHtR, and BMI were 0.866, 0.871, 0.872, and 0.831, respectively. CONCLUSION: it could be concluded that among anthropometric indices, both WHtR and WC had the strongest predictive power for identifying subjects with MetS in men and women. WHtR appears to be the best indicator of central obesity in women and individuals of short stature.

Introducción: han sido probados diversos índices antropométricos por su relación con el síndrome metabólico (SM), pero sin establecer puntos de corte entre diferentes grupos de población. Objetivo: este estudio tiene como objetivo evaluar el poder predictivo de varios índices antropométricos de obesidad central como predictores del síndrome metabólico en un grupo de adultos jordanos. Métodos: en este estudio transversal, 630 sujetos adultos (308 hombres y 322 mujeres) de edades comprendidas entre 20 a 70 años fueron reclutados en el Centro Médico Rey Hussein en Amman (Jordania). El diagnóstico de síndrome metabólico fue definido por los criterios de la Federación Internacional de Diabetes. Las medidas antropométricas (circunferencia de la cintura [WC]; relación cintura-cadera [WHpR]; relación cintura-altura [RCEst]; índice de masa corporal [IMC]) se realizaron y registraron siguiendo los procedimientos estándar. Se utilizaron curvas características del receptor (ROC) para determinar la eficacia de las medidas antropométricas como predictores de SM. Resultados: los resultados indican que, en los hombres, para identificar a los sujetos con riesgo de SM el área bajo la curva (AUC) de la curva ROC para WC era 0.851, AUC para WHpR era 0,842, AUC para RCEst fue de 0,85 y el AUC del IMC fue de 0,83. En las mujeres, el AUC para WC, WHpR, RCEst y el IMC fueron: 0,866, 0,871, 0,872 y 0,831, respectivamente. Conclusión: se puede concluir que entre los índices antropométricos, tanto RCEst como WC tenían el poder predictivo más fuerte para identificar a los sujetos con síndrome metabólico en hombres y mujeres. RCEst parece ser el mejor indicador de la obesidad central en mujeres y personas de baja estatura.

Evaluation of several anthropometric indices of obesity as predictors of metabolic syndrome in Jordanian adults / Evaluación de varios índices antropométricos de la obesidad como predictores del síndrome metabólico en adultos de Jordania

Introduction: anthropometric indices have all been tested for their relation to metabolic syndrome (MetS), but with no consistent cut-off points are yet established among different population group. Objective: this study aims to evaluate the predictive power of several anthropometric indices of central obesity as predictors of MetS in a group of Jordanian adults. Methods: in this cross sectional study, 630 adult subjects (308 men and 322 women) aged between 20-70 years were recruited at the King Hussein Medical Center in Amman (Jordan). The diagnosis of MetS was defined by the International Diabetes Federation criteria. Anthropometric measurements (waist circumference [WC]; waist to hip ratio [WHpR]; waist to height ratio [WHtR]; body mass index [BMI]) were performed and recorded following standard procedures. Receiver operating characteristic (ROC) curves were used to determine the efficacy of anthropometric measurements as predictors of MetS. Results: the results indicated that, in men for identifying subjects with MetS risk, area under curve (AUC) from the ROC curves for WC was 0.851, AUC for WHpR was 0.842, AUC for WHtR was 0.85, and AUC for BMI was 0.83. In women, AUC for WC, WHpR, WHtR, and BMI were 0.866, 0.871, 0.872, and 0.831, respectively. Conclusion: it could be concluded that among anthropometric indices, both WHtR and WC had the strongest predictive power for identifying subjects with MetS in men and women. WHtR appears to be the best indicator of central obesity in women and individuals of short stature (AU)

Introducción: han sido probados diversos índices antropométricos por su relación con el síndrome metabó- lico (SM), pero sin establecer puntos de corte entre diferentes grupos de población. Objetivo: este estudio tiene como objetivo evaluar el poder predictivo de varios índices antropométricos de obesidad central como predictores del síndrome metabólico en un grupo de adultos jordanos. Métodos: en este estudio transversal, 630 sujetos adultos (308 hombres y 322 mujeres) de edades comprendidas entre 20 a 70 años fueron reclutados en el Centro Médico Rey Hussein en Amman (Jordania). El diagnóstico de síndrome metabólico fue definido por los criterios de la Federación Internacional de Diabetes. Las medidas antropométricas (circunferencia de la cintura [WC]; relación cintura-cadera [WHpR]; relación cintura-altura [RCEst]; índice de masa corporal [IMC]) se realizaron y registraron siguiendo los procedimientos estándar. Se utilizaron curvas características del receptor (ROC) para determinar la eficacia de las medidas antropométricas como predictores de SM. Resultados: los resultados indican que, en los hombres, para identificar a los sujetos con riesgo de SM el área bajo la curva (AUC) de la curva ROC para WC era 0.851, AUC para WHpR era 0,842, AUC para RCEst fue de 0,85 y el AUC del IMC fue de 0,83. En las mujeres, el AUC para WC, WHpR, RCEst y el IMC fueron: 0,866, 0,871, 0,872 y 0,831, respectivamente. Conclusión: se puede concluir que entre los índices antropométricos, tanto RCEst como WC tenían el poder predictivo más fuerte para identificar a los sujetos con síndrome metabólico en hombres y mujeres. RCEst parece ser el mejor indicador de la obesidad central en mujeres y personas de baja estatura (AU)

Alarming high prevalence of metabolic syndrome among Jordanian adults.

OBJECTIVE: To evaluate the prevalence and the individual components of metabolic syndrome (MetS) in Jordanian adults. METHODS: In this cross sectional study, 630 adult subjects (308 men and 322 women) aged between 20-70 years were recruited from the clinics at the King Hussein Medical Center. The diagnosis of MetS was made according to the International Diabetes Federation (IDF) criteria-2005. Blood samples were collected after 10-12 hours overnight fasting and serum was obtained for biochemical analysis. RESULTS: The prevalence of metabolic syndrome according to IDF criteria was 51% (46.4% in men and 55.3% in women). Prevalence of increased waist circumference in the total sample was 71.6%, 46% for high blood pressure, 42.4% for elevated fasting blood glucose, 43.5% for low high density lipoprotein, and 50.2% for hypertriglyceridemia. CONCLUSION: The prevalence and individual components of MetS in Jordan were high. Screening of MetS is needed at national level to reduce the incidence of Type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD).